Healthcare leaders are drowning in a sea of “fires” — staffing shortages, technology decisions, frontline burnout, AI anxiety — and many describe the experience as chaos. But what if the real problem isn’t chaos at all?
In this special episode of Success in Chaos, Angela Adams sits down with her co-host Kandice Garcia, RN — CEO of TungstenQI Partners and Quality Improvement Director for the ACR Learning Network — to reframe how leaders see, and lead through, the complexity of modern healthcare.
Kandice traces her unconventional path from exercise physiologist to radiology nurse to architect of one of the most successful improvement programs in the country — the RITE program at Stanford, which became the foundation of the ACR Learning Network’s Empower program. Eighty-five projects later, working with Cleveland Clinic, Mayo, MD Anderson, Stanford, and community hospitals alike, she has a sharp diagnosis: healthcare is not chaotic. It’s complex. And complex environments require fundamentally different leadership than the linear, manufacturing-style approaches we’ve inherited.
She unpacks the dual empowerment model that drives results: frontline staff hold the knowledge of where problems actually live, while leadership controls the structures that sustain or sabotage improvement. Real change demands both. Through a vivid example of prostate MR image quality, Kandice shows why surface-level fixes fail — and what it takes to redesign systems that hold up under pressure.
She also takes on the elephant in every health system: AI. Her perspective is grounded and practical — the cavalry isn’t coming, the staffing crisis isn’t ending, and AI is a real solution if leaders build the strategy, relationships, and integration to make it work. AI won’t replace healthcare workers, but the ones who use it well will outperform those who don’t.
For directors, C-suite leaders, and anyone driving improvement in a system that feels unmanageable, this episode is a reset on what good leadership looks like right now.
Kandice’s book recommendations:
- Multipliers, Revised and Updated: How the Best Leaders Make Everyone Smarter
Author: Liz Wiseman - Team of Teams: New Rules of Engagement for a Complex World
Authors: Gen. Stanley McChrystal, Tantum Collins, David Silverman, and Chris Fussell - Humble Inquiry: The Gentle Art of Asking Instead of Telling
Author: Edgar H. Schein - Creativity, Inc.: Overcoming the Unseen Forces That Stand in the Way of True Inspiration
Authors: Ed Catmull and Amy Wallace
Episode Chapter Guide
1:00 From exercise physiology to radiology nursing
3:00 The Stanford story: RITE program & Dr. David Larson
7:00 Building the ACR Learning Network’s Empower program
9:00 Why Tungsten QI Partners was born
13:30 Complex vs. complicated: why healthcare isn’t chaos
17:30 Dual empowerment: connecting frontline knowledge to leadership
20:45 AI in healthcare: the cavalry isn’t coming
26:30 Books shaping Kandice’s thinking
Full Transcript
AI-generated transcript. Accuracy may vary; please excuse any transcription errors.
Angela Adams, RN: Welcome to Success in Chaos. We wanted to do this episode a little bit different, so you are actually going to be hearing from me and Kandice this time. We have never done this where we kind of went into our backgrounds and what we’re passionate about and how we got where we are in our career and how we’re driving success in chaos. So we’re really excited to do this episode. So I’m Angela Adams, CEO of Inflo Health.
Kandice Garcia, RN: And I’m Kandice Garcia, CEO of Tungsten QI Partners and Quality Improvement Director for the ACR Learning Network. Hey, I’m so excited.
Angela: So today, I am too. Today we have Kandice Garcia. She’s absolutely amazing as you guys already know. One of the surprising things that I learned about you early on Kandice was that you started your career in exercise science and physiology. And I would love to know from that experience how you ended up in the healthcare side of the business.
