This Week Health

Building culture in a remote world. A great discussion with Stephanie Lahr, CIO at Monument Health. We caught up with one another at the Healthcare 2 Healthcare event in Montana where she shares some insights into how she has been able to build culture remotely. Fantastic insights, I hope you enjoy.

Transcript
Bill Russell:

Today in health, it,

Bill Russell:

Another one of our interviews and action.

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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.

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It.

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

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I hope you're enjoying these interviews and action.

Bill Russell:

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

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chime conference, and now the healthcare to healthcare event.

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I've really enjoyed doing them.

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, 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.

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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

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enjoy another one of these interviews

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alright.

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Another interview from the healthcare to healthcare conference, this

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is a, a severally conference.

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It's an invitation only event by serious healthcare.

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And so we're talking with Dr.

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Stephanie LAR again, it's been a while since we've talked as it

Stephanie Lahr:

has been always great to talk to you.

Stephanie Lahr:

That always

Bill Russell:

great.

Bill Russell:

Um, so we're in your neck of the woods.

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And now we're we're in Montana, but, but you classified it

Bill Russell:

as your neck of the woods.

Stephanie Lahr:

Yeah, well, I, yeah, I was saying I live in rapid city,

Stephanie Lahr:

South Dakota, which is about 725 miles from here, but it's a day's drive.

Stephanie Lahr:

So, you know, out west, if you can get there in a day, it's

Stephanie Lahr:

local, I did grow up here.

Stephanie Lahr:

Now

Bill Russell:

you grew up in Montana now you're at monument health.

Bill Russell:

Yep.

Bill Russell:

So, uh, we haven't talked in a while.

Bill Russell:

What's due at monument health.

Bill Russell:

Well, you guys.

Stephanie Lahr:

Yeah.

Stephanie Lahr:

Um, gosh, there's so much fun stuff happening right now.

Stephanie Lahr:

Um, you know, I think as we are coming through COVID, we are, um, we're, we're

Stephanie Lahr:

still faced with a number of challenges.

Stephanie Lahr:

I think there are some new things that have really come out of it that

Stephanie Lahr:

we're all experiencing, particularly as it relates to, um, staffing

Stephanie Lahr:

shortages, uh, the, the expense of, of those, um, resources, burnout, you

Stephanie Lahr:

know, and those things extend into.

Stephanie Lahr:

Technical teams.

Stephanie Lahr:

They extended to our clinical teams.

Stephanie Lahr:

All of our teams are kind of stretched and, and dealing with

Stephanie Lahr:

challenging issues right now.

Stephanie Lahr:

And so I feel like that is such an amazing opportunity for technology

Stephanie Lahr:

to be able to come in and help relieve some of the burdens.

Stephanie Lahr:

And I'll say, you know, I mean, I think right now my number one goal

Stephanie Lahr:

is to bring back the joy to medicine.

Stephanie Lahr:

And, and I don't mean that just for my clinical.

Stephanie Lahr:

I mean, really for everyone who is involved in the care delivery, um,

Stephanie Lahr:

you know, part of the system, we need to bring the joy back to their work.

Stephanie Lahr:

And I think that, you know, looking at technology right now, we're

Stephanie Lahr:

right, for those opportunities, there's automation opportunities,

Stephanie Lahr:

there's efficiency opportunities.

Stephanie Lahr:

And, and we're also at a point where we have some great

Stephanie Lahr:

foundational systems in place.

Stephanie Lahr:

So now we can start building on that, um, foundation.

Bill Russell:

You talked about bringing the.

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Back to medicine, but you're one of the reasons I like talking to

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you is you have to be pragmatic.

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It's not like some of the larger health systems or, you know, I, when I was

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CIO, I had 750 people reporting into me.

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You don't have 750 people.

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And, uh, we also had an innovation budget, those kinds of things.

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And there are those health systems that are doing that, but

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you have to be very practical.

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Talk about some of the, some of the practical ways that you're trying

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to bring joy back to medicine.

Stephanie Lahr:

So, um, I think, you know, one of the great things

Stephanie Lahr:

about being an organization, my size

Bill Russell:

decision

Stephanie Lahr:

making is very, we're very flat.

