This Week Health

I caught up with Scott Joslyn, the CIO for UC Irvine. There is a wisdom that only comes from experience and Scott's decades of experience comes through in this conversation. I hope you enjoy.

Transcript
Bill Russell:

Today in health, it,

Bill Russell:

Another one of our interviews and action.

Bill Russell:

This comes from the healthcare to healthcare event, which I was a guest

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at from the serious health care team.

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It was in Montana.

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And I was able to sit down with a handful of CEOs.

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And I'm going to share those with you here shortly.

Bill Russell:

My name is bill Russell.

Bill Russell:

I'm a former CIO for a 16 hospital system and creator of this week in health.

Bill Russell:

It.

Bill Russell:

A channel dedicated to keeping health it staff current and engaged.

Bill Russell:

I hope you're enjoying these interviews and action.

Bill Russell:

We were able to do these interviews at the health conference, the

Bill Russell:

chime conference, and now the healthcare to healthcare event.

Bill Russell:

I've really enjoyed doing them.

Bill Russell:

, just a reminder.

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We're going to get back to our normal programming where I take

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a new story, break it down.

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And talk about why it matters to health.

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It.

Bill Russell:

We're going to be doing that as soon as the interviews are done we have

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done 10 from the chime conference eight from the health conference and

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we have five from the healthcare to health care conference so i hope you

Bill Russell:

enjoy another one of these interviews

Bill Russell:

all right.

Bill Russell:

We're doing another interview from the healthcare to healthcare summit, a

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serious event that is for their clients.

Bill Russell:

I'm here with Scott, Jocelyn, chief information officer

Bill Russell:

and chief innovation officer.

Bill Russell:

Correct.

Bill Russell:

Anything else we're going to add to that anytime

Scott Joslyn:

soon.

Scott Joslyn:

I don't want anything added to that.

Scott Joslyn:

It's fine.

Scott Joslyn:

The way it is

Bill Russell:

at a UCI.

Bill Russell:

So you made the move from Memorial care to UCI,

Scott Joslyn:

correct?

Scott Joslyn:

I've been at UCI health for almost two years.

Scott Joslyn:

And another couple of.

Bill Russell:

Two years, two years in a couple of weeks.

Bill Russell:

Wow.

Bill Russell:

Um, so what's what's top of mind.

Bill Russell:

I mean, there are two very, are they, similar systems

Bill Russell:

are very different systems.

Bill Russell:

They are once, once an academic medical center, once not an academic model,

Scott Joslyn:

Memorial care is a non-academic medical center, although

Scott Joslyn:

they train residents and the likes.

Scott Joslyn:

So, but they're not academic per se.

Scott Joslyn:

UCI medical center is an academic medical center.

Scott Joslyn:

It's got a school of medicine, the school of pharmacy school.

Scott Joslyn:

The school of public health, we educate, we produce physicians

Scott Joslyn:

and, um, residents and the like,

Bill Russell:

so do you find those two to be very distinct in terms

Bill Russell:

of the requirements of the role?

Scott Joslyn:

Well, I was always told that academic medical centers are more

Scott Joslyn:

complex than I think to some degree.

Scott Joslyn:

It's true.

Scott Joslyn:

Um, I found them to be somewhat more complex and at the same time, more

Scott Joslyn:

interesting, a more diverse, I really enjoy working with the faculty chairs.

Scott Joslyn:

It's great to know that there's a whole university, that's so much behind us,

Scott Joslyn:

but the schools of engineering and computer science, for example, produce

Scott Joslyn:

graduates that could be potential employees for us, but they're also

Scott Joslyn:

doing all kinds of incredible research, whether it's cyber security, um, in

Scott Joslyn:

particular researchers research on data.

Scott Joslyn:

So, um, one of our faculty physicians produced a predicted model with respect

Scott Joslyn:

to COVID the likelihood that a patient will end up on a vent for example.

Scott Joslyn:

And so that kind of thing happens, um, alongside regular ordinary care.

Scott Joslyn:

So I there's a lot of synergy.

Scott Joslyn:

Um, I think it's terrific.

Bill Russell:

And you guys are, you guys are building a new building.

Scott Joslyn:

We're building a new medical center, 145 bed facility

Scott Joslyn:

to open in four and a half.

