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Today on This Week Health.

(Intro)   And the important thing for us, if we want the culture that helps us produce the results this company needs, we have to listen and we have to react. 

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) all right, here we are for another keynote episode. We're joined by Marty Paslik, returning guest, CIO for HCA.

Marty, welcome back to the show.

It's great to be back with you, Bill. It's good to see

you. I was looking through your bio and you have three degrees from the University of Louisville.

I do. I do. I wish that represented this honorable pursuit of education, but it was more like I got a degree.

I couldn't get a job that I wanted, went back, got another degree. And then, honestly, I was working and really wanted something that might help me further down the line from a managerial perspective. And that's when I did go back for my

MBA. Actually, I thought about it. Those were, the 80s were good years for Louisville basketball, weren't they?

They were excellent. I was in school in the prime time. was in school during both national championships and it was a blast being a student during that

time. I could imagine. My daughter, by the way, went to Baylor for three years. They had a women's basketball championship, they had a men's basketball championship, and they had a sugar bowl victory.

She graduated in three years. She goes, well, that's pretty normal, isn't it? I'm like, No, it's not really normal to have that kind of success. And she goes, well, man those were great nights camping out with people going to see the games. I'm like, yeah that's a special experience.

Yeah. And, just as a side note, I was a high school basketball player and so during my college years, pickup basketball happened at one of the smaller gyms on campus.

And so I got to play basketball against all those guys. And, not that I belong out there, but but I certainly was on the same court in pickup with those guys, which was, it's amazing, not just how big they are, but how fast they are. And I quickly understood why my high school career was the end of my basketball time.

They are athletes to play division one. and play at that elite level. Well, let's talk a little health IT. I always start these with a question. Tell us about HCA. I think a lot of our guests know about HCA, but just give us the background on HCA.

Well, we're the largest, investor owned, provider, company in the United States.

We have, nearly 200 hospitals, and probably more importantly, we have, more than 2, 000 sites. Care. We're in some of the fastest growing markets in the United States. We're, a full, care continuum, company from, urgent cares to freestanding EDs to, surgery, surgical centers, to our hospitals.

And so, quite the footprint, for our company. I should probably also add, 300, 000 employees.

Wow. And we're going to talk a little bit about that scale. In fact, let's start with the scale. Multiple hospitals under the. HCA, Healthcare Banner.

how do you ensure the technology and the, the IT systems are consistent and efficient across all the facilities? That's got to be a huge challenge.

Well, it's a great question, and I think that generally speaking, healthcare, if you've seen one hospital, you've seen one hospital. I think, the beauty of HCA is, decades ago we began this Pursuit of shared services.

So if you go into a typical hospital today, you're going to see what you think you're going to see. You're going to see a business office. You're going to see a human resources department, and you'll probably see a fairly significant IT presence. Well, you won't see that in an HCA facility.

That's because, the HR function, the business operations, are all pulled together in a consolidated state. And those consolidated centers provide services. dozens, if not a hundred or more different hospitals. And so when that's the business model, as you might've guessed, it also represents what our systems do.

So our systems support those shared services and that helps. with consistency. Now, with that said, much of our innovation comes from the very local level. So, a hospital CEO might see a piece of technology that they think is very interesting, and we want them to take to be on the lookout, to embrace that kind of technology.

The only thing we ask is that they come through a process that we call TPA or third party applications. And what that process does is first of all, validate. If this product really works, will it scale for HTA? Two, is it secure? And then three is, hey, has anybody else already looked at this and maybe have a different solution somewhere else in the company?

And can we help marry these needs together? Or maybe someone has looked exactly at the same vendor, has already installed it somewhere else, and how can we leverage or scale? to start implementing it in multiple facilities or multiple divisions. And so we try to play both sides of it a little bit.

we try to keep a very, standardized set of applications, but we also want to have this ability to embrace new technologies wherever it might come into, contact with the organization.

As you're talking about that, I'm reminded of when I was at St. Joe's, We created a governance process that essentially they had to go out and ask and find out what other hospitals were using things.

And the number of requests went down because they were talking to each other. And it was amazing how many times they found, Oh, this has already been implemented. and more times than not, we'd have two or three hospitals coming to us saying, Hey, the three of us have implemented this.

We would like to. scale this up and take some of the power. that's a fantastic approach. , you mentioned innovation and it's great that you have grassroots innovation coming up from the how do you balance innovation and operations? You have a significant operation and you also have a, it's healthcare.

You have a great need to innovate.

I would have said, five or so years ago, That was such an appropriate question because it, there was a give and take, between, the effort and the money spent on operations versus the money and effort spent on innovation.

