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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, Another one of our interviews and action. This comes from the healthcare to healthcare event, which I was a guest at from the serious health care team. It was in Montana. And I was able to sit down with a handful of CEOs. And I'm going to share those with you here shortly. My name is bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in health. It. A channel dedicated to keeping health it staff current and engaged. I hope you're enjoying these interviews and action. We were able to do these interviews at the health conference, the chime conference, and now the healthcare to healthcare event. I've really enjoyed doing them. just a reminder. We're going to get back to our normal programming where I take a new story, break it down. And talk about why it matters to health. It. We're going to be doing that as soon as the interviews are done we have done 10 from the chime conference eight from the health conference and we have five from the healthcare to health care conference so i hope you enjoy another one of these interviews alright. Another interview from the healthcare to healthcare conference, this is a, a severally conference. It's an invitation only event by serious healthcare. And so we're talking with Dr. Stephanie LAR again, it's been a while since we've talked as it

Stephanie Lahr:

has been always great to talk to you. That always

Bill Russell:

great. Um, so we're in your neck of the woods. And now we're we're in Montana, but, but you classified it as your neck of the woods.

Stephanie Lahr:

Yeah, well, I, yeah, I was saying I live in rapid city, South Dakota, which is about 725 miles from here, but it's a day's drive. So, you know, out west, if you can get there in a day, it's local, I did grow up here. Now

Bill Russell:

you grew up in Montana now you're at monument health. Yep. So, uh, we haven't talked in a while. What's due at monument health. Well, you guys.

Stephanie Lahr:

Yeah. Um, gosh, there's so much fun stuff happening right now. Um, you know, I think as we are coming through COVID, we are, um, we're, we're still faced with a number of challenges. I think there are some new things that have really come out of it that we're all experiencing, particularly as it relates to, um, staffing shortages, uh, the, the expense of, of those, um, resources, burnout, you know, and those things extend into. Technical teams. They extended to our clinical teams. All of our teams are kind of stretched and, and dealing with challenging issues right now. And so I feel like that is such an amazing opportunity for technology to be able to come in and help relieve some of the burdens. And I'll say, you know, I mean, I think right now my number one goal is to bring back the joy to medicine. And, and I don't mean that just for my clinical. I mean, really for everyone who is involved in the care delivery, um, you know, part of the system, we need to bring the joy back to their work. And I think that, you know, looking at technology right now, we're right, for those opportunities, there's automation opportunities, there's efficiency opportunities. And, and we're also at a point where we have some great foundational systems in place. So now we can start building on that, um, foundation.

Bill Russell:

You talked about bringing the. Back to medicine, but you're one of the reasons I like talking to you is you have to be pragmatic. It's not like some of the larger health systems or, you know, I, when I was CIO, I had 750 people reporting into me. You don't have 750 people. And, uh, we also had an innovation budget, those kinds of things. And there are those health systems that are doing that, but you have to be very practical. Talk about some of the, some of the practical ways that you're trying to bring joy back to medicine.

Stephanie Lahr:

So, um, I think, you know, one of the great things about being an organization, my size

Bill Russell:

decision

Stephanie Lahr:

making is very, we're very flat. Um, I can have great conversations with all of our executive leadership, um, our physician leadership and, and really come to some conclusions and execute on those things quickly. So that makes it easier, um, in some respects, but, you know, I think things that we're looking at right now, we've, we've created some really strong. With vendors like nuance, for example, where we're leveraging ambient clinical intelligence, um, and allowing our providers and to have that relationship, bring that intimacy back to the relationship with the patients. Exactly. Yes. Not sit with our backs to the patient's sitting at the computer. Um, and it's not, it's not a tool that everyone needs, but we've identified a way to be able to sort of, um, select providers that we think that that is a great tool for. And so. Rolling that out to them. We, um, are looking at automation in a variety of other respects. You know, we're, we're working on a really great project to be able to, um, take some of our clinical workflows, um, monitoring what's happening throughout the hospital. I think you've maybe even talked to the, the CEO of that company recently artist's site, um, but had some really exciting conversations with my, um, health system board and our finance and investment committee, even just this. And there's a real understanding at that board level, that transformation is not optional. We are going to have to do something and we, and we won't know exactly what the right fit is going to be until we do it. So we're just going to jump in and we're going to start doing some of those things. And I, and again, I think that's one of the great things about being our size is that we can just do that. The

