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May 18, 2023: The nature of work is changing and hospital systems need to keep up. On this Keynote, CIOs Will Weider (formerly PeaceHealth), Reid Stephan (St.Luke’s), and Brad Reimer (Sanford Health) join in a discussion about the future of healthcare. Why does remote work have staying power? How do organizations address the challenge of perceived loss of productivity in remote work? How do organizations accommodate employees who cannot work from home? How do organizations approach onboarding new employees and integrating them into the culture? How are staffing shortages impacting the healthcare industry at a national and geographic level? What are the key challenges faced in hiring and retaining remote employees with the right skills and temperament? For major upgrades or implementations, is it effective for teams to continue operating in largely remote work environments, and what strategies have been employed to ensure successful implementation?

Key Points:

  • Staying power of remote work
  • Work environment and privacy
  • Balancing remote work autonomy and in-person interactions
  • Staffing shortages
  • Remote work environments for major implementations

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This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Today on This Week Health.

(Intro)how would we market this and scale this kind of more system wide? Leverage the expertise you already have and the automation that's probably already occurring that you're maybe not aware of and build from there.

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.

Welcome everybody. We're gonna be starting the webinar in about three minutes as we usually do. We give people some time to. Come in and join the webinar. This is part of our leader series CIO discussion around the changing nature of work.

We're going to address remote work, and we're also gonna address staffing shortages and some of the strategies and approaches to that. While we're letting people come in we have a tradition of starting this. With just the group of us having a discussion and getting to know a little bit more about people.

I, the question last year was first computer, we've moved on from that and now we're doing first job out of college. Does not have to be healthcare related, but first job out of college. What was your first job out of college? Will Weider, or we will start with you.

I went straight into healthcare it, working for sms.

I thought I was gonna be a programmer. And then I SMS came recruiting to Eastern Michigan University and so everything was kind of set in motion from that recruiting visit.

Gotcha. Eastern Michigan. What's their mascot?

Well, when I was there, we were the Hurons and now it's the Eagles.

They missed a big opportunity to go to the E M U Emus.

That's brilliant. That would've been interesting. Reid, Stephan what was your first job out of

college? Yeah. I worked for a value added reseller called CompuCom. They put us through a three month kind of bootcamp where we got certified Microsoft Engineering, Nobel Engineering.

Banyan Vines back in the day and then worked as a contractor essentially. The great thing was I got exposed to different industries from healthcare to manufacturing, to hospitality to education, and a range of the size of businesses, small to large. So just a really good exposure to a lot of different backdrops like, and how they use technology differently.

So a great foundation for my career.

That's fantastic. We'll have to share copy comp stories cause I worked there for a while. All right. Brad Reimer, what was your first job outta college? Yeah,

so I graduated with a business degree, so I actually went right into banking as a credit underwriter.

And that was boring enough that it, I needed to find a new career and quickly started training myself up in IT, so, but that was the first job.

All right. I'll give people one more minute and I'll tell you, my first job out of college was in healthcare, which is kind of weird cuz the next job I had in healthcare was as a cio.

So the first job I had, I moved to Wolfborough, New Hampshire population, like 500. It's a winter resort town for people from Boston on Lake Winnipesaukee. Couldn't find a job, so I got a job at Huggins Hospital. And I worked in the ED checking people in with paper, by the way. Right. So, yeah, so that was my first job outta college.

All right. We are we're gonna get started. You guys may have noticed that this is not the panel that we thought it was gonna be. As is the nature of working with CIOs and their schedules are dynamic and two of our CIOs had to bow out of the of the discussion due to conflicts or other things that were going on.

And I really appreciate Brad and Reid stepping in to fill those spots. So Tricia, Julian will not be here. And let's see, Andy Crowder. Andy was the other one who's not gonna be here, so, alright, so, where are we at? Intro? Okay. Well, I wanna thank everybody who's on here. I wanna thank our panelists and we will just get right into the introduction. So we have Will Weeder, retired CIO of Peace Health Reid Stephan, CIO for St. Luke's in Boise, Idaho, and Brad Raymer, the CIO for Sanford Health. So gentlemen, this is gonna be an interesting discussion.

As I said, we're gonna go in two different directions. We're gonna talk about remote work, but we're also gonna talk about staffing shortages and some of the strategies. They may not be as related as we would like, but they both have to do with I, I think post pandemic world of work for us work has changed in the nature of work has changed.

So, before we go to too far down to discussion I let's start with the remote work stuff. Will and you're gonna be speaking from a Peace Health standpoint. What percentage of the workforce? The overall workforce and then the IT workforce was remote?

Yeah. Yes, I am speaking from the peace health experience, even though I retired from there a month ago.

Shout out to my Peace Health peeps. I see you out there on the attendees list. Almost everybody in the IT division went from, went to work remotely during the pandemic and stayed working remotely. I think PeaceHealth was very progressive in the way they handled that transition, trying to make decisions that were best for the.

Caregivers as Peace Health calls, their calls, their employees. The only people were the field services teams. 50, one of the 350 people. So 15 to 20% stayed behind and the rest went to work remotely.

And I have a feeling we're gonna hear the similar kind of stats. Read. What about St. Luke's?