Stephanie Lahr:

Um, I can have great conversations with all of our executive leadership,

Stephanie Lahr:

um, our physician leadership and, and really come to some conclusions

Stephanie Lahr:

and execute on those things quickly.

Stephanie Lahr:

So that makes it easier, um, in some respects, but, you know, I think things

Stephanie Lahr:

that we're looking at right now, we've, we've created some really strong.

Stephanie Lahr:

With vendors like nuance, for example, where we're leveraging ambient clinical

Stephanie Lahr:

intelligence, um, and allowing our providers and to have that relationship,

Stephanie Lahr:

bring that intimacy back to the relationship with the patients.

Stephanie Lahr:

Exactly.

Stephanie Lahr:

Yes.

Stephanie Lahr:

Not sit with our backs to the patient's sitting at the computer.

Stephanie Lahr:

Um, and it's not, it's not a tool that everyone needs, but we've

Stephanie Lahr:

identified a way to be able to sort of, um, select providers that we

Stephanie Lahr:

think that that is a great tool for.

Stephanie Lahr:

And so.

Stephanie Lahr:

Rolling that out to them.

Stephanie Lahr:

We, um, are looking at automation in a variety of other respects.

Stephanie Lahr:

You know, we're, we're working on a really great project to be able to, um, take some

Stephanie Lahr:

of our clinical workflows, um, monitoring what's happening throughout the hospital.

Stephanie Lahr:

I think you've maybe even talked to the, the CEO of that company recently

Stephanie Lahr:

artist's site, um, but had some really exciting conversations with my, um,

Stephanie Lahr:

health system board and our finance and investment committee, even just this.

Stephanie Lahr:

And there's a real understanding at that board level, that

Stephanie Lahr:

transformation is not optional.

Stephanie Lahr:

We are going to have to do something and we, and we won't know exactly what the

Stephanie Lahr:

right fit is going to be until we do it.

Stephanie Lahr:

So we're just going to jump in and we're going to start doing some of those things.

Stephanie Lahr:

And I, and again, I think that's one of the great things about being our

Stephanie Lahr:

size is that we can just do that.

Stephanie Lahr:

The

Bill Russell:

artist's eye conversation was interesting.

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And it's interesting that I'm talking to you about it because when people hear AI,

Bill Russell:

computer vision and those kinds of things, No large academic medical center out of

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LA or know that's what they're thinking, but you're implementing that there.

Bill Russell:

And how does that lead to again, I'm just going to keep coming back to

Bill Russell:

this, bringing joy back to medicine.

Stephanie Lahr:

Yeah.

Stephanie Lahr:

So I think it does it in two ways.

Stephanie Lahr:

One, um, it allows us to gain an understanding of what's happening

Stephanie Lahr:

within our walls and within the health.

Stephanie Lahr:

That to a level of granularity we don't have right now.

Stephanie Lahr:

Right.

Stephanie Lahr:

All of the documentation, all of the data points that we have

Stephanie Lahr:

are actually, you know, sort of representations of the real information.

Stephanie Lahr:

But for example, when a document comes out of an exchange between a

Stephanie Lahr:

patient and a provider, that's not truly what that conversation was.

Stephanie Lahr:

It's a representation of it.

Stephanie Lahr:

Any box that I check in the EA.

Stephanie Lahr:

That's not actually when it happened and what happened.

Stephanie Lahr:

It's a representation of that created typically after the fact.

Stephanie Lahr:

And I think one of the things that's really awesome about technology like

Stephanie Lahr:

artist's site is it's going to allow us to have a much more granular,

Stephanie Lahr:

real time understanding of what's happening so that then we can look

Stephanie Lahr:

at processes and improve them, reduce friction and create efficiency.

Stephanie Lahr:

And then the other piece for me, when we talk about the joy of

Stephanie Lahr:

medicine, you know, there's a lot of statistics out there that talk about.

Stephanie Lahr:

You know, an ICU physician spends 14% of their time with a patient.

