July 28, 2023: In this keynote episode featuring Jeffrey Sturman, the CIO for Memorial Healthcare System, delve deep into a fascinating comparison between the healthcare sector and the Masters tournament, exploring the distinct values driving each industry. What might we glean when we compare the workflow of the Masters tournament and healthcare systems, and what does this reveal about the core values driving each industry? As consumer experience becomes a priority, what key changes can truly enhance the patient journey? What barriers might they encounter, and what digital tools could help overcome these for a smoother patient flow? In discussing staffing issues, How does this influences patient flow, care quality, and overall efficiency. With a growing remote workforce, how can healthcare maintain a robust organizational culture, and what long-term effects might these strategies bring about? Is healthcare a "black hole", and how this narrative could shape digital tool adoption and strategic focus?
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Today on This Week Health.
These are hundreds of thousand, millions of dollars. And if you see a robot that's being utilized at 20%, You gotta ask the question why? 📍
Thanks for joining us on this keynote episode, a this week health conference show. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health, A set of channels dedicated to keeping health IT staff current and engaged. For five years, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our keynote show. CDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders. Now onto our show.
(Main) A 📍 ll right. Today we're joined by Jeff Sterman and this is a spur of the moment interview. Jeff and I just spent the last weekend at the 2 29 project event in Charlotte, North Carolina. And today we're just gonna talk about some of those topics and some of the things that are going on, Jeff.
Welcome back to the show.
Thanks, bill. It's been way too long since I talked to you. It's been what, maybe 48 hours?
I don't know. About 48 hours. I love the fact that you still have the master shirt on. Still rubbing it in for me. I wore for you, I wore for you. It the masters, I did a show on the Masters, the things I learned at the Masters, and so some of the things I thought were relevant for healthcare is just.
How customer-centric the whole operation is. It really is kind of amazing. They don't try to gouge you. The food is reasonable. I mean, they could gouge you, the food is reasonable. The shirts like the one you're wearing. People are like, oh, you got a master shirt. It's, it's a $75 shirt. It's not obscene where they could easily have charged twice that for that shirt.
You're right. Isn't it fun? I mean, we always talk about this, about taking the consumer experience to the next level in healthcare. These guys kind of figured it out and they make everything so, easy to, to navigate. And get things done and buy clothes. Let me tell you, I told you I spent way too much money when I was there.
And so yeah we really could borrow a little bit from that in healthcare.
Well, how about the workflow? I mean, just think about the workflow. So we, so you get in line to go into the store cause they have to do a little crowd control cause there's a lot of people trying to get in there.
Once you get in, There are all these counters and stuff, but there's people there to get you your shirts, get you your stuff or whatever. It's all laid out real nicely. You go through and you pay, and by the way, I mean you pay in like seconds. It's just, it's really quick. You get outside and they go, would you like to ship the stuff or would you like to, put it away?
So if you wanna put it away so you don't carry it around, there's, one line you get into if you wanna ship it immediately, you get into another line. And they come by, they scan your driver's license, and they go, okay, here's your ticket. When you get to the front, hand 'em your ticket, you hand 'em the ticket and it has all your information, right, your address and all that stuff.
And that checkout process is seconds. I love that kind of workflow. Are we starting to do that in healthcare Where? We're thinking about the amount of time and all the different touch points of people coming into our health systems.
You talk about the Masters and that workflow and how easy it is.
And you're right, I, when I left there with that bag of stuff and gave them my ID and I don't even remember I remember now cause I got the bills to prove it how quick and easy it was, but it was so fast and so, yes, I mean, in healthcare and even not just the Masters, but think about Disney and all the things that you're doing at Disney, they pass through lines and get through these kind of agendas quickly.
That's what we're doing in healthcare. So Fast pass the idea of Fast Pass, I think was borrowed from Disney. And we're doing that in our electronic health record now. So patients are coming into our physician offices, our clinics or wherever they need to, and they're getting in with relative ease.
It used to be, you're waiting in these lines, sometimes lines are backing up, sometimes, you gotta answer the same questions 10 times over and fill out paperwork. Now in the digital world, I mean, why are we doing that? And so many places are still doing that, but we're trying to make it easier.
we had 12, 13 of your peers in the room at the 2 29 event. Are there general topics that, that we discussed or you heard from your peers that you're like, there, there's a lot going on in this specific space right now?