Kandice: Yeah. Well, you know, it’s like, feels so long ago now, but I spent like a decade of my life in the gym and I loved it. I loved it there so much. What amazing people. Yeah. Exercise is everything. But really, that’s where I started to hone my skills of like change and leading people and setting goals and accomplishing like long term commitments to life. Right. It’s complicated to change your life. There’s exercise and diet and sleep and water and all the things that go into it. So I spent about, like I said, about 10 years focused, had a career in exercise. I went to graduate school in exercise physiology and started working with patients. And that’s when I realized, wow, there’s a lot about the body and disease and taking care of people that I don’t know anything about. I should go to nursing school.
Angela: Easy.
Kandice: And so that’s, because clearly that’s like the next thought there. Yeah. So I did an accelerated bachelor’s in nursing and somehow ended up in radiology as a radiology nurse, which, you know, once you’re there, you don’t leave. It was a great environment. I loved imaging services. I got to work across multiple modalities, primarily in IR. When I was there, also was in CT and MRI and actually got to do a little bit in ultrasound. And so it really was this like new whole new world of healthcare that I didn’t, had no idea even existed. And so because I was somebody who liked to make things better, I’m a compulsive improver. And so apart, I can’t help it. I literally cannot help it now.
Angela: I love that — a compulsive improver.
Kandice: They had a part-time role in quality improvement that came up. It was the first of its kind in that department. And so I applied. They gave it to me. I didn’t know what I was doing, but we were starting a lean journey at that organization. So I started doing Kaizen events.
Angela: As soon as they got your application, they were like, we’ve got a sucker on the line. Like, look at this girl, she’s ready. She doesn’t even know what she’s getting herself into.
Kandice: I had no idea. I had no idea. I was just out there trying to solve problems. Be like, come on everybody, we can do it.
Angela: You —
Kandice: But you know what? We did make some big changes. We redesigned the front desk. I did a series of like patient education videos that are somewhere archived, I’m sure. I hope I never see them again. I know. My gosh. Young me. She was so helpful. It was. It was me and one producer. He sat in an office. We sat in a little closet and did these videos. It was so fun.
Angela: We need to get our hands on those for sure. Were you like recording them on VHS back then? Just kidding.
Kandice: But one day my director, administrative director, David Sostarich pulled me aside and he said — I know he’s still in radiology, still directing. He’s amazing. That’s right. That’s right. He did just make a move. Shout out to David Sostarich. He was so kind. He came with me one day and said, I know I’m going to regret this, but there is a full-time quality improvement —
Angela: I know David! He’s still, yep, he’s amazing. He’s actually at Marin. Yeah, he’s at Marin. Yeah.
Kandice: Position in radiology at Stanford, I think you should apply. And so because of him, I applied for the position and I got it. That is why he was such a great leader is those who can see the potential in their staff, put them in the right position, give them the right opportunities. I’ll be forever grateful for him. And I mean, he does it for everybody though. It wasn’t just me. He was just that kind of leader.
Angela: What a great leader. That’s a great leader. Yeah.
Kandice: Yeah. So that’s where I met Dr. David Larson, who had been recruited to Stanford from Cincinnati Children’s Hospital to transform the way they did quality at Stanford. I was his quality manager and we had — we ended up with a team of three project managers. So there was a good group of us that were coming in to kind of design and facilitate Dr. Larson’s vision for improvement. One of the things that — one of the things, all of the things that we were in charge of was change, just change in the department, whether it was like implementing a new product or facilitating improvement, meeting departmental goals. We were in charge of it. And so you could imagine there’s a lot to do. So his vision was that if we teach our frontline staff how to participate in improvement, we can increase our problem solving capabilities exponentially. So —
Angela: Yeah. Yeah, get everybody involved. That’s amazing.