Stephanie Lahr:

An ICU nurse spends 34% of their time with the patient that other

Stephanie Lahr:

big percentage of the time is on administrative and other kinds of

Bill Russell:

tasks specialists who also practice medicine.

Stephanie Lahr:

Exactly.

Stephanie Lahr:

And, and we can flip those ratios and get them spending 15% of time

Stephanie Lahr:

on the administrative tasks by automating them in the background.

Stephanie Lahr:

Again, if I had an exchange with you and we can turn that into a doc.

Stephanie Lahr:

Or if I can understand that the patient is moved from here to here

Stephanie Lahr:

and this person needs to be notified, why would I ask a person to do that?

Stephanie Lahr:

Why would I ask a nurse to be managing those things?

Stephanie Lahr:

We've done it because it's been the easy answer.

Stephanie Lahr:

Oh, the nurses right there have them do it.

Stephanie Lahr:

We we've come to a breaking point.

Stephanie Lahr:

We can't ask them to do one more thing.

Stephanie Lahr:

And in fact, given the staffing shortages, if we're going to ask them to do one more

Stephanie Lahr:

thing, it has to be something clinical.

Stephanie Lahr:

So we're gonna have to take some of the other stuff off the

Bill Russell:

plate.

Bill Russell:

Specifically, let's talk about the nursing shortage.

Bill Russell:

Cause it's, it's one of the things I'm hearing.

Bill Russell:

I'm also hearing an it shortage by the way, I'm hearing it for sure.

Bill Russell:

Challenge to hire those.

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So let's go in those two directions.

Bill Russell:

So nursing shortage, um, I assume that's hitting you where you're at.

Bill Russell:

Absolutely.

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Are you having this issue?

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I'm hearing this over and over again where people are leaving

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to become traveling nurses.

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They're making five times what they're making locally.

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They're going to go do that for a year or to pay for their kid's education.

Bill Russell:

Then there.

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And worked for you and you're going to take them back because there's

Bill Russell:

a nursing shortage where you're at.

Bill Russell:

How, how are you guys thinking about that problem?

Stephanie Lahr:

Well, I think the number one thing that we're thinking

Stephanie Lahr:

is how do we make our place, the place that people want to work?

Stephanie Lahr:

Um, the money is only one part of why a person chooses to work in a certain place

Stephanie Lahr:

or go down a path with their career.

Stephanie Lahr:

And so our differentiator to your point, we're a not-for-profit community health.

Stephanie Lahr:

We're not going to pay the most.

Stephanie Lahr:

Um, but we can look at other things that make us attractive,

Stephanie Lahr:

make us a great place to work.

Stephanie Lahr:

Um, that can be other things that our, our HR teams and

Stephanie Lahr:

experienced teams are working on.

Stephanie Lahr:

But again, I feel like that's then a big burden on my shoulders, which I'm

Stephanie Lahr:

happy to take on to sort of say what would differentiate us, what would make

Stephanie Lahr:

a nurse say, gosh, when I go work at Monmouth, I get to spend all my time with

Stephanie Lahr:

the patients cause all these other, so, I mean, I think it's all tied together.

Stephanie Lahr:

One, we may need fewer nurses possibly over time.

Stephanie Lahr:

If we can really start automating some of these processes, but even if we don't,

Stephanie Lahr:

even if we need the same number there.

Stephanie Lahr:

Much happier doing the work that they spent, all of their

Stephanie Lahr:

clinical time training to do.

Stephanie Lahr:

Nobody went to nursing school or medical school.

Stephanie Lahr:

So they could be like, I'm going to be the queen or the king of the EHR.

Stephanie Lahr:

This is going to be fabulous.

Stephanie Lahr:

They did it because they want to be interacting with patients.

Stephanie Lahr:

Okay.

Stephanie Lahr:

It's

Bill Russell:

interesting to hear you talk about one of the things you've

Bill Russell:

done is building community remotely.

Bill Russell:

I've been talking to CEOs about this, and to be honest with you, one of the things

Bill Russell:

I've been saying is I'm, I would have struggled to make this transition to.

Bill Russell:

You know, seeing everybody through a screen, I like walking into their office.