I mean, I think the one that resonates with me so much right now is those of us that are in multiple hospital type environments larger healthcare systems or even mid-size patient flow obviously came up a lot. How we're getting patients in our hospitals. I mean, I have a bad experience right now.
My mother-in-law's actually in the hospital and And she's been waiting in the emergency room for, I don't know at least 16 hours already. And so it's amazing what we are doing from a digital standpoint to help facilitate some of that patient flow. I need to influence that on my own healthcare system a little bit more right now.
And we are trying to do that from, standing up command centers to incorporating virtual health even more. I
I'm hearing that more, I'm hearing more and more of the concept of standing up command centers. What does a command center look like for patient flow?
I. So, we're just starting this journey.
And it's been slow to come in part because of construction and actually building out a presence of actual facility that we're doing. But for us, patient flow is really think. And just by way of background, I think every, most of your viewers probably know who Memorial Healthcare System is, but six hospitals Southeast, part of Broward County.
Close geography. All of our hospitals are overflowing right now with patients. So if I can decant from one of my hospitals or multiple of my really big hospitals and get patients to the best place to treat them in the most effective manner, that'll, prove to be a great advantage.
Now, at the same time, I can't transfer every patient, so I just need to get patients out of their beds in the ed, into beds on the inpatient floors as quickly and efficiently as possible. So that's what we're thought thinking about from a transportation, from a discharge management standpoint, from an admission standpoint, how do we get patients in and out as efficiently as possible?
If you look at my metrics, bill and I just was looking at this yesterday, we have. Hours, literally hours of patients who are identified as being able to be discharged, but four hours later they're still in house. And I have patients in my emergency room that need to get into a patient bed for whatever reason they need to be admitted.
And so from a consumer experience standpoint, that's not where we wanna be. So I think from a command center efficiency. And thinking about how we look at the metrics, the data, and we move patients more effectively throughout the healthcare system. Meaning not just one hospital, but my six hospitals.
That's the idea of this command and control center. So,
It's interesting. I was talking to somebody and there was a major academic medical center, a well known academic medical center, and they had that very same problem of getting people discharged. And they said, there are some cases that they've tracked where people were in the hospital nine hours longer than they needed to be cuz they couldn't track down the physician that needed to sign off.
On that person leaving. And so nine additional hours in an overflowing hospital is really detrimental to the overall process, especially when you have people waiting to get in. And so you end up with, I've been in some of those health systems where you just have people in the hallways.
Oh we have people in our hallways, I mean, I hate to admit this, but you go through my two biggest hospitals on any evening or certainly every weekend, you got patients in the hallways. We're waiting to get them up on the floors right now. I think, in this post covid, if we can actually say that time, people are not afraid to go to the emergency room anymore and they're utilizing it.
And from our standpoint, That may not be the, necessarily the payer mix that we want in our emergency room or in our hospital, but you know, we're a community-based healthcare system. We're taking care of everyone and and we're doing the right thing for the community. I'm so proud of that.
But it is a very difficult time, especially with another subject that came up at our event in Charlotte this past weekend. And that was, just staffing. Staffing from a nurse standpoint, staffing from an IT standpoint. I mean, I met with a vendor yesterday to talk about how we can use some more innovative ways from a recruitment standpoint.
Not just for it, but also for nursing and clinical areas. But when you have your patients, That are overflowing your ED and you're trying to get patients out of the hospital that are ready for discharge, and then you have the staffing issue. It's all compounded on each other.
So I'm being interviewed this afternoon.
I'm interviewing you this morning. One of the questions I sent over was what are some of the top problems that CIOs are facing and working to solve right now? I'm curious what your thoughts are on that question.
I think we just covered two of them. I mean, certainly I think I don't think the CIOs are all that different than probably a lot of our other executives.
We're all dealing with staffing issues. We're all dealing with a remote workforce, and so, how do you sustain culture in this world of and environment where we know that? Keeping talent and building talent and attracting talent is very difficult for everybody. And even in it, we have an organization that's very much hybrid.