Bill Russell:

artist's eye conversation was interesting. And it's interesting that I'm talking to you about it because when people hear AI, computer vision and those kinds of things, No large academic medical center out of LA or know that's what they're thinking, but you're implementing that there. And how does that lead to again, I'm just going to keep coming back to this, bringing joy back to medicine.

Stephanie Lahr:

Yeah. So I think it does it in two ways. One, um, it allows us to gain an understanding of what's happening within our walls and within the health. That to a level of granularity we don't have right now. Right. All of the documentation, all of the data points that we have are actually, you know, sort of representations of the real information. But for example, when a document comes out of an exchange between a patient and a provider, that's not truly what that conversation was. It's a representation of it. Any box that I check in the EA. That's not actually when it happened and what happened. It's a representation of that created typically after the fact. And I think one of the things that's really awesome about technology like artist's site is it's going to allow us to have a much more granular, real time understanding of what's happening so that then we can look at processes and improve them, reduce friction and create efficiency. And then the other piece for me, when we talk about the joy of medicine, you know, there's a lot of statistics out there that talk about. You know, an ICU physician spends 14% of their time with a patient. An ICU nurse spends 34% of their time with the patient that other big percentage of the time is on administrative and other kinds of

Bill Russell:

tasks specialists who also practice medicine.

Stephanie Lahr:

Exactly. And, and we can flip those ratios and get them spending 15% of time on the administrative tasks by automating them in the background. Again, if I had an exchange with you and we can turn that into a doc. Or if I can understand that the patient is moved from here to here and this person needs to be notified, why would I ask a person to do that? Why would I ask a nurse to be managing those things? We've done it because it's been the easy answer. Oh, the nurses right there have them do it. We we've come to a breaking point. We can't ask them to do one more thing. And in fact, given the staffing shortages, if we're going to ask them to do one more thing, it has to be something clinical. So we're gonna have to take some of the other stuff off the

Bill Russell:

plate. Specifically, let's talk about the nursing shortage. Cause it's, it's one of the things I'm hearing. I'm also hearing an it shortage by the way, I'm hearing it for sure. Challenge to hire those. So let's go in those two directions. So nursing shortage, um, I assume that's hitting you where you're at. Absolutely. Are you having this issue? I'm hearing this over and over again where people are leaving to become traveling nurses. They're making five times what they're making locally. They're going to go do that for a year or to pay for their kid's education. Then there. And worked for you and you're going to take them back because there's a nursing shortage where you're at. How, how are you guys thinking about that problem?

Stephanie Lahr:

Well, I think the number one thing that we're thinking is how do we make our place, the place that people want to work? Um, the money is only one part of why a person chooses to work in a certain place or go down a path with their career. And so our differentiator to your point, we're a not-for-profit community health. We're not going to pay the most. Um, but we can look at other things that make us attractive, make us a great place to work. Um, that can be other things that our, our HR teams and experienced teams are working on. But again, I feel like that's then a big burden on my shoulders, which I'm happy to take on to sort of say what would differentiate us, what would make a nurse say, gosh, when I go work at Monmouth, I get to spend all my time with the patients cause all these other, so, I mean, I think it's all tied together. One, we may need fewer nurses possibly over time. If we can really start automating some of these processes, but even if we don't, even if we need the same number there. Much happier doing the work that they spent, all of their clinical time training to do. Nobody went to nursing school or medical school. So they could be like, I'm going to be the queen or the king of the EHR. This is going to be fabulous. They did it because they want to be interacting with patients. Okay. It's