Yeah. We bucket our staff into a few, in three, three different categories. So remote meaning they're fully remote, doesn't mean they can't come on site. It just means that they do, they have hotel in cubicle. That's about 20% of our department. And I think that's probably fair for shared services as well, kind of broadly.

Then we have onsite, these are the folks that Will, was just talking about your field services, tech clinical engineering folks that have to be here to do their work. That's probably another 20% that fit that category. And then about 60% of our staff are hybrid, where they're in the office some days and remote other days.

Fantastic, Brad.

Yes. A very similar kind of pattern here as well. We've. We've went away from the term hybrid and just kind of went to flex and we started to offer like four tens. For some people sometimes it's a, in the office, out of the office type arrangement for certain days of the week.

For the, for those that have the options. So kind of excluding the boots on the ground, people that actually need to be at the elbow With caregivers, we probably have 75% of our staff taking advantages, some type of a flex

arrangement. That's fantastic. Couple things I overlooked. One is if you have any questions, you can go ahead and ask them in the chat.

I do want you guys to know that we've received 45 other questions with the registration form. So we're gonna integrate those questions into the discussion. As as we move along and, one of the questions right out of the shoot is this the new norm? Is this what we're gonna five years from now?

Do you project, this is what we're going to be this is what we're gonna experience this type of flex work or remote work being the norm. Does it have staying power? Will what are your thoughts?

Yeah, I really think so. And I think the only reason folks our questioning if things should go back are because they're holding onto old norms, they're holding onto real estate holdings and don't wanna, they wanna justify how to use those.

So, I, but I just think this is the superior model and I think it's the cost of doing business. You're not gonna be able to recruit talent. Yeah.

You called me out on social media for something I said on that, so I appreciate that. But why so let's go into the why. Brad, why? Why does this have staying power?

Cause I think we're all gonna agree that some form of what we have right now is gonna be what we're doing. So why? Why is this a better model and why should we continue on this model?

I think just with the talent shortages, providing flexibility is just gonna give you access to a broader pool of talent.

And so I think that definitely is going to be a component of why it sticks. And I think just the new talent that's coming outta school and that early in their career generation, that is a high value. A high value thing for them to be able to provide that flexibility and capability if they're starting a new family or just wanting to have more flexibility in the location they work, whatever it is.

So providing some of those non-traditional benefits I think is really just gonna be key for making sure that we can attract the right talent and keep the talent that we already have.

Reid any why will you guys keep doing it?

Yeah. I think, early on, three years ago now, when we started to really think about this differently than we ever had before, we intentionally decided to like, avoid extreme kind of views out of the gate.

So on one end, the A view might be, Hey, this is awesome. Let's sell our buildings. Let's cancel our leases. Everybody go home. Work where you want. The other end is, I don't think this is gonna work. Let's four or five days in the office, maybe we'll allow some flex kind of time away. I think both of those approaches are problematic.

So if you set those aside, that still leaves you with a pretty meaty bell curve area to operate within. And we found a lot of value just in recognizing early on, like we're not quite sure what this needs to look like or will look like, but we're committed to having open dialogue to learning, to adapting as we go.

And that's that service very well. I remember early on I had an employee came to me with tears in her eyes and she said, this is. This flexibility. I like that word. Brad has been so helpful because this was the time when schools had shut down. Distance learning was there. She said, I'm a single mom and if I didn't have this ability to work remote, I don't have family in the area.

I don't know what I would do. That experience has stayed with me and it's made me realize this flexibility can empower employees to have that work-life prioritization kind of ownership, and that's really important. That creates an engaged, productive workforce in our experience.

So permission to be the curmudgeon.

That's Cause we've all been in that room, right? We've been in that room with some people who are sitting there going, oh, this isn't gonna work. That kinda stuff. Because every organization has some of those at the table when you're having those conversations. So I'm gonna throw out some of the common things that we hear.

And don't hate me, I'm just, I'm playing a role right now. Hey, we're losing productivity. How do you address that challenge when somebody's in that leadership meeting and they say hey, we're just flat out, we're not getting as much stuff done as we used to get done. What's the argument back on that?

So we maybe have a little different scenario. Cuz we've got our staff and our staff was prior to pandemic spread across a really large geography. So we didn't have a lot of the teams that the whole team was in one location. So they were used to working in. This remote environment, even if they were in the office, they were just in different offices.

So some of those communication styles and communication patterns and our collaboration methods and those types of things had already been tried and true. So it, it doesn't feel that different from when we were doing it, whether they're sitting, at home or in a share office or. Somebody's actually coming into the office and the flow of work just really hasn't changed that much.

So that's what we kind of lean back on, is the same type of work is still getting done. We're actually seeing some more protected time in terms of some heads downtime, but it's very norm that we've been supporting the, we've got 47 different hospitals across a wide footprint and we've just got 'em spread out anyway.


Other thoughts from the two of you,

Reid? I was gonna say, I think when that, when I get asked that question or someone kind of leads with that that premise, I kind of try and understand, well, how are you measuring productivity? Like, let me understand the data that you're looking at that's kind of leading you to this conclusion.