Kandice: Yeah, but it’s not easy to do because people don’t know how to do quality and it requires a really structured way of doing it. You have to have a path that everybody is walking together in order to keep them together all towards kind of a shared goal. So I guess that was about 12 years ago, the RITE program was born — that’s Realizing Improvement Through Team Empowerment. It’s a team-based, project-based, multidisciplinary improvement program where we teach a structured process for improvement while also getting projects done. And so in our first six month cohort, we completed eight major departmental projects from decreasing no shows in MRI to increasing or improving mammography positioning. I think we did a stroke code project, you know, decreasing the door to CT time for not pre-notified strokes. I mean, it was a wild success. We were able to accomplish a lot and we trained all of the staff. I think we ended up training like 50 staff members in our first cohort.
Angela: Oh that’s amazing. So then that was the impetus or that was the behind the scenes of the Empower program that we know today that is part of the ACR. Okay, that’s interesting. I didn’t know that whole part.
Kandice: Yes. Yes. Well, we spread it to the entire hospital. So Stanford uses the RITE program as their method for improvement. And they’re doing problem solving all over the hospital. So decreasing time for transplants, pharmacy, lab, neurology, ophthalmology. We really call it the problem solving machine because it really does just, yeah, turn out projects. And six years ago, we partnered with the ACR to create the national platform for improvement called the Learning Network, where organizations from across the country come to solve global problems in radiology with us through the Empower program. Oh yeah, we have —
Angela: Which is how Kandice and I met. Somehow, someway, we got ahold of each other and we were solving the same challenges through Inflo Health. I wanted to — I think we wanted to comment on something that you guys had out for guidance around incidental follow-up. And I was like, I’m just gonna reach out to this lady. And then the rest is history. We found our commonalities in mission and it’s been amazing. Of, well, I guess it’s been like what? Four years now that we’ve known each other. It’s been.
Kandice: Four years now, we’ve done about 85 projects through the network at organizations across the country. All the big ones — Cleveland Clinic, Mayo, MD Anderson, Stanford, URMC, and then of course our health systems like Advent, Osher. We have done small radiology groups, like our small community hospitals like St. Tammany, Terrebonne, Salinas Valley, radiology groups like RIMI, RMI, Rad Partners, like you name it, we have been able to help facilitate change across these organizations. And it has just been such a gift to collect all these like-minded improvers who really want to make a difference.
Angela: Yeah, no, that’s incredible. So then tell me what the catalyst was for you to create Tungsten QI Partners.
Kandice: Yeah, so back to our compulsive problem solving is that, you know, we saw a problem was that, hey, although we have this wonderful improvement machine that is the best way to train staff to get projects done, to solve these massive huge problems, like there is a bit of a barrier to entry. It’s like, and let me, I’ll talk about two different people that — or two different types of people that we interacted that the program is not great for, it doesn’t work for.
Number one is, if you are a one person and you have hope and you have drive and you want to make things better, but your organization isn’t quite there or we call it the stars have not all aligned, meaning that your organizational goals plus your resources plus your leader in the area plus the staffing, like all of those things kind of align for you to participate in a big project. If those things aren’t always all together, where do you as an individual go to learn more about improvement, make things better, get support, especially quality managers or our up and coming leaders.
So we have created basically the Tungsten QI improvement community where you can come and just join us. We lovingly call it the island of the misfit toys. It’s like if you are a person who feels out of place with all of this hope and all of this possibility, like come join us, we’ll help you.
Angela: *(laughs)*
Kandice: But there we have things like book clubs and like, you know, fireside chats with Dr. Larson and, you know, different types of education and knowledge and community. We have discussion boards. You can ask for help. We’ll do private coaching. We’ll do, you know, process mapping, just like kind of a resource place, but more of like a community. Like you are not alone. You are right to believe that there is a way forward and that there is a better future for all of our patients and our staff and like come join the community because that’s what we’re all doing there as individuals.
And the second one is for our leaders. You know, leading in an environment of improvement is different than what we have been doing in the past. You know, it takes a different style of leadership. It takes a different vision for the future. There is no future in improvement and change without technology integration. And we’re in a place right now where we are expecting our healthcare leaders to know how to do this — to know how to select technology, how to integrate it, how to optimize it, how to redesign roles and responsibilities, how to get rid of the variability that these systems have created. I don’t know about you, but that is a whole skill set in itself and we cannot expect our leaders to do this independently.