Bill Russell:

interesting to hear you talk about one of the things you've done is building community remotely. I've been talking to CEOs about this, and to be honest with you, one of the things I've been saying is I'm, I would have struggled to make this transition to. You know, seeing everybody through a screen, I like walking into their office. I like talking to them. I like the informal conversations. It was, ah, it was, uh, it was part of the reason I love the job is, is the community that you're able to build, bringing people together that people used to make fun of, you know, the birthday parties and that kind of stuff. But I love that stuff. That was, that was great stuff. But you've made you seem to have made that transition, so I'm sure 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 lot of those things in different ways, but get a lot of the same fun out of it. So, um, you know, my team we've had a real focus and this does get to, you know, the shortages of it. People I'm now competing with health systems in New York and Ohio, and wherever that may allow a person to stay in rapid. But work for them remotely. And so that has really changed

Bill Russell:

the landscape. I can hire in 48 states now. And I'm

Stephanie Lahr:

like, wow, I know I said, which two are the ones you're not cut? I was hoping maybe we'd be one of them. We're not, um, or actually I should say we are, they can hire in our state. And so one of the things, you know, I've worked hard on, I I'm a very social person. I needed the social interaction, even if we couldn't be in person. So, um, my team and I have created. To be able to do that. Even still virtually we have, um, fun all hands meetings. We play games, which help people get to know each other. It helps people take some of the, um, the intensity off of the work. Um, and you know, th there are just like, you can do a comedy show virtually. There are ways you have to do it a little bit different, but it's actually pretty fun and a way to be creative. I'll give one example last year, over the holidays. What we used to do was we had a. Who would go to people's offices and kind of like create a little bit of havoc and be, you know, uh, uh, decorated. And then that person would gather all that stuff up and go and take it to a new office and elf that person's office. So last year during COVID, I was like, well, we still want to do this. How can we do this? So what we did instead is we put together eight boxes of Elfin fun. And during our all hands meetings, we would like the publishers clearing. Show up at somebody's doorstep, you know, in our region, it's not hard to do and close enough for our teams to be together and we'd knock on their door and we would deliver them their Elfin package, and then they could do it within their home office or whatever they wanted. You just have to be creative. You know, we still, we can still be very personally connected. I'm very excited to get back to the point where we can be doing more together. I think hybrid is absolutely. I'm going to be the ideal. I will have a lot of people who like being home at least a good part of the time. And that again, creates retention, um, opportunity. But I think we're, we're going to want to have a blend and we have a lot of fun trying to think outside of the box on how to do some of those things. I'm going

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to

Bill Russell:

come back to you on Montana trivia. But before that, w it's interesting. I was at the health conference and the health conference. They really strive to have a, um, representation of male, female. And they weren't able to even get close this year. And one of the things we heard a stat, I think it was yesterday. You heard a stat of the number of women who are leaving the workforce and they were, they're given a choice and they chose their family and they're doing that. But I mean, you, the pandemic was challenging for you too. I mean, you're, you're at home a CIO doctor and. Your kids are like right in the other

Stephanie Lahr:

room doing their thing was like, when are we going to talk about the math homework

Bill Russell:

and eight year old, they respected your office. And,

Stephanie Lahr:

um, I mean, you know, she respected, I don't know about that. Actually. It was, it was actually maybe a kind of fun for them to my eight year old in particular, um, not, not shy. So he's known to sort of peek in on meetings at times and want to say hello and, you know, get to know the team. A lot of my. No, it was my kids. Right. And they probably know them better now than they did before. They maybe saw them at a team picnic twice a year. Now they actually see them quite often. And that's been something we've reciprocated if it's we've made it okay for others as well. Right. We all just had to kind of navigate our way through. Um, and you know, it's been a lot at times I was happy for the schools to open up again. Um, but I do think it has been nice to. Make it okay. To understand that people have these lives outside of their work and they can blend if they need to.