Scott Joslyn:

It will be on the campus of the university.

Scott Joslyn:

So our president medical center, 420 beds soon to be four 60 is in the

Scott Joslyn:

city of orange, which is about 10 miles north of the university campus.

Scott Joslyn:

So four and a half years from now will be, um, two hospitals, not one.

Scott Joslyn:

And, um, there you

Bill Russell:

are.

Bill Russell:

Yeah.

Bill Russell:

And you're right in the middle of a very competitive market

Bill Russell:

in a competitive landscape.

Bill Russell:

I love the fact that you have the innovation officer.

Bill Russell:

And we actually face sort of similar challenges cause I was CIO in that

Bill Russell:

same market and you have some pretty advanced, um, innovation, it capabilities

Bill Russell:

around engagement around, uh, around the consumer, especially around the consumer.

Bill Russell:

I think both Kaiser and Providence have arms that are really focusing

Bill Russell:

on that consumer, that consumers.

Bill Russell:

Um, how, how are you viewing that?

Bill Russell:

How is, how is a UCI going to be able to offer your, your community,

Bill Russell:

that level of, uh, experience?

Scott Joslyn:

Well, I think it's a catch up game for us in many

Scott Joslyn:

respects, largely because Kaiser in particular, but also Providence.

Scott Joslyn:

Um, we're early, um, Providence has their incubator and Reverend Martin, and

Scott Joslyn:

they're just a very good organization.

Scott Joslyn:

And they've been at it for awhile.

Scott Joslyn:

I think the organization, they really laid things out well with Keiser.

Scott Joslyn:

Um, I mean, just look at their thrive program, what an

Scott Joslyn:

incredible label for something.

Scott Joslyn:

It was just a beautiful label as a brilliant piece of marketing and they

Scott Joslyn:

have, and they've been on epic now.

Scott Joslyn:ir contract and not August of:Scott Joslyn:

Memorial care to go live, but they've been live for decade and a half.

Scott Joslyn:

They have lots of.

Scott Joslyn:

And the very serious about it.

Scott Joslyn:

Um, they have lots of people working over the innovation space

Scott Joslyn:

and they, um, have focused on the experience of their members, not

Scott Joslyn:

even customers, but their members.

Scott Joslyn:

And they've done a lot to steer them, manage them, guide them, educate them.

Scott Joslyn:

And I think they set the bar.

Scott Joslyn:

So for, for me, I look at it as we need to be that good.

Scott Joslyn:

Um, um, and, and in some ways maybe do things that are different that are

Scott Joslyn:

unique to us as an academic model.

Scott Joslyn:

But they just execute exceptionally well.

Scott Joslyn:

So I admire them.

Scott Joslyn:

Um, and yes, they are.

Scott Joslyn:

They are certainly competitors.

Scott Joslyn:

We live in a very competitive space.

Bill Russell:

Do you break that experience down and say, okay, we're going to work

Bill Russell:

on this aspect of the experience that the basics, the blocking and tackling,

Bill Russell:

if you will, the, the communication between the clinician and the patient,

Bill Russell:

the communication around the scheduling, the communication around a procedure.

Bill Russell:

I mean, how do you, how do you break it down by.

Bill Russell:

Pretty big challenge, right?

Bill Russell:

Experience means a lot of things.

Scott Joslyn:

You, you need to, to break it apart into the pieces and

Scott Joslyn:

tackle the ones that matter to us from an operational standpoint, but more

Scott Joslyn:

importantly, the ones that matter to the patient and access is a problem.

Scott Joslyn:

Getting an appointment is a problem.

Scott Joslyn:

Communicate with your providers, the problem.

Scott Joslyn:

So all of those represent an area of activity, even, um, consents or

Scott Joslyn:

video visits or a remote patient.

Scott Joslyn:

But first and foremost, it is, um, to have a consistent picture

Scott Joslyn:

for all the various doors that UCI health represents virtually.

Scott Joslyn:

So to speak, whether it's get an appointment, find

Scott Joslyn:

out something I have cancer.

Scott Joslyn:

Um, I'd like to get a consult, whatever that is is to put those

Scott Joslyn:

together into a series of capabilities that we put inside our website.

Scott Joslyn:

And the challenge is one to get them done.

Scott Joslyn:

Secondly, To array them in such a way that it's a somewhat seamless experience.