And so at Tungsten QI, we created a whole arm where we support our leaders in doing just that. Whether it’s selecting technology, integrating technology, we support technology companies in supporting their organizations to meet the outcomes. Or if it’s just actually just do it — how do we — how do I move forward? I’m in this place. I want to do improvement. Where do I even start? And so we have what we would call more traditional consulting services where we’ll come in for a bit of time and we’ll partner with you in helping you get unstuck and move forward towards the vision that you know you have. Although it’s not like traditional consulting. It is definitely more based on our philosophies of improvement, team-based problem solving, measure development, communication, and real achievable outcomes.
Angela: Oh, that’s amazing. No, I’m glad — that’s that’s work that’s needed. I’m glad you’re out there doing it with organizations. One place I wanted to go next, like a lot of leaders feel like they’re constantly putting out fires. We started this podcast called Success in Chaos because we wanted to highlight people that were still driving success against the chaos. You said that you thrive in chaos. You’ve mentioned that on several podcasts. What is your perspective on complexity versus complicated that allows you to see a path forward when maybe some other people would feel like, I’m just hitting a wall?
Kandice: Yeah, I think understanding the difference — the first step is understanding the difference between complicated, complex and chaos. Those are different things and require us to interact with the environment in different ways. So just off the bat, I think it was Dr. Larson in our first, very first podcast that we ever did really talked about the different — yeah. There’s so much good knowledge in that one too. Oh my God, I was so nervous.
Angela: Yeah, don’t judge us on that one. It was our first foray. It’s so good. I feel like we were super awkward. We were like, oh hi, my name is, yeah.
Kandice: I’m just really so nervous. Yeah, no, no, it’s fine. It’s fine. We grow so much every time. But he did touch on that. It is not — healthcare is not a chaotic environment. It’s a complex environment. But it can seem chaotic because there’s a lot of things that you need to be able to understand and recognize in order to kind of make sense of it all. But the difference between complexity and complicated is that complicated is —
Angela: Yeah.
Kandice: It’s very much more like manufacturing where it is lots of things coming together, but they’re fairly linear. You can organize them and they’re step by step. Where a complex environment like healthcare is systems and processes all coming together and each one of those systems and processes is actually just a group of people. It’s people coming together and doing these things. While the process or the steps can be fairly predictable on paper, it is actually people interacting with people and that’s what makes it feel chaotic or unpredictable. But when you under — yeah, when you understand it like that, the way that you would lead in a complex environment is different than the way you would lead in a complicated environment. And I think what we have done is we have taken a lot of very structured, very —
Angela: Yeah, no, I would agree.
Kandice: Antiquated management styles, techniques, and apply them to healthcare, not understanding that the environment requires a different type of leadership. Less of a dictator, more of a gardener.
Angela: Yeah. Which I feel like the dictator style of leadership has phased out. I mean, at most places, it used to be like, I’m the CEO and I said what I said and we’re going to do it my way. Now you see a lot of upper management leadership, C-suite that’s like, no, I want to bring my team along. I want this to be, you know, everybody is in this. I want everybody to feel ownership of this mission. And so I do see that, especially post-COVID. I feel like that helped a lot of health systems to go through that, though it was a really difficult time. Almost every person that has come on the podcast has pointed back to that time period and said, man, we learned so much about how to lead, team cohesion. It broke down everything, right? Because everything that we knew in healthcare kind of just collapsed overnight and we had to rethink. And so —
Kandice: Yeah. Yeah.
Angela: I think every single guest has brought up that time period of like, man, this was transformative for our teams and that they came out of it in a better place after going through all of that. In your work, you focus heavily on this dual empowerment idea. How do you manage when you have frontline staff, very different than leading executive leadership — you have to get them both like headed in the same direction. Tell me how you get both aligned and engaged in your projects with Tungsten.