And what I find is oftentimes it's anecdotal kind of reaction. It's not based on data. And if it is, sometimes it's based on maybe the wrong measurements. Productivity is not how long you're online. The amount of time that you're spending potentially working, it really is like, what's the output that you're providing?

And we've seen that there's been, there hasn't been a decline in productivity and in a lot of areas we've actually seen an improvement in productivity with this approach.

It does force you to make sure you have systems to be able to bring visibility into the work that's being done. And you can't manage by looking over someone's shoulder.

And I would argue that was never a good way to manage, to begin with, and so now you're managing by looking at the, as Reid said, the output. And you gotta have good tools to see what those outputs are. Be it closed tickets or project progress in the project throughput. But you gotta have those systems in place.

Yeah. So what about aren't there people that can't work from home? Like, it just doesn't work. They don't have the bandwidth. They, their home isn't situated in a place that they could do that. They have distractions in the home. Doesn't that exist? I mean, w won't you hear that argument as well?

We have to accommodate those people, especially if they, have been working on site to begin with. People don't have good working conditions at home. Don't even have the space, don't have the bandwidth. And I think all of us have programs that are accommodating, especially since we already have the space available.

Yeah, and that's actually, that was one of the questions down here. It's like if you're gonna put people outta their homes, are there. Are there minimums? Like do you have to have a, do you require a certain amount of bandwidth? Do you require a certain work area for them, a privacy area, and those kinds of things?

Is that something that your programs put together? I'm not calling on you and I know this makes it very difficult cause you don't want to jump in. Feel free to jump in. No, happy

to jump in. So we have, we put together just a really simple remote and kind of flex worker playbook to follow and it gives guidance along all those things.

Like, you need to have a. A quiet place to work, a place kind of reserved for your working environment. It can't be in the middle of your living room with your family kind of around there as well. You have to have adequate bandwidth to be able to meet the needs of your job. There's video conference etiquette, that we documented as well.

So all those things are important to define going into it so that expectation is understood by the employee that it's, it really is a privilege to kind of have this flex work agreement. And here's the requirements to fully embrace that privilege.

Yeah, and I, I saw the question they asked if there are specific requirements and my experience is that people will say, no, I don't have a good working condition before you have to go and say, sorry you didn't meet this specific requirement.


I think the other things we will hear from We'll hear from people. I, we will hear about productivity, we'll hear about the work environment, we'll hear about culture, and we will hear about the serendipity. We hear this from Apple and whatnot and from other people. And actually, so culture I want to get your comments on culture, and I'm gonna call on all three of you.

I'll give you several topics. The culture serendipity that chance meeting with somebody where you come up with new ideas. And then I think the other one is Jamie Diamond with with JP Morgan Chase. He had two comments. One, which I think is irrelevant for us, which is essentially if JP Morgan Chase's employees don't come back to New York City, a whole bunch of businesses are gonna go bankrupt, dry cleaners, restaurants and so forth and so on.

And he might be right, they employ a lot of people. But the other thing he said is, We have apprentice type programs that are really hard to do without being elbow to elbow. And we really want to reinstate those apprentice programs where people learn at the elbow. So, so any one of those three topics, culture, serendipity new employees, onboarding them, getting them to be a part of the program.

Brad, I'll start with you. Any of those three topics. I'll just

lightly touch on each of 'em. From a culture standpoint, like I said, we kind of had that environment anyway, so it really hasn't changed our approach for how we onboard team members and those types of things. The serendipity piece, what's interesting is some of the groups.

That I wouldn't have expected from. So network engineering, for example, they self-organized on a day that they want to come into the office because they started realizing that the stuff that they would hear over the shoulder on somebody troubleshooting whatever, just they're learning was kind of missing.

So they've self-organized some of that and it's because of those little encounters during the day or things that you would hear. Around your desk or, at the water cooler. It's, that's definitely missing. And I think people are starting to acknowledge that on their own without us having to force it, like from a leadership standpoint of, Hey, every Tuesday we're gonna be in the office.

Which there's good reasons for doing that for some teams, but there's definitely that self-learning side of it. And then we've started to incorporate some of these questions just within our regular one-on-ones and annual reviews and those types of things. And if somebody has. A desire for a particular career path.

Some of those do benefit from having some more face-to-face interactions, maybe getting in front of the different operational leaders and building some of those relationships. And we do say that in those situations, you're probably gonna get some benefit from being in the office more frequently and making those connections more intentional rather than just sitting on a video call with your video off and never really interacting with people in a deeper, more relationship building way.

Yeah. You see that? Will, what are your thoughts?

Yeah, the serendipity thing, this notion that if we randomly talk to people, something good's gonna happen just doesn't hold water for me. I think talk about bad productivity, being cornered in the 15 minute discussions about trivial issues at the copier machine.

I find that when I work remote that the. Conversations I have are intentional conversations. The meetings I have are intentional meetings. And yet, in teams land people can still knock on the door and come in and ask questions virtually, and so there's nothing lost there as well.

So, I don't think that serendipity notion holds water for me. I would also say that, the team that I work with at Peace Health and I get. Little no, no credit. They recognized right away how important managing the culture was, and they took action to have game nights, to have retirement parties, birthday parties, 8:00 AM huddle for all the managers, and so they were looking at ways to interact and to engage, not only to get work done, but to show appreciation for each other and enjoy each other's company.