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I like talking to them.

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I like the informal conversations.

Bill Russell:

It was, ah, it was, uh, it was part of the reason I love the job is, is the

Bill Russell:

community that you're able to build, bringing people together that people

Bill Russell:

used to make fun of, you know, the birthday parties and that kind of stuff.

Bill Russell:

But I love that stuff.

Bill Russell:

That was, that was great stuff.

Bill Russell:

But you've made you seem to have made that transition, so I'm sure

Bill Russell:

you love the face to face, but, but how are you able to make that.

Stephanie Lahr:

Yeah, I, I do love the face-to-face, but I think we can do a

Stephanie Lahr:

lot of those things in different ways, but get a lot of the same fun out of it.

Stephanie Lahr:

So, um, you know, my team we've had a real focus and this does get

Stephanie Lahr:

to, you know, the shortages of it.

Stephanie Lahr:

People I'm now competing with health systems in New York and Ohio, and wherever

Stephanie Lahr:

that may allow a person to stay in rapid.

Stephanie Lahr:

But work for them remotely.

Stephanie Lahr:

And so that has really changed

Bill Russell:

the landscape.

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I can hire in 48 states now.

Bill Russell:

And I'm

Stephanie Lahr:

like, wow, I know I said, which two are the ones you're not cut?

Stephanie Lahr:

I was hoping maybe we'd be one of them.

Stephanie Lahr:

We're not, um, or actually I should say we are, they can hire in our state.

Stephanie Lahr:

And so one of the things, you know, I've worked hard on,

Stephanie Lahr:

I I'm a very social person.

Stephanie Lahr:

I needed the social interaction, even if we couldn't be in person.

Stephanie Lahr:

So, um, my team and I have created.

Stephanie Lahr:

To be able to do that.

Stephanie Lahr:

Even still virtually we have, um, fun all hands meetings.

Stephanie Lahr:

We play games, which help people get to know each other.

Stephanie Lahr:

It helps people take some of the, um, the intensity off of the work.

Stephanie Lahr:

Um, and you know, th there are just like, you can do a comedy show virtually.

Stephanie Lahr:

There are ways you have to do it a little bit different, but it's actually

Stephanie Lahr:

pretty fun and a way to be creative.

Stephanie Lahr:

I'll give one example last year, over the holidays.

Stephanie Lahr:

What we used to do was we had a.

Stephanie Lahr:

Who would go to people's offices and kind of like create a little bit of havoc

Stephanie Lahr:

and be, you know, uh, uh, decorated.

Stephanie Lahr:

And then that person would gather all that stuff up and go and take it to a

Stephanie Lahr:

new office and elf that person's office.

Stephanie Lahr:

So last year during COVID, I was like, well, we still want to do this.

Stephanie Lahr:

How can we do this?

Stephanie Lahr:

So what we did instead is we put together eight boxes of Elfin fun.

Stephanie Lahr:

And during our all hands meetings, we would like the publishers clearing.

Stephanie Lahr:

Show up at somebody's doorstep, you know, in our region, it's not hard to do and

Stephanie Lahr:

close enough for our teams to be together and we'd knock on their door and we

Stephanie Lahr:

would deliver them their Elfin package, and then they could do it within their

Stephanie Lahr:

home office or whatever they wanted.

Stephanie Lahr:

You just have to be creative.

Stephanie Lahr:

You know, we still, we can still be very personally connected.

Stephanie Lahr:

I'm very excited to get back to the point where we can be doing more together.

Stephanie Lahr:

I think hybrid is absolutely.

Stephanie Lahr:

I'm going to be the ideal.

Stephanie Lahr:

I will have a lot of people who like being home at least a good part of the time.

Stephanie Lahr:

And that again, creates retention, um, opportunity.

Stephanie Lahr:

But I think we're, we're going to want to have a blend and we have a lot of

Stephanie Lahr:

fun trying to think outside of the box on how to do some of those things.

Stephanie Lahr:

I'm going

Stephanie Lahr:

to

Bill Russell:

come back to you on Montana trivia.

Bill Russell:

But before that, w it's interesting.