Kandice: Yeah, well, you know, the way I like to describe it is like the frontline staff is our knowledge. They’re the ones who actually know, right? So when you’re not working the process, you don’t actually know what’s going on. You have an idea, you have a theory, but you don’t live the day to day. You don’t know the actual small, nuanced problems that arise or challenges or workarounds. And so we call our frontline staff kind of like the knowledge and where they see the problems. And then you have this upper level — in the org chart upper, upper level leadership who are responsible for the process. They’re responsible for supporting the process and they’re responsible for the outcomes of the process. And so they have to make decisions about what’s happening. They have to provide resources. They have to do these things, but they don’t actually know what is needed.
And so when we’re actually going to change an environment, you have to not only bring those two people or those two levels of leadership or participation in the organization together so that everybody participates in improvement from where we stand. But improvement doesn’t just happen at the front line. It also happens at the management of the process or the leadership of the process. And actually a lot of the improvement is done about the structures that support the process, not just the process itself. And so it requires this dual empowerment or dual dimensional improvement that these projects will do. That’s why improvement is so hard is because it’s not just here that you’re improving, you’re improving all of this.
So for example, when we’re doing let’s say prostate MR image quality, we want to improve the quality of our prostate MRs — very important exam, very important for them to be good. You may get on the front line and be working with the staff and they’re like, the technologist continues to select the wrong protocol. I think on the surface, the problem solving is create a guide so that everybody knows which protocol to select and have them do it, right? But if you take three steps back, you realize actually the protocols vary across scanner. We don’t use the same naming convention on all scanners. We don’t alert our technologists to when the protocols have been changed.
Angela: Oh interesting.
Kandice: And so the solution is actually maybe creating a role and responsibility in your department of somebody who’s supposed to manage protocols. Or maybe it’s investing in a technology that shares protocols across your fleet. So those are systemic changes. Those are systematic changes that need to happen at the leadership level, but they can only be understood at the front line. And so —
Angela: Yeah, I know that makes sense. Because it seems like such a simple thing — like, well, why are they choosing the wrong protocol? That seems like a simple thing. But when you really break into it, it’s got all of these complexities. So you have to bring those teams together. That’s pretty interesting.
Kandice: Yeah. It’s in all problems like that. They’re complex and multi-dimensional and deep. They go deep. So I improved.
Angela: Yeah, let’s talk about AI. So much — I would say energy, curiosity, anxiety around AI and healthcare right now, and even thinking about, like, we hear the headlines all the time, which I’m so sick of it. I’m so sick of hearing —
Kandice: Yay!
Angela: AI to replace radiology, you know, like, can we please, can we stop with this? But tell me your thoughts on, you know, human roles versus AI, human in the loop, you know, or do you argue that AI elevates the staff, replaces the staff? Like where is your head on technology, even applications to radiology, which is the most advanced in the specialties for AI around healthcare? Tell me what your thoughts are.
Kandice: Yeah. Well, I mean, first, like what a time we’re living in. This is — this is in history. I can’t wait to look back on all this and be like, what were we doing? What did we just do? And so I think that a lot of the fear comes with the unknown about where this is going and how it’s going to work. And honestly, I share those fears. I really do. I think we have to be cautiously optimistic about how we move into this space.
Angela: What a time.
Kandice: You know, working with leaders to select and implement technology, working with frontline staff to kind of actually optimize the technology that they have, I get to see, you know, how this is playing out in a lot of different arenas. And, you know, one of the things that we have to acknowledge in healthcare, which may be different than other industries, is that we are not surviving as an industry. Like we are in crisis mode. Like there are not enough staff members. There are not enough people to do the work. It is very painful for our patients to participate with us. It’s very painful for our staff to be part of it. And I know, you know, a lot of our staff members say that, you know, I live in my life in this kind of like technology age, and then they walk into the hospital and I feel like I’m going back in 15 years and you know, the technology is just not there.