Unfortunately, we don't live in that world anymore. we live in a world with two gas pedals, and both of them are being pressed to the ground because both are equally important, and they both, To some degree feed off of each other. So we have to have a kind of continuous, operational mindset in order to be excellent stewards of the company's money, we have to make our own money on the operational side in order to help.

With a very aggressive innovation agenda. And so they're tied together, but have never in my career until, really in the last few years, been in an environment where it is financial resiliency on one side and it is what's new and how do we get it implemented on the other, and we want both of them and we want to.

Full speed ahead.

I was looking at the Gartner hype cycle for AI yesterday, and first of all, I was shocked at the number of dots on the graph itself. It's amazing how many dots there are. But generative AI is at the peak of the hype cycle, and I'm wondering how much higher that peak can go, because it seems like we're talking about it all the time.

The one I was surprised on is computer vision is moving out of the trough of disillusionment into the... I forget what their plateau of productivity or whatever they call it. Those two things as we look at all the things that are going on in healthcare, are there technologies you're looking at that you're thinking, hey, this is probably going to change some things and we really have to keep a close eye on this.

Well, I think first of all in healthcare, I think there are actually still some fundamental technologies that still have pretty long runways. I would look at like mobility. We've made a large investment in mobility where we, we have over a hundred thousand iPhones across the company, which has changed the way we communicate.

has increased our collaboration. But when you think about generative AI and how you're going to deliver those kinds of capabilities, boy, that phone, that mobility platform is just going to be absolutely critical when it comes to camera vision, I would just even start at the fundamental level of just cameras, period.

I think that, for years, there's been a little bit of a stigma about cameras, but our society has. I think understood that, that's an important element, whether you're protecting a city or you're trying to take care of patients. And I think one thing we're really excited about right now, we have several pilots going on right now is our virtual nursing pilots, where we've taken a highly tenured nurse, who has spent their time walking those floors every day, and we are putting them behind the camera and zooming them into the rooms to relieve the administrative burden off of our nurses on the units.

So we have a virtual nurse doing admission assessments. Doing the discharge planning and you know this Bill, that, that is a huge lift off the shoulders of these nurses that are bedside every day. objective is, hey, how can we use these technologies to reduce this administrative burden and let nurses practice at the highest level of the, of their technical capability.

And so, obviously, camera vision leads into that, and I think we will see a day where camera vision starts to help us even alleviate that administrative burden even more, we're seeing cameras being able, one, hey, if we keep a car in a lane, we should be able to keep a patient in a bed.

And so how do you use things that have been used in other industries to do things better in our world? There's, you know this, in hospitals, false risk is a significant challenge. And to be able to use technology that when my grandmother starts to lean a little bit to the left, that computer sees it and, in your car, it buzzes your steering wheel.

Well, in the room, it might say, hey, Mrs. Smith, you need to move a little bit to your right. And so I think that's, I think there's going to be some great advances there. And then of course the general AI space, I think our partnership with Google. is very intentional. It's intentional from a foundational perspective.

We need more speed and more elasticity from an infrastructure perspective, but we also wanted to have a partner that we believe is going to be a leader in the generative AI space. And so We have a number of efforts. You probably saw we just had a press release yesterday or the day before where we announced our collaboration with Google on the generative AI space.

I mean, I think, we're a very conservative company. We're gonna put in the right controls, we're gonna have the right governance, but going to be looking over the edge here when it comes to generative AI and we're going to be an absolute leader in health care when it comes to that next generation of capability.

Yeah, I think Google's going to be a great partner there. And I did see that press release and it's interesting to me because people feel like Google's playing catch up and what they don't realize is Google has been leading for the last, like, 15 years and then all of a sudden OpenAI popped up there.

In one specific area, but Google, if you look at Google's AI roadmap and whatnot, it's extensive and it's a lot of focused AI efforts in healthcare. They're going to be a great partner I believe for HCA and for others. I know they're partnered with Mayo Clinic as well and as others out there.

There's a lot of things going on as a CIO. How do you prioritize the investments? it's got to be challenging because I mean, operations still is a significant part and you got to make sure that's running. You talked about 100, 000 iPhones, that's significant. You got to keep all that stuff going.

And then you just have all of these new innovations that are just around the corner which can help our nurses, can help our physicians, can allow us to be more automated and provide better care. How do you prioritize all these things? It's a lot of good things in front of you to, that are calling your attention.

Traditionally, I think we were probably a lot like a lot of other health systems where governance did it, right? Now, would say, today, real blessing I have in this role is I'm surrounded by

technologists. senior leadership team of HCA. is so technologically savvy that every discussion has substance to it.