Bill Russell:

Yeah, my wife and I we're actually we're in the opposite joy. Our youngest is 21 and in college. So when the pandemic hit, she was forced home and you know, the pandemic has some silver linings and one of them is just being with family. Yeah. One of the things I remember a saying in the middle, I'm like, man, I'm glad our kids aren't that age, that little age where it's like, I need to get out and need to all those things. On the

Stephanie Lahr:

flip side, I will add just given your earlier comment about women leaving the workforce. This is a really concerning issue to me as I think about, um, you know, women as, as a constituency of our workforce, whether we're talking about in medicine or, or anywhere and maintaining that diversity and, um, and thought process. 3 million women left the workforce, um, in the United States. And, you know, during this time period. And so as we look at nursing shortages and you know, it shortages and all of the things that we're seeing, 3 million women left the workforce. And I think we're going to have to dig in and understand I had the luxury of finding a way to be able to balance both. But what that tells me is we've not set our infrastructure. To support that more broadly. And I was very fortunate to have a situation that I could make that work, but a lot of women apparently didn't feel like they could. And I think we're going to have to walk through that as we recover from, this is how do we, um, reinvent and reframe some of how we do work. Some things, obviously a nurse cannot bring their child to the hospital while they're providing beds. But maybe our organization could be providing childcare directly or more directly at this point, right? Yep. That would be an option. Or, you know, maybe we need to have childcare at the hospital in the middle of the night. Maybe we have a single mom who would be happy to take the night shift, but there, you know, all, there's all kinds of ways that we might need 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. And just on your slide, you don't remember.

Stephanie Lahr:

No, I totally know. It's two hundred and thirty two hundred thirty, one hundred and thirty different license plates in the state of Montana. Literally, as you drive down the highway, you will think you're seeing a whole bunch of different states represented. No, just look closely. It's probably yet another of the Montana license plates, which I think is fine. It's 230 license plates. There's less than a million people. So you know what I mean? Like you kind of really, you can have a pretty unique license plate and that's pretty

Bill Russell:

interesting. Just

Stephanie Lahr:

crusted over a million people in the last census. And we can

Bill Russell:

look in every direction and we don't see all that many 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. I 90 starts where

Stephanie Lahr:

I, 90 starts in Boston finishes in Seattle. Wow. And, uh, funniest story. I, I, before I lived, um, in rapid, I lived in Coeur d'Alene. Another, I like to live on nine 90 apparently. Um, and, uh, uh, there used to be a joke that you could make it from Boston to Seattle without stopping if you made the light in Wallace, Idaho. So Wallace Idaho was like the last place that I, 90 was kind of formalized, tiny little town, um, mountain town, and there was a stop. Uh, they're on for many, many years, about 15 years ago, or so they finally fixed that, but yeah, that

Bill Russell:

was, and you used to live in Montana. So for many years though, they did not have a speed limit on some of these roads.

Stephanie Lahr:

Yeah. I still get asked that people are like, wow, it's so cool at Montana. Doesn't have a speed limit. Well, it was three years from 1998 to 2001, um, didn't last, super long. And actually there was a speed limit. It was called reasonable. So for me, I type a overachieving. Don't want to break the rules kind of person. It was actually really stressful because I didn't know which line to be in. I would see a police

Bill Russell:

officer on the major highway doing 35,

Stephanie Lahr:

like, oh, is this okay? Yeah. Um, so for me personally, I'll, I'll take a speed limit any day, but yeah, it didn't, it didn't last long. The, the statistics that went along with the outcome of that were not favorable. Stephanie, thank you for your time. Great to talk to you again.

Bill Russell:

Don't forget to check back as we have more of these interviews coming to you, that's all for today. If you know of someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week, health.com or wherever you listen to podcasts, apple, Google, overcast, Spotify, Stitcher, you get the picture. We are everywhere. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health. VMware Hill-Rom Starbridge advisors, McAfee and Aruba networks. Thanks for listening. That's all for now.

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