Bill Russell:

I was at the health conference and the health conference.

Bill Russell:

They really strive to have a, um, representation of male, female.

Bill Russell:

And they weren't able to even get close this year.

Bill Russell:

And one of the things we heard a stat, I think it was yesterday.

Bill Russell:

You heard a stat of the number of women who are leaving the workforce and they

Bill Russell:

were, they're given a choice and they chose their family and they're doing that.

Bill Russell:

But I mean, you, the pandemic was challenging for you too.

Bill Russell:

I mean, you're, you're at home a CIO doctor and.

Bill Russell:

Your kids are like right in the other

Stephanie Lahr:

room doing their thing was like, when are we going

Stephanie Lahr:

to talk about the math homework

Bill Russell:

and eight year old, they respected your office.

Bill Russell:

And,

Stephanie Lahr:

um, I mean, you know, she respected, I don't know about that.

Stephanie Lahr:

Actually.

Stephanie Lahr:

It was, it was actually maybe a kind of fun for them to my eight year

Stephanie Lahr:

old in particular, um, not, not shy.

Stephanie Lahr:

So he's known to sort of peek in on meetings at times and want to say hello

Stephanie Lahr:

and, you know, get to know the team.

Stephanie Lahr:

A lot of my.

Stephanie Lahr:

No, it was my kids.

Stephanie Lahr:

Right.

Stephanie Lahr:

And they probably know them better now than they did before.

Stephanie Lahr:

They maybe saw them at a team picnic twice a year.

Stephanie Lahr:

Now they actually see them quite often.

Stephanie Lahr:

And that's been something we've reciprocated if it's we've made

Stephanie Lahr:

it okay for others as well.

Stephanie Lahr:

Right.

Stephanie Lahr:

We all just had to kind of navigate our way through.

Stephanie Lahr:

Um, and you know, it's been a lot at times I was happy for

Stephanie Lahr:

the schools to open up again.

Stephanie Lahr:

Um, but I do think it has been nice to.

Stephanie Lahr:

Make it okay.

Stephanie Lahr:

To understand that people have these lives outside of their work

Stephanie Lahr:

and they can blend if they need to.

Bill Russell:

Yeah, my wife and I we're actually we're in the opposite joy.

Bill Russell:

Our youngest is 21 and in college.

Bill Russell:

So when the pandemic hit, she was forced home and you know, the pandemic

Bill Russell:

has some silver linings and one of them is just being with family.

Bill Russell:

Yeah.

Bill Russell:

One of the things I remember a saying in the middle, I'm like, man, I'm

Bill Russell:

glad our kids aren't that age, that little age where it's like, I need to

Bill Russell:

get out and need to all those things.

Bill Russell:

On the

Stephanie Lahr:

flip side, I will add just given your earlier comment

Stephanie Lahr:

about women leaving the workforce.

Stephanie Lahr:

This is a really concerning issue to me as I think about, um, you know, women

Stephanie Lahr:

as, as a constituency of our workforce, whether we're talking about in medicine

Stephanie Lahr:

or, or anywhere and maintaining that diversity and, um, and thought process.

Stephanie Lahr:

3 million women left the workforce, um, in the United States.

Stephanie Lahr:

And, you know, during this time period.

Stephanie Lahr:

And so as we look at nursing shortages and you know, it shortages and all

Stephanie Lahr:

of the things that we're seeing, 3 million women left the workforce.

Stephanie Lahr:

And I think we're going to have to dig in and understand I had the luxury of

Stephanie Lahr:

finding a way to be able to balance both.

Stephanie Lahr:

But what that tells me is we've not set our infrastructure.

Stephanie Lahr:

To support that more broadly.

Stephanie Lahr:

And I was very fortunate to have a situation that I could make that

Stephanie Lahr:

work, but a lot of women apparently didn't feel like they could.

Stephanie Lahr:

And I think we're going to have to walk through that as we recover

Stephanie Lahr:

from, this is how do we, um, reinvent and reframe some of how we do work.

Stephanie Lahr:

Some things, obviously a nurse cannot bring their child to the hospital

Stephanie Lahr:

while they're providing beds.