And they fully understand the risks that are involved with certain technologies, the value that they believe they can derive of it. And even, the challenges of how those technologies need to need to overcome to, to be deployable. And \ it's really for a company as big as HCA, it's actually pretty easy.

And that is the CEO of this company, the CFO of this company, the COO of this company. They guide us and it's not a, let's meet once a month. It is a continuous conversation about the opportunities we have in front of us. And we discuss not just the opportunity itself, but we weigh it against other types of investment opportunities that we have, and that works both in front of the curtain for IT and behind the curtain. We just recently sat down and talked about some things we want to do from an operational perspective, and that, like something for the field, gets talked about in the same context.

And we make some, I think, some really excellent decisions because of the fluid nature of it. the flexibility of it. It's not like, let's have a budget. It's like, hey let's keep this a an ongoing conversation. And that has worked extremely well for

us. So you've been at ACA for a couple of decades now a fairly long time.

I'm curious what's been the most significant change that you've witnessed? in the health IT landscape since you started your tenure at HCA?

Yeah, so, I began at HCA as a software developer by Treg. And I just celebrated a few months ago, my 38th year with the company. And I don't think this comes as a surprise to your listeners.

When I came into IT, we were absolutely 100 percent a support organization. We were 100 percent a cost setter. Out of sight, out of mind kind of organization. And you wind that clock. Nearly four decades into the future, and now is rarely, if you quiz me on when's the last key strategy of this company that didn't evolve technology, I would be able to answer it to you.

So today we are an absolute partner. We our leadership in the company overall is well respected. Our credibility as. Not just the deliverer of technology, but a participant in the discussions of what we deploy and when do we deploy it is just it's almost a day and night scenario from 30, 30 some odd years ago.

It's great. It's, we're able. come to the table, not just with, look at this widget we have. We get to come to the table now and say, have you ever thought about doing this with our patients? Have you ever thought about this technology and how it could change this workflow? Man, that is really powerful and says a lot.

And that's not just at HCI. I think you're going to see that, that evolution has occurred in almost every significant IT operation in our industry.

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Again, I'm going to come back to scale. You have a large team that is delivering these services to the organization and serving the organization in this way.

how do you develop and maintain that culture within IT? That's one aspect of it. maintain a consistent message throughout the organization? How do you make sure that all parts of the organization are being served? How do you do that with such a large organization?

Well, it is large, IT is about 6, 200 people, about 65 percent of them are here in Nashville and the other 35 percent are in our 15 divisions across the U. S. It really just starts with the roots of the company. We're a company founded by physicians who wanted a better way to execute health care.

And our mission statement here is. Paramount. don't know else how to say it. I always tell people, when you're an Auburn grad and you walk up to another Auburn grad and you say, War Eagle, they know exactly what you mean, right? There's this connection. At ACA, if you use the first three words of our mission statement, just the first three words, if you say to anybody above all else, they immediately know what you're talking about.

And that's just about our commitment to the care and improvement. And when you have that kind of start from a culture perspective, it's actually pretty easy, right? I would even go as far as saying that if you talk to the majority of our technologists, They would rather be referred to as a healthcare professional first and a technologist second.

so, culture here has a good starting point, now you can screw that up, boy, you get this great heads, head start. Now in IT, we're fortunate. We have One of the highest employee engagement scores in the company. And I'd say part of that is, is, and this feeds back into the culture is, I think we're pretty active listeners.

So when we do that survey twice a year we've got 6, 200 colleagues. We'll get nearly 9, 000 comments on our employee engagement. And I won't share with you how many bottles of wine I have to go through to read 9, 000. But because... Because let me tell you, no matter how high your employee engagement scores are, and how proud you are personally of your organization, you're going to get constructed criticism.

People are going to say, need to do this

differently. I don't like how this is operating. And the important thing for us, if we want the culture that helps us produce the results this company needs, we have to listen and we have to react. We have to put in action plans that address those things. And I think we've done that fairly consistently.

And when we've done that, the scores speak for themselves. And I think that's a big part of the culture as well. And then the last thing is, I mentioned before that I started off as a software developer. And have tried, and you can imagine how many organizational levels there is in an organization that has 6, 000 people.

But I would hope that my colleagues regardless of the level of the organization they are

at, would would view me first as a colleague and not as the CIO. We have lots of different channels that allows me to sit and work with people on a one to one basis and when I have an individual contributor look at me and go, Hey, you can just stop right there, Marty, because what you're saying is absolutely wrong.

Then I know we're doing something right when we have that kind of freedom of communication where everybody's just pulling in the same direction and it doesn't really matter where you're at in an org chart.

give me an idea of... It's interesting, you try to make the really large organization small so that you have those interactions.