Angela: Yeah.
Kandice: So I think number one is that this is a great solution for us as an industry because the cavalry is not coming. There isn’t a thousand technologists just waiting for us to like hire them. They’re not coming. The staffing shortage is not ending. You know, the budget crisis is not ending and we have to find an alternative solution. And so AI is a great solution in theory. So —
Angela: *(laughs)*
Kandice: How this gets implemented, the strategy you use, what you use AI for, how you use it in your organization, and then how you redesign your organization around the AI is what is actually going to make the biggest difference for you. Obviously, selecting the right companies, the right people — AI is not just about the technology. It’s a long-term relationship with the companies. I cannot stress this enough because implementing is just day one.
Angela: Yeah.
Kandice: It’s, you know, on how we’re going to work together and make this work as a team. But there are opportunities for staff. And I would always say if somebody is looking to implement AI, start with the things that AI does really well, which is organize information, maybe find information. Data — oh my goodness. There is so much information within the system that we are having such a hard time pulling out. And this world of AI agents and just access to information is opening up to us. So there’s actually a lot of things that you could or should be doing that you’re not doing because you don’t have the ability to do it. And AI will be able to fill that gap. As well as decrease variability in the things that are fairly standardized, like reminder calls, like billing, authorization. People are spending their time doing this where AI could really do these things, but AI doesn’t work —
Angela: Yeah. Yeah, the repetitive tasks. It’s amazing to me how many repetitive tasks like — our extremely educated, knowledgeable, experienced nurses and case managers and even physicians are still doing a lot of this repetitive work. That’s like a prime example of where AI can immediately offer value.
Kandice: Information organization. I just was in the hospital and they had two full-time staff managing a spreadsheet to organize information. They were like going in and updating it every day, changing it. And I was like, oh my gosh, this is a great — this is a great opportunity right here. So I think that, you know, as Nina Kottler and Dr. Larson say, you know, AI is not going to replace radiologists, but radiologists who use AI will replace those who don’t. And I think that’s the true for all healthcare workers. That’s true for all organizations. So the strategy, the effectiveness of the implementation and the integration of your staff with AI actually is the way forward. And that’s what we really try to help to do is to see that this can be done in a way that supports your staff, doesn’t replace them, and supports your operations to elevate you, not only above your competitors, but in service of your patients, which is the ultimate goal.
Angela: Yeah, absolutely. Well, this was amazing. I’m glad we got to spend this time talking. You’re doing amazing work out there with all of these amazing healthcare systems, leaders, and frontline staff. So thank you for your contribution. We always end with the same thing. So what are you reading? What’s influencing you right now? Anything that you can give the audience?
Kandice: I know. Thank you. I mean, this is not just decorative, although it is beautiful with all the colors, but we are obsessively reading about improvement. I think one thing that our program and our methods do really well is it’s not just lean. It’s not just Six Sigma, not just model for improvement. It’s really the amalgamation of all of these ideas when it comes to change, data, people, process — we take it all together. We take it all in. And if I had to say there’s like — I’m gonna limit it to four. My four major foundational books that I tend to recommend all the time are *Multipliers*, *Team of Teams*, yes, *Humble Inquiry*, and then *Creativity, Inc.* I would say those are my top four. Yeah. Good. Yeah. Yeah.
Angela: Good one. Love it. Oh nice. I don’t think I’ve read *Creativity, Inc.* but all the other ones. Yeah, I love *Multipliers*. It’s a great book. Yeah. That’s amazing. Well, thank you. Thank you, audience, for listening in today. You want to do our closeout?
Kandice: Oh yeah. On my notes up. Thank you for joining us today on Success in Chaos. You can like, follow, and share wherever you get your podcasts. And thank you to Inflo Health for your production support. It was so fun today. Bye everyone.
Angela: Thank you, Kandice. Bye, guys.