Yeah. That's exceptional. And you're, you guys are sort of communicating that you hired professionals, they know how to function in person and not in person now.

Like they're, they act accordingly. Read any additional,

Yeah, I would say like for me, like serendipity is synonymous with relationships and what we've observed is when we went to this kind of flex work and a lot more folks working remote, we observed that individual teams actually knit together even more closely.

They started doing daily kind of huddles on Microsoft teams, and even though they'd sat by each other previously, Those huddles served to intentionally like group them together. They would see like signs of a personality in the background, a pet, a picture on the wall, and it really forged tighter relationships.

But we saw a potential downside was that inter-team dynamics potentially became more transactional. So because they weren't together like face-to-face or in person as much, it was no longer like Scott on the cybersecurity team. It was just cyber team. And so we've thought through, well, how do we still acknowledge the employee's preference to have this autonomy, but recognize that there's great value in that in-person interaction because it forges relationships that.

It's hard to measure the value, but there absolutely is value in those interpersonal relationships that we develop at work. And so we held a last year we held a May the fourth barbecue and it was optional, but we had a few hundred people show up and it was. It was fun because there were people that hadn't seen each other in person for like almost two years to that point.

And so you heard things like, like, dude, you got old, or just like people saw, like people had changed in those two years. And so from that we've really been talking about how do we create this kind of a of a poll. Influence where people aren't feeling pushed to come into the office, but we're doing things to attract them.

So they come in do the work they could do at home, but also then get that uplift of creating some of those relationships that they, you maybe can't. Forge as organically as you can when you're just in person. So I think there's a balance there, but I think that's really real really important to the culture.

And it works for us because 98% of our staff live within 30 minutes of two of our main offices. If we were spread out across multiple states in the entire country, Then I think it's a different kind of flavor, so it's very relative, but for us, that works nicely.

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now, back to the show.  

Well, about 65% of our questions were on staffing shortages.

So we're gonna, we're gonna split the time, roughly a, across that I will say this, that from my perspective managers become. Even more important than they were, and they were important before, but your direct supervisor is so critical in terms of communication, in terms of connection, in terms of direction.

I mean, all those things become just absolutely critical. And then this, the second thing is hiring people specifically. With the understanding that they're gonna work remotely and looking for the right skills isn't the right word, the right temperament, the right person and just understanding that.

I process things auditory. That's why I do a podcast, right? That's why I do webinars. I talk to people. That's how I process things, and we'll just talk things out. Well, being in this office, there's no one for me to talk to unless I get in front of them and so, there's skills that you have to develop and know and understand, and we have to look for people who can operate in this environment and operate well.

So I really appreciate what you guys are saying and I'm not completely a curmudgeon on this. I. Although I will miss a lot of the aspects, I won't miss people being in one office and then two offices down, being on a teams call when you know it's just silly. I mean, and they fought a commute to get there, and now they're doing the same thing they would do if they just stayed home and didn't have a half hour commute.

So, let's talk clinical staffing shortages specifically. This is this is a, an acute issue, maybe not as acute as it was nine months ago, but still very acute from the conversations that that I've been having with with, we just had a C M I O meeting. And it's still obviously we have a higher cost burnout and just a lot of things associated with this.

What I'd like to do with with with, let me think the best way to get this started is how are you see is the I'd like to get a feel for if the clinical staff shortages. Is a national issue or if it's geographically based, are you all facing some aspect of a clinical staffing shortage at this point?

Brad what is, what does it feel like where you're at? Yeah.

I think it's national, if not worldwide. Because even the trend for everybody doing international nurses and those types of things at some point that pool is going to. Continue to just get tighter in terms of who's available and those types of things.

In rural, we've kind of always had a tough time, attracting talent, especially when you get into some of the physicians and specialties to some of these more remote locations just because of the lifestyle and the location and those types of things. And then you just add the overall shortage from a national standpoint, it does make it really tough.

Reid, are you experiencing the same thing?

Yeah, it's, we have a, certainly a higher number of travelers than we did kind of pre pandemic, but I'll share with you just a little antidote from yesterday that's kind of helping me think about this differently. I was talking to one of our CNOs and I said something like, Reid, I know that you know your nurses, like, they're fatigued, they're stressed.

Like we're trying to, we want to come and help reduce friction. And she kind of cut me off and she said, She's like, this is a hard profession. And we all knew that coming into it. Like, we didn't do this because we thought it was gonna be an easy way to make a living. And yes, like there, there's fatigue, but she's like, I round and when I talk to my nurses, like they're engaged and they feel fulfilled in their work.

And there's almost a sense of, the more we talk about being fatigued and stressed, the more we kind of feel fatigued and stressed. She said The best thing that we can do to help nurses. Is don't come and say, Hey, we're gonna help solve your friction. Like come meet with us and say, Hey, help us design the right technology solutions, the right workflows.

Like what do you think is going to make this better? Because clearly they're spending too much time documenting in the ehr. There's manual repetition things you're doing that we can automate, but they don't. They don't wanna be rescued. They wanna have a seat at the table to design. A more optimal workflow, and that sounds super obvious as I'm saying it, but it was really kind of a paradigm shift for me mentally.