So that what I'm attacking and what I'm trying to figure out is how do you build that culture? How do you sustain a culture? I'm so proud of the culture that we've had, and I think the culture at Memorial in particular is unique and wonderful, but how do you keep the culture of people together when you're physically not together?
And there's some little things that you can do, and I think we're doing them. Whether it be town hall meetings or I live in Florida, so we love being outside. We get together outside on a regular basis. Not all that regular cuz it's expensive and hard to get everyone together. But then I have people that are really not very close.
They've moved a couple hours away, they've moved into different states. I've even hired some people more recently that are in different states. But there are times where I think it's really important that we get together. And so that's one thing, or maybe that's multiple things that we're trying to figure out in terms of culture, building, staffing patient flow.
We've talked about virtual care and thinking about access. This is a huge. Problem across the country. I don't think memorial's different than many other places, but access points are, you never have enough of them. And there's so many areas that I think we can influence from a digital standpoint to help
solve in part some of the access problems we have. The one silver lining, if there is one, and I've said it a million times and we've all said it is maybe some of the virtual health, the telehealth programs that have been built in the early days of Covid and really developed during covid and matured.
Are here to stay. So maybe we can actually learn from those opportunities about how we can leverage that ongoing and again, evolve them to be more focused on today versus, the last three years. And I think virtual health can create amazing areas for access, more prediction and proactive care around remote patient monitoring.
Those are the things that are top of my list.
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It's interesting as you go through those things we had a great conversation at the 2 29 project about hiring and whatnot and it was interesting to me the different policies. One of the CIOs said, you can live ever anywhere you want.
You just have to be able to be here within one hour. Well, that sort of draws a circle around unless you have, I guess, a jet or whatever. It just sort of draws a circle around that health system to say. It's one hour drive to this location. And the rationale there was it's hard to really connect with the clinicians if you're an analyst trying to design solutions for them if you're not gonna be elbow to elbow.
And then we had other people who were essentially saying, look, I don't have that same thought process. And so, I've found that these people can participate in huddles, digital huddles. They can listen and they can understand they're effective. It's interesting how even with a different set of base principles or beliefs that we're all trying to build culture and and really being effective in a lot of different modalities.
A hundred percent. I mean, that that's the challenge. Like I said, I think, everyone from a leadership standpoint is gonna maybe have a little bit of a different slant here. I have a, fairly old school mindset when it comes to, having people together at the same time.
I know that's not what my team needs and wants. In fact I would go out on a limb and say, if you make me bring everyone back every single day into a physical building, I'm gonna lose a lot of people. Cause in the world of technology, and I, everyone knows, I say I'm a healthcare guy first, but in the world of technology that a lot of my team is, they can go get jobs in a lot of other places, other industries and maybe make more money.
So, Maybe do things that they really wanna do. Cuz if they don't have a passion for healthcare, they probably shouldn't be in this industry. Because it is a different and unique animal. And so I think You are right. It's a very hard thing to navigate just on the staffing side and understand where people are.
I really do think there's value in getting together. But I need to also build strength in my team and sometimes that means some specialized areas. I'm gonna be okay with not being an hour
away. Yep. Yeah, no, absolutely. When Preparing for my interview, what are the problems that CIOs face?
I said, the number one problem is helping healthcare systems dig outta the financial hole that they're currently in. And sometimes there's a problem that's so big and it's right in front of your face that some of the other stuff gets obscured. And, part of our role as the CIO is to be able to see beyond that we need to, and you've articulated it, well still focus on access, still focus on culture, still focus on advancing telehealth and those kind of things.
But for a lot of healthcare CIOs, especially depending on their size, There's like nothing else they can focus on right now because it's such a looming problem. What are the areas cuz I I would assume you face this a little bit as well at Memorial. What are some of the areas that have delivered some savings, some efficiency, some gains that have helped to ease the economic burden that our financial stress that the health systems are currently under.
Well, I hope that we don't look at it or digital as a black hole. As, a couple CEOs ago used to call it. And we actually,
oh I remember it well.
It's like in my interview process when I got the job at St. Joe's, it's like, I, what's the number one thing you want to do? It's like, I just wanna know what's going on. And the word black hole came up like four times.