Scott Joslyn:

And I have tried, and we are starting to crest the issue of, for example, we only

Scott Joslyn:

want you to be a stranger once I want to remember you just the way United remembers

Scott Joslyn:

me or fidelity remembers me, or for that matter, the water company remembers me.

Scott Joslyn:

When I come back, we don't do that.

Scott Joslyn:

Good a job at healthcare, but we also have lots and lots of doors.

Scott Joslyn:

So I think that's first and foremost, As part of the experience thing is like,

Scott Joslyn:

we remember you, we value your time.

Scott Joslyn:

We don't want you to have to repeat yourself.

Scott Joslyn:

And I'll set in set aside intake forms.

Scott Joslyn:

Those are pain in the neck as well.

Scott Joslyn:

You have to fill this out multiple times.

Scott Joslyn:

We need to solve those problems.

Scott Joslyn:

That bothers patients experience matters and drives our clinicians nuts.

Bill Russell:

Yeah.

Bill Russell:

I, I do want to talk about your first hundred days, but I also want to

Bill Russell:

talk about the new facility because from time to time, I run into people

Bill Russell:

that are doing new facilities.

Bill Russell:

And the biggest challenge with the new facility is it's new on the day it was

Bill Russell:

opened, but how do you keep it fresh?

Bill Russell:

You know, how do you, how do you plan for what it needs to be?

Bill Russell:

You're going to have it done in four and a half years.

Bill Russell:

How do you plan for what it needs to be 10 years from now, or even 15 years from now?

Bill Russell:

And is that even possible?

Bill Russell:

And, and what's, what's your thought process going

Scott Joslyn:

into that?

Scott Joslyn:

Well, it, um, I think first, the first thing is to recognize.

Scott Joslyn:

And you may recall on my presentation this morning, one of my fears is how do

Scott Joslyn:

we avoid building a new old hospital?

Scott Joslyn:

We have to think outside the box and are there ways that we can

Scott Joslyn:

keep it competitive, so to speak.

Scott Joslyn:

And I don't mean so much competitive with others, but on par with all the new

Scott Joslyn:

capabilities that are there, we can't rebuild the facility in room sizes will

Scott Joslyn:

be room sizes, but we know there'll be.

Scott Joslyn:

But what's in the patient room and how the patient room functions

Scott Joslyn:

is going to evolve over time.

Scott Joslyn:

So I don't know other than to one, be aware to have awareness.

Scott Joslyn:

Secondly, we know that being situationally aware, loaded with sensors, um, and having

Scott Joslyn:

the ability to run essentially as sort of a factory and all of its various lines.

Scott Joslyn:

And to watch that factory perform, to look for bottlenecks, cure

Scott Joslyn:

bottlenecks, and maximize our.

Scott Joslyn:

For the sake of maximizing the amount of care we can provide.

Scott Joslyn:

The second part of that is are there pieces of equipment, even

Scott Joslyn:

something as mundane as a bed that we might think of as a service?

Scott Joslyn:

Could I have my monitoring from GE or one of the other companies be, um, not

Scott Joslyn:

just a one-time or periodic capital purchase with follow-on depreciation?

Scott Joslyn:

Could it be.

Scott Joslyn:

Something like a subscription or a service now that may have a price

Scott Joslyn:

premium, that's all to be negotiated.

Scott Joslyn:

But the idea is, is to keep pace with Phillips or Spacelabs or one of the

Scott Joslyn:

other monitoring companies so that we are using relatively new equipment

Scott Joslyn:

all the time on a continuous basis.

Scott Joslyn:

So maybe the facilities will look different, but by and

Scott Joslyn:

large, you know, patient will be a patient room, but we want.

Scott Joslyn:

The technology in those rooms fresh.

Scott Joslyn:

Um, and I think a lot of it's now going to be behind the scenes and virtual.

Scott Joslyn:

So it's less physical, it's more virtual.

Bill Russell:

Uh, the thing I liked about your presentation this morning

Bill Russell:

is you have so many years under you.

Bill Russell:

Somebody who walked into what you walked into probably

Bill Russell:

would be a little overwhelmed.

Bill Russell:

And you're just looking at it going.

Bill Russell:

I've seen a lot of this before.