That was really helpful.

I want to come back to that, but will, I wanna give you an opportunity to talk about how the nurse staffing shortage is being experienced in Oregon.

Yeah. It's a significant issue in the Pacific Northwest as well. Anything that requires a RN degree is challenge, well, it's not just the bedside nurses, but, risk or clinical documentation specialists.

All those folks are heart

recruit. It's interesting. Reid, you just brought up something that's interesting to me cuz I, I was talking to somebody about about the EHR build and the optimization work and that kind of stuff, and I don't know how it happened, but somebody was sort of communicating to me that the nurses.

Weren't at the build table. The physicians were at the build table, but the nurses weren't necessarily at the build table. And because of that's a lot of the cleanup that we have to do. Now I'm not gonna, I'm not even sure I want to call on any of you, cuz I don't want to call you out on it.

But I've heard it more than once. I mean of just, They just didn't have as prominent a seat at the table as the clinicians and therefore the systems was kind of clunky for them when it first rolled out. Re Reid, I guess I'll come back to you.

I think that is a directionally accurate statement that we all probably experienced to some degree.

And in our case, like our nurses. That's the clinical group that's in the EHR the most. And so we really need to figure out how do we minimize that friction that they experience today by having to spend an hour after shift to try and catch up on documentation. It's those kind of things, but again, like learning from the past and including them in that design this time, not thinking that we know how to best design for them.

Well, what's the best thing you've heard? I'm gonna go to all three of you. What's the best thing you've heard to minimize the. The time to give them time back in their day to maybe minimize the the mundane tasks that they're doing. What's the best thing that you've heard of so far, or that you've either heard of or that you've implemented?

Brad will go to you.

Yeah, I think there's some fundamental things that are happening just with the digital experience space to where as we're looking at, let's say the pre-registration process in doing that digitally and not requiring that front office assistant to go through all the paperwork and those types of things.

There's things like that I think are just naturally gonna come as we modernize and put more digital effort towards a lot of these workflows. They're just gonna make 'em better and we'd have an opportunity then to reconstruct and make 'em more efficient, more effective. And those types of things.

I, I'm not sure that. The most effective place is to try to go back and squeeze more juice outta the EMR in a different way. I mean, there's obviously optimizations that need to happen there. But I think the things that are gonna benefit both the patient experience as well as our clinician and caregiver experience I do think that those are gonna come with the digital transformation pieces that we're doing.

Will what's the best thing you've heard to really. Improve the the experience and the efficiency of the nurses at this point?

Yeah. Historically when we stopped cutting strips off of monitors and taping them into records back when we had the paper records, that was good.

If you wanna go way back, I think, If we're looking for ideas, a, I think e h r governance structure that scrutinizes every new piece of information that somebody wants collected. There needs to be somebody thinking through is this additional effort worth all the extra work.

And because the e h R has gotten to the point of where it is, it's much time as it take, as a cumbersome it is through a thousand paper cuts, right? It's not because. Epic designed it that way. It's because, this group of people wanted to collect this data, these group of people wanted to improve billing in this way.

And it, you have to look at that and scrutinize it and make sure we're not just collecting information because somebody had a good idea or thought it was a good idea six months ago and nobody's ever looked at the data.

Yeah. It's it's amazing how many initiatives kick off work downstream that we don't.

We don't think about until it's actually being done and they're like, are you kidding me? You just added and it doesn't, it, it accumulates, right? You just added two minutes per patient. I see this many patients, you just added 60 minutes to my day, and you're like, really? It's only this little piece of information.

But there's 50 of those, right? That they have to collect that information. Reid from a nurse standpoint what are some of the things you guys are looking at?

Yeah, I'll just, I'll share three from like more sophisticated to more mundane, and I totally agree with Brad I. There's limited value in like a complete rebuild of the EHR for nursing.

I think your natural ongoing optimizations will yield benefit, but a complete overhaul, I think the juice just is not worth that squeeze. So then you look at, well, what are the things that we can do to automate, augment around the nurses? So I think AI presents a really compelling use case to look at, whether it's kind of site-based AI capabilities, but looking at what the nurse does.

And then learning what that action is and then automating that into the ehr. So the nurse then just has to verify or validate what they did versus all the steps to actually document what they did. We can start to do that. So we have a pilot to really prove that out. We have a virtual RN program where our virtual care center can do admin discharge thing for patients, which is a huge time saver for the nurse on the floor, and is a great patient experience because the patient's not waiting then for the nurse to have time to get there.

They got someone that can remotely connect with them and get them in and out more quickly. And then, this is a simple one that we observed just doing a rounding visit. We were talking to our nurses about we have MyChart bedside coming out and the chance for patients to order meals through that, and the nurse at the tail unit said most of my patients aren't going to be able to navigate that on their own.

And in fact, today one of my big friction points is I have to order for them. I have to call the food services, and oftentimes I have to wait on hold upwards of 30 to 45 minutes. So I'm carrying this phone around as I'm working, waiting for someone to answer and then place the order. Well, that's an easy thing to solve.