What are some of the methods or practices that you have to talk to as many or be in front of smaller groups of people within the IT organization so that you can listen to them? I realize there's also that. for the entire organization. I'm just going to focus it in right now for the IT organization.

How do you make it small? How do you interact with as many of them as possible?

Well, first of all I would say for any c i o you gotta do something that, that fits your own style, right? That's the first thing. But I would just say also it has to be very multi-channel. So, one of the thing, one of the things my assistant does for me every month is one month she will grab a round table of people in it that is so disparate from the organizational chart that none, nobody knows.

Everyone else in the room and I'll sit with them and we'll just simply go around the room and introduce ourselves and talk about what we do. And then of course, I should know everything everyone does in the room. I add a little bit, a little color to it, and it just allows us to have a kind of conversation you'd have around your own dinner table.

So we do that one month for managers and directors and another month we do that for our individual contributors, but probably the one, Thing we do that I think really breaks those barriers down is we have this little thing that we've done for, gosh, I can't believe this it's 13 years. We've been doing this thing that we call virtual hallways.

And this is a, every Friday from eight to 11, we do six 30 minute segments that cover a rotating list of topics. And I and other leaders in the organization. We go into the room. There's no powerpoints. It is just, and no one knows the questions. We just come in and we chat about a project and we ask each other questions.

And I can remember back in 2010 when I started it, people were intimidated. Don't get me wrong. I walk in a room and I'm asking questions and then you discover everybody's prepping for the meeting and they're having meetings before the meeting and all that crazy stuff. And I believe today we have finally gotten to the place where people just walk in, grab a donut out front and go, Hey, what's on your mind, Marty?

And I'll ask them some questions and we'll just have a dialogue. Just like if we had bumped into each other in a hallway. And that's where the phrase comes from. And I just think you do that over every Friday. You do that. And we literally have hundreds and hundreds of people that rotate through those six segments.

It just, it starts to create that atmosphere of, hey, we're just all in this together. I have my role, you have your role. We're just trying to get to the finish line.

That's bold to go in there not knowing the questions ahead of time and just letting it fly, see how it goes. I'm curious though, but as a former programmer, My first question as a former programmer is, what was your language of choice when you were programming?

Now, absolutely did things in COBOL, but I worked primarily in a language called PL1, if you remember it. It had a kind of a sister product called Pascal, if you remember that.

And so our laboratory system was built in in PL1. So, that's what I started off with. Now, again, when I'm having those colleague to colleague conversations and I end up with a room of software developers and I'm trying to imply to them how they should do something and make the reference that, Hey, y'all do remember I was a programmer.

I don't even want to describe you the looks I get back. From, the younger generation. They look at me like, that was not programming.

Hey, Dad, things have changed since the last time you were programming. That's right. Like, man, that's brutal. So, I'm a former programmer as well.

And I still program because I just like doing it. I mean, do you ever have a need to get a programming fix? Do little things on the side, not for the health system,

Well, first of all, I remind them that one function that I built in my day is still in production today. I,

make sure they realize that, just so that when I'm gone, they'll make sure to decommission that first, probably. It's a great question, Bill. I, I loved being a software developer. I loved I loved becoming lost. In trying to either fix something or lost in trying to build something. Because, there was times when I was a developer that when I figured something out that was broke, or I built something that when I compiled it and all of a sudden it worked, there's no bigger rush.

It's like a sports rush. It's I, when my early days, I thought to myself, they're paying me to do this because I just loved it. I really did. And I tell people today, my biggest, most difficult transition as a leader or as a professional was going from an individual contributor to a manager.

I thought that was the thing I wanted, but six months into it, I came home and told my wife, I'm going to tell him I want to go back. I want to go back to being a developer. I love being responsible for my own work. And she obviously talked me out of that, but but that shows you how much I loved it.

you got a thing in my head now about. I wonder, as a hobby maybe I should kick around a little Python around. That

would be pretty awesome. It is fun. I, just as an example we will finish this conversation. I will drop it into an automation, and I will have a complete, I will take the script.

It'll generate, AI will generate the transcript from this interview. And then I did a whole bunch of things through automations and whatnot. And essentially it'll go through generative AI and it'll come back with the show notes. It'll come back with key points. It'll come back with the rhetorical questions, which is a framework that we use over here.

It'll come back with titles, social media things. It'll do all that within about 10 minutes. of you and I finishing this conversation.

Hey Bill, will it make my comments smarter?

I don't know. But, hey, Google, I don't know if you saw that announcement.