Bill Russell:

I know what it looks like to build a building.

Bill Russell:

I know that I know the challenges and the ramification.

Bill Russell:

Um, but it was interesting how you touched on so many different things you

Bill Russell:

touched on, uh, on innovation, innovation framework, you touched on, uh, labor,

Bill Russell:

labor challenges, how you're doing that you touched on, uh, not only the facility.

Bill Russell:

Yeah.

Bill Russell:

We're building silly, but we're also keeping an eye on hospitals and

Bill Russell:

we're advancing in hospital at home.

Bill Russell:

And those kinds of things, just keeping an eye on those

Bill Russell:

companies and what's going on.

Bill Russell:

Um, you know, you, you were active in the conference.

Bill Russell:

Around clinical innovation as well, clinical automation as well.

Bill Russell:

Um, do you think there's something that comes with having

Bill Russell:

done this for so many years?

Bill Russell:

Is it your clinical background or is it just having done this for so many years,

Bill Russell:

you're able to, to not get overwhelmed by it because there is a lot going on.

Bill Russell:

It's funny.

Bill Russell:

Every time I ask a CIO what's top of mind, I get different answers every day.

Bill Russell:

It's kind of amazing.

Bill Russell:

Well,

Scott Joslyn:

it's hard to pick one thing.

Scott Joslyn:

Um, I think he experienced really bad.

Scott Joslyn:

Long ago I practiced pharmacy.

Scott Joslyn:

I know what the physicians do.

Scott Joslyn:

I can generally speak their language.

Scott Joslyn:

A degree in business helps to understand marketing or for that matter, even

Scott Joslyn:

micro economics, some of the theories behind outsourcing, for example, um,

Scott Joslyn:

and then, you know, having programmed and does some things like that.

Scott Joslyn:

I have some vague recollection of technology and frankly, that's

Scott Joslyn:

probably one of my weakest spots, but there's good people to do that.

Scott Joslyn:

But I think it's just years of experience.

Scott Joslyn:

And as I cited in the presentation this morning, I grew up in a period of time

Scott Joslyn:

where there was self-development followed by best of breed systems, followed

Scott Joslyn:

by monolithic systems, such as epic.

Scott Joslyn:

And now in the current period, which has almost like another big

Scott Joslyn:

sea change to where the EHR is obviously critically important.

Scott Joslyn:

Its footprint has expanded.

Scott Joslyn:

It's helped.

Scott Joslyn:

Organize the various departmental systems into a single thing.

Scott Joslyn:

And it's no longer complete in that.

Scott Joslyn:

So much of the data lives outside of the HR.

Scott Joslyn:

So not to subvert it, but it's to surround it.

Scott Joslyn:

And it almost looks to some degree like best of breed again.

Scott Joslyn:

Um, I actually think it's two things going on, right.

Scott Joslyn:

As I use the phrase, creative assembly, it is going out and picking partners

Scott Joslyn:

and others to augment my EHR, to be more complete across multiple venues of care,

Scott Joslyn:

including things outside the facility.

Scott Joslyn:

And I think the other thing is happening.

Scott Joslyn:

It's not like best of breed at all, but super aggregation.

Scott Joslyn:

It is.

Scott Joslyn:

And the aggregation relates to data.

Scott Joslyn:

All of these things that we're putting in place to generate

Scott Joslyn:

data and to generate signals.

Scott Joslyn:

And the interesting thing about being part of an academic medical

Scott Joslyn:

center is the ability to inject.

Scott Joslyn:

The signals and scale and begin to look for signals in the noise.

Scott Joslyn:

So that's a by-product of having these systems is that we're generating

Scott Joslyn:

data, um, about our operational environment to, for example, do a

Scott Joslyn:

better job at predicting readmission.

Scott Joslyn:

Every readmission costs us, or basically I'm sorry.

Scott Joslyn:

Every 0.1% improvement in readmission is about a four or $500,000 impact

Scott Joslyn:

to our bottom line in our interest.

Scott Joslyn:

Economically is in our interest for the sake of the patient.

Scott Joslyn:

You know, we don't want them coming back, coming back as an error.

Scott Joslyn:

That's why it is the way it is and regulation.

Scott Joslyn:

So I, remote monitoring program, for example, or our mobile urgent care

Scott Joslyn:

is to have people go home safely and don't allow them to decompensate

Scott Joslyn:

and attempt the problem immediately.