Like we can figure out some digital way for the nurse to be able to submit that order on her phone or on some other mechanism. So there's just, it's a target rich environment. There's a lot of little things we can do that'll add up to a huge cumulative benefit for that nursing friction that exists


I'm looking at all, all the questions that are coming in. Let me hit some of the questions that we received. Just, I'll go rapid fire here. How do we not leave behind the older population or those without access to technology when systems start to focus more of their outreach digitally and encourage remote care?

I think we all have remote care initiatives. Brad, I'm gonna come to you on this one. Because you're really remote. So, how do we make sure that nobody gets left behind in this push to to digital solutions for remote care?

Yeah, we, so we've had this debate internal a little bit is how much are we really gonna be able to influence digital literacy within our patient population?

And there's things that we can do to make it easier. And I think that's really where we need to focus our efforts is looking at the solutions that we do offer remotely. And are we making 'em just really intuitive and really focused on something that's gonna. Be easy for them to be able to use.

And I think, through, through Covid the virtual visits and things that we did to put in place for remote patient monitoring were, they were easy to deploy because they were fairly simple and not overly integrated and sophisticated. And. I think that's something we need to be paying attention to as we roll forward with, hospital at home and all of those types of things that are gonna be pushing more of this care towards our patients from a technology standpoint and the training mechanisms, the support mechanisms and making it easy to use and having really that product management mindset to where you're really paying attention to their full end-to-end journey.

And not just a particular spot solution in that journey, I think is gonna be really important for the long term literacy and effectiveness of a lot of those remote technologies.

Well, this is one of the areas that I'm really bullish on and kind of excited about every time I go to HIMSS. Or ViVE I'll see a new set of devices that are designed for the home that are so simple.

I mean, and they just keep thinking about it from the consumers around this specific problem. Like, we're gonna put this in Bill Russell's home and he has to take his own blood pressure. How do we make this as simple as possible? And I have one of those devices here. And it's like you press a, you put it on by the picture, you press a button and it takes the blood pressure and oh, by the way, connects up to the internet and it sends that over.

And it doesn't have to be a high speed internet connection in order to send telemetry data back. That's not, it's not a lot of data, quite frankly, to get back and forth. So I think there's a, an awful lot of things that can be done with low bandwidth. And some of these really cool advancements that are being made and primarily, I mean, the devices aren't changing primarily around the usability of those devices and the simplicity that is being introduced around those devices.

Reid, here's a question for you. What is the best way to approach the naysayers to leveraging technology like computer vision?

Well, it's funny you asked that because we're going through that, and I wouldn't even say naysayers, maybe just like cautious skeptics. And so I think it's, you really have to not lead with a technology.

So we're doing a pilot with Artisight, and so it can't be about like deploying Artisight. It has to be about, Hey, we, we hear you. We've rounded, we understand the friction that you experience in your workflow. There is. There's technology that has emerged that's viable, that's proven that we think can help in this area.

And then like seeing is believing. And so then not just having them sit in meetings with us to kind of talk through it, but pulling in others that have done it. Maybe go do a site visit where this is actually live. We took our c n E down to look at a lab where this was live to let her see it kind of, hands on experience.

And that was invaluable because now she comes back and she's an advocate for. This is something that, that we need to pursue. Not for the technology, but for the experience for everyone involved, the caregiver, the patient, all the support staff around it. It's this uplift that everyone benefits from.


Yeah. Getting those champions and will, here's a question that's I mean you mentioned governance before. What role can simplification of the health system's application portfolio play in streamlining staff? And reducing fatigue. I'm curious what your approach to that is or has been.

Sure. Well, I have passion around this topic, and I don't think most of us are doing enough or managing that portfolio of applications. I think I, we need to be careful though to assume that just because we have fewer. Applications will have less work to do. The staffing ratios aren't gonna change.

So, and I think largely what we're seeing is people that are very aggressive at reducing the number of applications, either because they're going getting rid of niche applications, going to platforms, or because they have differences across organizational units and they're standardizing on one all that great and hard work is counter.

Balanced by more stuff coming in, new technologies like Reid just talked about. So at best you're trying to stay even.

Yeah, it's it's, it. I think we kicked off an application rationalization project. I was talking about this yesterday. We kicked off an application rationalization project when I was cio.

And after six months, we had increased the number of applications because we found them. Like we didn't even know how many we had. It's I'm sorry. It is a laugh or cry situation. I do want to talk about the travel travel nursing challenge. Cuz there's quite a few questions about it.

How do you stem the tide of travel nursing? Is it negatively impacting the health system? Finances? Or it is negatively impacting finances all over the us And there's several kinds of those questions. And it's, I'm curious, I'm talking to three CIOs. I'm curious if is this is this a technology or is this a supply chain?

Is it a negotiation? Is it a human ca I mean, what, I mean, I assume you're exploring all sorts of solutions to this. Not just the technology solution. Reid, we'll start with you. I mean, how do, we're getting pulled into this conversation. What's our role as CIOs? Yeah.

And it's a multifaceted problem, right?

There's not like a solution for it. So on one, one part of the Rubiks cube is, We need to graduate more nurses, so our local nursing school can only graduate so many, and there's like legislator, like controls that govern that. And so we're working then with the state legislator to figure out how do we increase the pipeline of nurses that come out of our local nursing schools.