Google is well, Microsoft's doing this as well. They're incorporating it into Mail. They're incorporating it into Word. They're incorporating it into Docs and all that other stuff. And now you're going to be able to start an email by saying, hey, in my voice. Respond to this email, and you're going to have a draft in there in most of the major email platforms, and I don't know who we're going to be talking to anymore.

I don't know if The email is going to be coming from each other, or if it's going to be coming from AI, AI talking to AI, essentially, it's a brave new world that we're entering.

Well, I heard a, a great comment, the CEO of Alphabet, they asked him, what would he compare?

And this is the best answer I've heard today. And he looked at the reporter and said, FHIR.

Yeah, that's a

great answer. The invention of FHIR. And, he's right. And I think our world is going to, this is going to be a real test for our world.

It really is. And are we all, are we going to be responsible? Are we going to do the right things with this technology? It's going to be a real big question mark going forward.

Satya Nadella was at EPICS UGM, and he was talking about this, and he said, look, there's The dream machine is three things.

One is it takes natural language input and that's generative AI. It takes natural, we just ask it to do some, it does some. The second thing is a reasoning engine. That's the actual GPT. That's the transformer. It's actually reasoning and it's bringing answers back. He said, but the, one of the most important things is the design construct.

He said, the design construct has to be one of a co pilot, not a pilot. And he's like, if it's a co pilot. then you can see how it gets used in medicine because it comes alongside and it assists us in the process. But the minute it becomes a pilot, that's where we get into the sketchy area of do we want it driving the car?

Do we want it deciding what a diagnosis is? No, we don't really.

No, we use the phrase here of being consistent with making sure that we have a human in the loop. And we use that phrase over and over again, always ensure humans in the loop, and I think that's that's the key.

And you're, and he's absolutely right. Is that once we start to give up everything, then what are we? And I think that's that co pilot analogy is a great one.

Well, let me close with this one. I want you to imagine, some of your best partners, some of the best vendor partners that you deal with and interact with.

I'd love for you to describe the relationship, describe... What makes them a good partner and what value they bring to you in your

role? Well, first of all, I'd say that I always make this distinction between vendors and partners. Vendors typically provide us technology that is, that can be bought from two or three other different folks.

Partners can also sell us that exact same thing, but they take the time and the effort to help us fully utilize it. And if you think about that takes it something special from a partner because if they spend the time and energy to help you take technology. I read one time that the technology in the iPhone by a normal consumer less than 10 percent of its capabilities are ever used.

Well, we probably could say That there's a majority of applications and technologies we use in healthcare are probably 50 percent or less utilized. A partner helps us take that 50 percent to 90 percent at their expense. They're not making an extra dollar by helping us drive it from 50 They sold it.

It's, the money's in the bank. But if they take the time to help us really drive from 50 to 90, then I can just speak for myself. Next time they have a great idea, I'm all in. Because I'm in on partners that will help us take technology and get it as fully utilized as possible in our organization.

Yeah, that's an interesting framework and an interesting metric. When you're talking about hundreds of care facilities and whatnot having those kinds of partners is, I would imagine, invaluable. It's a great addition to your overall team. Let's lied to you. I said that was going to be the closing question. Let me ask you this question.

CIO. How long have you been in the CIO role now?

It will be 12 years next June, so 11 years. 11 years. 11 years. I was shocked, Becker's came out with this report of the the longest tenure of the top 10 health systems. And I don't, I mean, I don't track that personally. And I looked at it and there I was at 11 years old at 11 years.

And I think the next one on the list was like two. And so quite, quite the tenure. I've been very fortunate. Yeah.

Well, the CEO role has seen a lot of turnover since the pandemic and the CIO role as well. And maybe that's where the question goes. I mean, was going to ask you, you've seen a lot of evolution in the role over the last couple of years.

what do you think is going to be needed in that role of CIO over the next five years? And, what kind of skills could a person who's listening to this develop to be ready to step into CIO role?

you gotta always have, the table stakes is you gotta be a pretty good technologist, I think that this is like, the duh moment of this interview, but you're gonna have to have pretty strong business acumen. I mean, you've got to speak the language of your key stakeholders. Yeah. It's not just speaking the language and be able to do the soundbites. You need to have a sense of understanding of the operational challenges that they have, you have to be able to know enough about.

There are operations that when you see a technology, you can, in your own mind, apply how it can be a strategic advantage to a business unit. I think that's, I think that our stakeholders are really looking for is they're not just looking for a technology provider anymore.

They're looking for a partner that's going to help them create solutions together.

I agree 100 percent and I appreciate your wisdom and I appreciate you taking the time to share it with the community. Marty, always great to catch up with you. Thanks again.

It's

n

great to catch up with you too. I look forward to talking again sometime.

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