Scott Joslyn:

It's in their interest, it's in our interest.

Bill Russell:

So you were one of the early adopters of epic.

Bill Russell:

Kudos for that.

Bill Russell:

I guess my question is in this best of breed world, what's the, what's the move.

Bill Russell:

Now that a CIO is making that you're maybe 10 years from now,

Bill Russell:

I'm interviewing them going.

Bill Russell:

You were the first one to make the move there or whatever.

Bill Russell:

What's that, what's that thing that you're looking at going?

Bill Russell:

Is it, is it these data aggregation platforms?

Bill Russell:

Is it, is it, um, you know, the, the, uh, computer vision?

Bill Russell:

I mean, what, what is it that you're looking at going?

Bill Russell:

This could, this could fundamentally.

Bill Russell:

Change some things, how we, how we practice healthcare.

Scott Joslyn:

Um, well I think it's in the area of AI and with that

Scott Joslyn:

almost by definition, data aggregation or AI operates and does well when

Scott Joslyn:

it's able to see a bunch of data.

Scott Joslyn:

Now we've heard in the presentation today, the, depending on how you

Scott Joslyn:

approach AI, it doesn't always take billions and billions of records.

Scott Joslyn:

It depends on how you do it, but I think it's AI and.

Scott Joslyn:

Along with that, what we've heard.

Scott Joslyn:

And from gardener, for example, in the real-time health system, isn't an

Scott Joslyn:

environment that's situationally aware.

Scott Joslyn:

What does that mean?

Scott Joslyn:

There's sensors and it's not, we're trying to spy on people.

Scott Joslyn:

It is more about what's going on.

Scott Joslyn:

What can the computer tell us about the activities in the medical center?

Scott Joslyn:

What's the patient doing?

Scott Joslyn:

Are they turning off in enough?

Scott Joslyn:

Do they present a false.

Scott Joslyn:

Um, what does that tell us about the care and can we optimize it,

Scott Joslyn:

but it's the changes going on?

Scott Joslyn:

I think in the area of automation, which along with it means computer

Scott Joslyn:

vision, um, are decided, for example,

Bill Russell:

I know it's getting loud around us.

Scott Joslyn:

That's right.

Scott Joslyn:

Um, they're working on a new chip that actually can smell now.

Scott Joslyn:

Humans can smell pseudomonas and dogs can smell.

Scott Joslyn:

Um, and so what else can be, it's another sense beyond envision or in the case

Scott Joslyn:

of artist's side hearing, which we've seen at epic to be able to automatically

Scott Joslyn:

do the note with through NLP.

Scott Joslyn:

Now you have the idea of even being able to smell in the environment.

Scott Joslyn:

So I think it is the, um, the absorption of that data for the sake of

Scott Joslyn:

operations, intervention and improved.

Scott Joslyn:

And then I think it's the collection of that data over time that

Scott Joslyn:

allow us to find new insights.

Scott Joslyn:

Um, there's all kinds of debate in the literature about sepsis, for example,

Scott Joslyn:

what's the best algorithm for that.

Scott Joslyn:

And there's some debates among the HR vendors as to whether they have

Scott Joslyn:

something better than somebody else.

Scott Joslyn:

But nevertheless, there are things that are possible.

Scott Joslyn:

And I remember my days, a pharmacy that changes a shift, a nurse

Scott Joslyn:

would say, who'd been on all night.

Scott Joslyn:

I'm in my patient's going to crash.

Scott Joslyn:

What do you mean?

Scott Joslyn:

Well, the chances are they're going to code she, or he couldn't

Scott Joslyn:

really tell you why it was the 15 or 20 years of experience they had.

Scott Joslyn:

They could see something.

Scott Joslyn:

Now the computer can see that often in the physiological monitors, temperature,

Scott Joslyn:

pulse, and respiration, respiration changes that are very subtle collectively

Scott Joslyn:

together that are seen by instruments.

Scott Joslyn:

Can now do those kinds of things.

Scott Joslyn:

A nurse used to be able to quote, see that it was her.

Scott Joslyn:

We're now intuitions move to a new level.

Scott Joslyn:

Some of the other stuff is now done by Peter.

Bill Russell:

Yeah.