Yeah. I mean, I used to walk into a room and I'd be, I don't, I'm not sure my boss actually, not my boss, but maybe my boss's boss actually knew my name, but he knew I was the black hole.
I think that's how he commonly referred to me as. But you know, I do think that we can look at it and digital as more of a strategic focus today and even creating opportunities for revenue growth. And, we've talked about, thinking about, remote patient monitoring can be a new revenue stream for you.
We can get reimbursed from the payers, from Medicare for remote patient monitoring. It's not only doing the right thing for the community, keeping patients out of the hospital, or at least when they're discharged, giving them the tools so that we can monitor them so that there's not a readmission, which we've seen huge opportunity and Gaines in, in our value-based care area in our primary care contracts.
So I think remote patient monitoring, which is a, in my view, an element of virtual health capabilities is. One of those areas that we should all be investing time in. But in terms of efficiencies and thinking about all this big equipment, I mean, I gave a presentation this last weekend about how we have millions of dollars of equipment that is underutilized and some equipment that may be overutilized, but thinking about how we can shift service lines across our organizations and really, Guiding where patients go more effectively can actually be one better for our providers, two, better for the patient and the consumer, and ultimately save us a lot of money.
Because now we're gonna utilize equipment and, these pieces of equipment, MRIs, CAT scans, robots. These are hundreds of thousand, millions of dollars. And if you see a robot that's being utilized at 20%, You gotta ask the question why? And maybe it's because it's outdated and your providers don't want to use it.
Maybe you actually don't need it. Maybe you can sell it on the open market. But I think those are the data points and analysis that can really move the needle from a financial standpoint. Yeah,
and there was a lot of interest in that discussion in that conversation. And I think that is one of the things that a CIO can do is like, is say, do you realize we could capture this data, present it back, take this whole conversation out of the anecdote area and move it into the real data?
And sometimes when we move this stuff into the real data thing, people's eyes go, oh my gosh, we like. That, that MRI is only being used 34% of the time. It's like that's problematic cuz this one over here is being used, 92% of the time. Meaning that we're turning people away over here while this one sits idle.
And there exactly. A lot of conversation. I wanna talk to you about automation and AI and we'll close this out. Both of them have a sense a part of which they're going to replace hours, they're gonna replace human labor. Are you still finding pushback in that area where people go, Hey I don't wanna look at automation, I don't wanna look at AI
because it could potentially replace me, or are we moving beyond that argument now?
I think people are, at least in my organization, aren't scared about being replaced. There's so much work to be done. I know that we're all just, anything that can help relieve our day-to-day is probably a good thing.
We need more people than ever before. We can't find them, like we said earlier, so I'm not seeing that as an issue, but I'm seeing as an issue is that we're still in the infancy of this. So the business case, the roi the studies that really support that you need to do these sort of things, they're just maybe not as well established as they need to be.
We're seeing obviously big areas of robotic process automation, AI functionality in both clinical and business revenue cycle. It started more on the revenue cycle side, but now what I'm really seeing and I'm loving is the clinical guidance, the prediction. I'll give you an example. We're working with a couple vendors right now that I think are incredibly innovative and get out in front of clinical issues from a predictive and prediction standpoint.
And what I mean by that is secondary diagnosis, for example. So, We have some imaging studies. , we do more imaging studies than probably anyone else in, in Broward County, and you come into our hospitals for a particular issue and many times that level of information is documented. But it's in a very narrative way.
So hidden in your electronic health record now, is , a secondary potential diagnosis that goes untreated and not communicated well, but. One of the areas we're looking at, for example, is lung nodules. So how many lung nodules get undiagnosed or at least buried in the electronic health record when you come in for a totally different imaging study?
And if we can get out in front of this, I know it will save life. I know it will be the right thing for the community and we can get out in front of this that, oh I know this might be bad news for you, Jeff, but you came in for this imaging study last year. We noticed this secondary diagnosis of a lung nodule.
It's not an aneurysm today where you have to be worried about, but it's something we're gonna closely monitor. And I think those sort of things from an AI standpoint are going to be huge from a clinical guidance and prediction standpoint.
Let me do this to you. You came from the consulting world.