So that's one. The other thing is we're gonna have travelers here. We've always had travelers. We certainly wanna try and reduce that number because they're expensive. But our census is still incredibly high. So we have the need for the caregivers, so we need to make sure then that those high cost resources are doing the highest value work that their licensure allows.

And so one of the things that we're pursuing is today we have a one-to-one sitter kind of approach. And so we're piloting a virtual safety attendant, a virtual sitter program, because we have data to show, there's been times when, because no one's available. We have a sitter or we have a a traveler is assigned the role of a sitter.

I mean, that's a hugely expensive resource to do a lower value level of expertise kind of role. And so the ability then to have our virtual care center virtually monitor probably in a one to 12 ratio, a sitter kind of capability, well, that can then help us reduce the need for travelers and other staff and get them.

Potentially focus on higher value work. So it's just exploring all of those kind of opportunities to figure out how do we maximize the resources we have, and then draw down the higher spend resources and certainly don't have them allocated to lower clinical value kind of work in relation to their licensure.

Brad what how are you guys addressing this


Yeah. In very similar ways. So we've taken the opportunities with like the virtual sitters and are exploring some things. Understand, I think probably everybody's taking a look at Artisight and figuring out where there are opportunities to maybe change the way that the nurses need to interact and make them more efficient.

And figure out what you can. Say offload, but shift the work to those that maybe don't require that level of credentialing or whatever. So I, I think everybody's kind of doing that same thing. I don't know that I've got a bunch of unique stuff that we're doing beyond what Reid just went through.

Will any, anything to add in this?

No, just we as an industry lost our minds, a year ago. And I think some of this is self-correcting. We're not gonna pay $200 an hour for travelers anymore.

We'll get back to our show in just a minute. I am excited about our webinars this year. They have been going very well. What I've done is I've gone out and talked to people in the community and said, what works in webinars?

And they came back and said, look, this is what we want. We want a webinar that is not product centric. It's really focused in on the problems of health care. And we want people on there that are actually solving those problems. And so we have done that. And the response has been fantastic this year. We have another webinar coming up.

It is the future of care spaces. Where care is being delivered is changing rapidly. Even the care spaces within the hospital themselves are changing. Technology is being added in different types of technology. A. I obviously computer vision and whatnot is changing that modality as well as what's going on in the home and whatnot.

So we're gonna have that webinar June 8th at one p. m. Easter time. We usually have it on the first Thursday. Happens to be a little too close to my anniversary. So we're going to do June 8th at 1 p. m. Eastern time future of care spaces. We would love to have you be a part of it. If you are interested in being there, go ahead and hit our website.

Top right hand corner. We have a card. You can click on that card and go ahead and fill out the form and get registered today. We would love to have you join us we look forward to seeing you there. Now back to our show.

Yeah, so let's talk about some of the technology. Cuz when they come to the cio they're generally looking at you saying, look how can we free up hours?

How can we make sure that people are practicing at the top of their license? And invariably what I hear, In this conversation is ai ambient clinical listening computer vision, and we've heard some of that already today. I hear rpa. And those kind of things. What specific technology solutions have you seen yield some benefit?

Not that technology can solve this problem in and of itself. I don't want anyone to hear that, but I'm just, I'm curious if we've put forward any solutions or if we are, if we're, or if we're sort of just on the beginning of this journey of trying to figure this out. Reid, I'm gonna come to you again.


Yeah, no, you're fine. And maybe I'll answer it two ways. One is we've talked a lot about, staffing impact around clinical roles, but we see that in others as well. So food nutrition services, e v s, those have been really challenging roles for us to fill because the labor competition is so much higher.

And in some cases they can go get another job that's a higher dollar, an hour amount. And so we've had a lot of turnover there. And so we've looked at what are ways that we can reduce that reliance on the human labor. And so some simple things that we've invested in small scale that have proved out that we're now gonna expand robotic floor scrubbers vacuums that are kind of robot powered.

That have penciled out to actually reduce the FTE needed. And so that's been a really simple way to try and chip away at that challenge in that space. And then I think that, It's just, it's what you said. Some of this is still, it's emerging for us and so we're trying things, but our learning as we go, like rpa, we're certainly doing things in that space and we're really trying to validate assumption we've made and really trying to calculate the hard ROI to then justify additional investment in that space.

To switch it up just a little bit, will I'll come to you. Technology solutions. That have alleviated some of the hours and some of the burden.

Yeah. I think they've been. Relatively far and few between, especially given how much we've invested in information technology.

But I do feel like we're on a precipice here of seeing an acceleration of these technologies. It reminds me, at the beginning of my career, we talked about. Electronic health records and getting rid of paper records, and it seemed like forever, it was five years away and then all of a sudden, boom.

And partly I think because of the ma I'm sorry, meaningful use it just happened very quickly. All of a sudden I feel like we're. On the verge of seeing that through ai, robotics automation having a real impact on the amount of labor it takes to run a health system. And, if you look into the future every single f d e is an opportunity to bring artificial intelligence and some sort of automation to reduce that.

Soon it'll be just the cio. I used to read articles that in the future we won't have CIOs. Now I believe the CIO will be the last person left managing all the automation.