Bill Russell:

You're you're I mean, I'll close with this.

Bill Russell:

I mean, the, the amazing thing is how long you've been a CIO?

Bill Russell:

Um, I know, you know, I did it for, I guess I was there for about

Bill Russell:

six and a half years or so six years, six and a half as a interim.

Bill Russell:

And then as a full-time it takes a toll.

Bill Russell:

I mean, I, when I sort of stepped out.

Bill Russell:

Uh, there was a period of time where I'm going back to almost where I started

Bill Russell:

with you, which is, um, how do you coach CEOs today to say, look, I know it feels

Bill Russell:

like the weight of the world is on you because you have to look at supply chain.

Bill Russell:

You have to look at administrative, you have flooding clinical, you have

Bill Russell:

to keep these systems running your cybersecurity of all these things.

Bill Russell:

How do, how do you balance it?

Bill Russell:

Cause you, you know, you're not overweight.

Bill Russell:

Like a lot of us, you're not.

Bill Russell:

Um, and you're and you, uh, you know, she stepped out of one CIO role

Bill Russell:

stepped into another CIO role and it looks like you're ready to go.

Scott Joslyn:

Well, first of all, I don't think I'm any more overburdened

Scott Joslyn:

than certainly our CEO is or our CFO.

Scott Joslyn:

Um, but it's, it's how you, I guess, confront the burden if you will.

Scott Joslyn:

I, some days.

Scott Joslyn:

I can't believe I get paid to do what I'm doing.

Scott Joslyn:

I really like this work and I've done it for a long time,

Scott Joslyn:

perhaps longer than I should.

Scott Joslyn:

And it's, there's a whole new crop people that are incredibly bright.

Scott Joslyn:

Many people in my position now are physicians.

Scott Joslyn:

So they've got the clinical experience, the diagnostic experience,

Scott Joslyn:

everything that goes with it.

Scott Joslyn:

Um, and many of them started out perhaps as an undergrad in engineering.

Scott Joslyn:

But you know, if you really like your work, it, it, it, it, I

Scott Joslyn:

don't find it burdening to me.

Scott Joslyn:

I just think it's fast.

Scott Joslyn:

I also like to create, um, and I was fortunate to have good leadership

Scott Joslyn:

at my old place and in my new place.

Scott Joslyn:

Um, and I got new experiences.

Scott Joslyn:

I mean, I, over, I was asked to oversee research.

Scott Joslyn:

I was asked to oversee master planning.

Scott Joslyn:

Um, I was an advisor to, for a short period and I said, I wanted

Scott Joslyn:

to be on the venture capital board.

Scott Joslyn:

And I helped put our VC board together at Memorial care with Cedar

Scott Joslyn:

Sinai and summation health ventures.

Scott Joslyn:

And we just now put together a term sheet, um, to do that

Scott Joslyn:

kind of work inside UC health.

Scott Joslyn:

So we're, um, I think it's, it's, it's allowing yourself to not be confined

Scott Joslyn:

your role, take care of the basics.

Scott Joslyn:

You know, as I said this morning, the CIO though always wants to be at the

Scott Joslyn:

strategy table or whatever, you know, you don't get there until, you know,

Scott Joslyn:

the email works and the servers don't go down and your cybersecurity programs in

Scott Joslyn:

place, you needed to get the basics done.

Scott Joslyn:

That's your job one.

Scott Joslyn:

But as you get things under control and you build things,

Scott Joslyn:

then the chance to create.

Scott Joslyn:

And I think in my environment, I'm I was asked by the C E O to look at innovation

Scott Joslyn:

as well, because we need to do it.

Scott Joslyn:

I like to do it.

Scott Joslyn:

It suits me.

Scott Joslyn:

Um, and, but more importantly, the organization needs it.

Scott Joslyn:

So it's all, it's all applying technology and just new ways.

Scott Joslyn:

Yep.

Bill Russell:

Scott, thanks for the time.

Bill Russell:

It sounds like the session is starting, so we'll get back

Scott Joslyn:

up there.

Scott Joslyn:

That's great.

Scott Joslyn:

Thanks.

Bill Russell:

Don't forget to check back as we have more of these interviews

Bill Russell:

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Bill Russell:

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Bill Russell:

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Bill Russell:

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