I wanna put you back in the consulting world. So you stepped down as CIO at Memorial. And by the way this is hypothetical for those who are listening to just a snippet of this hypothetical, you leave Memorial, you go back into the consulting world. What's the service that you would stand up in a consulting practice if you were going back to CIOs in healthcare?
Yeah, it's a great question. I, I maybe have thought about this a couple times. I'm not looking to leave. I love delivering care through the way I'm doing it. Consulting I think, has shifted, but you know, for me it's all about process improvement and it's experience. I think there's such a gap from, an interaction early on with a patient and that first interaction is so meaningful.
So I think we all see this as, Consumerism or access. But I would love to ha figure out how we just make it a little bit easier for our patients, our consumers to navigate healthcare. So I label that as process improvement, but it's really that call center interaction. It's thinking about, omnichannel capabilities.
So let's deliver communications to our patients. The way they wanna be delivered to. And it doesn't mean that they have to call the call center. It means that they can chat with us, they can text with us, they can email, they can call us. And I think you gotta understand that there's different populations that wanna communicate with us differently and we all need to get there.
So I think all of that ties together. And to me that's strategic and process improvement at its best.
A former consultant as well. One of the things that I think has really helped me is to understand that. Healthcare is not a monolith. When people say, oh, healthcare provider, it's not a monolith.
I, they're, they really fall into four or five different categories for me, maybe six categories, if you count PE backed and whatever you count like the imaging centers and whatnot. But you have AMCs, you have IDNs, large IDNs, you have regional IDNs. You have Federally qualified health clinics.
You have small and rural health systems, a CIO of each one of those very different jobs, extremely different jobs. So the first thing is I would try to make sure people understood there's a difference. That's where I would start. But the next thing I would go to is a health system is like 50 businesses knit together by.
A handful of processes, and so they're like, Hey, let's bring AI into this. I'm like, into what? Like into imaging. Okay. Well, that's its own set of tools, its own set of processes, its own set of stuff. Let's bring AI into the consumer experience. Okay. That might be across the board. And, we're looking at optimizing, scheduling, workflow, cancellations, reappointments, that kinda stuff.
Okay. Yeah. I, we could do that across the whole board, but it, for me, it's. It's it's getting wins in certain areas. I've seen too many people try to boil the ocean. They go in and go, we're gonna apply this to, this health system. And I'd much rather have 'em say, we're gonna do this in oncology, or We're gonna do this in orthopedics, or we're gonna do this in whatever.
Fix that workflow, fix, from beginning to end and then go, okay, we've got it. We've got the recipe. Now let's go bake another cake and we'll do it in this
other area. I think that's absolutely right and I know we wanna close this out, but you know, my, my last comment probably would be just that point about not trying to do too many things at once, cuz we've been on this journey of accessing consumerism and doing what we think is right for the community.
We just went live. With the ability to cancel, reschedule, and confirm your appointment in an automated way. I mean, this is something that exists in so many other
industries I know, but I know how hard it is in healthcare. It's so hard.
It's hard and that's just a little piece of a chat bot capability that we're going live with.
And we're already seeing huge gains and calls that used to probably get abandoned because now we can do the more complex stuff. And these are things that, I think everybody's gonna be kind of glomming onto and figuring out. But it's those things that you need to start with. But if you try to, create all the automation in the world in your call center, You know that's not gonna happen quickly.
Yeah. Well one of these days we'll have to talk about your call center cause I know you guys have done some phenomenal stuff and we've had that conversation a little bit before. Jeff, I want to thank you for your time for this spur of the moment interview. Really
appreciate it. It's always fun, my friend.
I love the chance to have these conversations. I think If I were a CIO today, I would have every team member listen to a show like this one. I believe it's conference level value every week. If you wanna support this week health, tell someone about our channels that would really benefit us. We have a mission of getting our content into as many hands as possible, and if you're listening to it, hopefully you find value and if you could tell somebody else about it, it helps us to achieve our mission. We have two channels. We have the conference channel, which you're listening. And this week, health Newsroom. Check them out today. You can find them wherever you listen to podcasts. Apple, Google, overcast. You get the picture. We are everywhere. We wanna thank our keynote partners, CDW, Rubrik, Sectra and Trellix, who invest in 📍 our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.