Stephanie Lahr:

But maybe our organization could be providing childcare directly or

Stephanie Lahr:

more directly at this point, right?

Stephanie Lahr:

Yep.

Stephanie Lahr:

That would be an option.

Stephanie Lahr:

Or, you know, maybe we need to have childcare at the hospital

Stephanie Lahr:

in the middle of the night.

Stephanie Lahr:

Maybe we have a single mom who would be happy to take the night shift,

Stephanie Lahr:

but there, you know, all, there's all kinds of ways that we might need

Stephanie Lahr:

to just be thinking about it, but we can't just absolutely absolutely

Bill Russell:

types of license plates are there in the state of Montana.

Bill Russell:

And just on your slide, you don't remember.

Stephanie Lahr:

No, I totally know.

Stephanie Lahr:

It's two hundred and thirty two hundred thirty, one hundred and thirty different

Stephanie Lahr:

license plates in the state of Montana.

Stephanie Lahr:

Literally, as you drive down the highway, you will think you're seeing a whole

Stephanie Lahr:

bunch of different states represented.

Stephanie Lahr:

No, just look closely.

Stephanie Lahr:

It's probably yet another of the Montana license plates, which I think is fine.

Stephanie Lahr:

It's 230 license plates.

Stephanie Lahr:

There's less than a million people.

Stephanie Lahr:

So you know what I mean?

Stephanie Lahr:

Like you kind of really, you can have a pretty unique

Stephanie Lahr:

license plate and that's pretty

Bill Russell:

interesting.

Bill Russell:

Just

Stephanie Lahr:

crusted over a million people in the last census.

Stephanie Lahr:

And we can

Bill Russell:

look in every direction and we don't see all that many

Bill Russell:

people where we're at a distance from one end of Montana to the other,

Stephanie Lahr:

uh, on I 90, I think it's right around 515 miles on interstate 90,

Bill Russell:

90 starts.

Bill Russell:

I 90 starts where

Stephanie Lahr:

I, 90 starts in Boston finishes in Seattle.

Stephanie Lahr:

Wow.

Stephanie Lahr:

And, uh, funniest story.

Stephanie Lahr:

I, I, before I lived, um, in rapid, I lived in Coeur d'Alene.

Stephanie Lahr:

Another, I like to live on nine 90 apparently.

Stephanie Lahr:

Um, and, uh, uh, there used to be a joke that you could make it from

Stephanie Lahr:

Boston to Seattle without stopping if you made the light in Wallace, Idaho.

Stephanie Lahr:

So Wallace Idaho was like the last place that I, 90 was kind of

Stephanie Lahr:

formalized, tiny little town, um, mountain town, and there was a stop.

Stephanie Lahr:

Uh, they're on for many, many years, about 15 years ago, or so they

Stephanie Lahr:

finally fixed that, but yeah, that

Bill Russell:

was, and you used to live in Montana.

Bill Russell:

So for many years though, they did not have a speed limit on some of these roads.

Stephanie Lahr:

Yeah.

Stephanie Lahr:

I still get asked that people are like, wow, it's so cool at Montana.

Stephanie Lahr:

Doesn't have a speed limit.

Stephanie Lahr:Well, it was three years from:Stephanie Lahr:

And actually there was a speed limit.

Stephanie Lahr:

It was called reasonable.

Stephanie Lahr:

So for me, I type a overachieving.

Stephanie Lahr:

Don't want to break the rules kind of person.

Stephanie Lahr:

It was actually really stressful because I didn't know which line to be in.

Stephanie Lahr:

I would see a police

Bill Russell:

officer on the major highway doing 35,

Stephanie Lahr:

like, oh, is this okay?

Stephanie Lahr:

Yeah.

Stephanie Lahr:

Um, so for me personally, I'll, I'll take a speed limit any day, but

Stephanie Lahr:

yeah, it didn't, it didn't last long.

Stephanie Lahr:

The, the statistics that went along with the outcome of that were not favorable.

Stephanie Lahr:

Stephanie, thank you for your time.

Stephanie Lahr:

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