Chat cio, you haven't heard of this yet. There you go. Just ask it. Any question, you'll get an answer. Brad, I'd love for you to bring this home and then I'm just gonna rapid fire, start going through some of the questions we've been asked and we'll just do a real quick round of questions.

Technology a approaching this issue.

Yeah. So I'll I'll use an example. So I think everybody at least everybody that's on Epic is challenged with this new volume of work that's coming through MyChart messaging, for example. And there's just, there's a need for that to be looked at, and it looks like it's an area that is ripe for automation.

Let's screen and triage them and possibly auto respond with some bots and different things like that. And you apply ai, the promise for. Really impacting that amount of work, I think, is there, the acceptance of that and the trust factor from physicians on AI determining whether they should or shouldn't look at a particular message I think is gonna be a little bit of a barrier for adoption.

And we're seeing AI in those non-clinical spaces, I think get adopted in a quicker fashion than we are in clinical because we haven't done. I think it's because we haven't done our homework with those caregivers to explain to them why they should trust ai. How do mo, how does modeling work? How do they know if that model is relevant and in the population that was trained, comparative to the patient that's sitting in front of 'em, so that AI literacy and demystifying what AI and ML and what some of these technologies are, I think can help accelerate the adoption of some of those things that really could impact.

The amount of work that's on on that workforce.

Yeah. Transparency's. So key will Yeah.

You know that, and that reminds me too, that most of our workflows were established in the era of paper records. And there's a real opportunity here for us to rethink things and create more specialist positions.

Working remotely, covering large geographies to do very specialized work. Maybe it's something in the inbox where I am the refill person and I can manage refills for every physician in a 500 physician group because that's my specialty. As opposed to relying on the care team in the specific place that's trying to do 15 different things at once.

Yeah. I love that concept. I remember hearing a specialist talk about his use of telehealth, and he was using telehealth to go room to room. He used to go to each hospital, go room to room, and he started using telehealth for that specific purpose. And there was telehealth in the patient rooms.

And essentially he said, I freed up almost a full day a week of my time, so I didn't have to go from hospital to hospital. I didn't have to go from room to room and whatnot. I could do those things. I could document in a way you went. It was, it's a good example of rethinking how we practice medicine in the digital age and in some cases we haven't really rethought it right.

Interesting. I did notice that some health systems are starting to charge four messages to physicians. Any of you adopted that, that model yet? No. No. Yeah, and it's not a lot just, I don't want people to get the impression that every message that comes across is there's, the cash registers going, it's, they look at it based on the amount of work it generates.

So if, they saw the doctor a month ago for something and they're coming in with something completely different. And asking, detailed questions, they're essentially saying there's a charge associated with that, but it has, in the studies that they've done, it's cut down the number of messages that have come in, but then it's a question of quality and access that we're worried about.

All right. Let's hit some questions. Would love to hear more about nursing caregiver counsels that Reid mentioned. Have these councils evolved over the over as staffing challenges have become more impactful, how is the feedback loop becoming more integrated to the IT organization?

Yeah, it's still it's evolving.

So these councils have existed for a few years now, and just in the last year we've really become aware of them and how to interact with them. But each unit has a nursing care council, and it's made up of a few nurses within that unit who then help to. Influence culture, be a feedback loop from the floor to the a and m and the leaders.

And then we found that's a great modality for us to plug into, to listen and understand the concerns they have. And also maybe understand friction points that they don't even realize are friction points. They just have become so accustomed to doing it a certain way. They can't imagine any other way.

And so we've had some great breakthroughs of just kind of highlighting, Hey, this kind of four step process, we think we can help you do this in one, and now that we've got this council, let's sit down together and actually design this. So it's just simple open collaboration and conversation that forges relationships and a trusted partnership more than this transactional interaction that existed in the past.

Fantastic. Next question. What new activities are leaders implementing to increase staff engagement? Will,

Yeah, I think I covered a little bit of this. I think it's important that you have lots of Fun meetings and you have lots of meetings that communicate from the top all the way through the team that, or the division that you lead.

So we had a monthly town hall. We did that even before the remote work and became much more important afterwards just to make sure we all understood what has changed in the last month. What's our primary focus? What is it that we're trying to get done?

Cool. For large upgrades or implementations, do you think it is effective for teams to continue to operate in largely remote work environments?

Did any of you do a major upgrade or a major implementation with remote workforce?

So we're part of the Epic Connect program and we just did an implementation of bringing somebody onto that. There was a fairly sizable system. Within the last six months or so, and we did a lot of bring people back on site staff, some of the command centers and those types of things physically so that you'd had a little bit different.

High bandwidth communication between people and still did a lot of that implementation onsite. Now we've got the same thing happening with the Workday implementation. We're doing all of that remote, so I, we're seeing both flavors of it and just kind of, looking at the particular project or implementation and I don't wanna say customizing, but assessing what the onsite needs are kind of per project.

I I have talked, I have done some interviews and talked to some people who've done full-blown epic implementations during the pandemic. So, clearly it can be done. It's it's just like everything else we're doing. It's a new muscle, it's a new set of processes and workflows that we just haven't.

Haven't had to do before, but we're seeing it low hanging fruit opportunities around automation. I'd like to hit each of you for one idea around automation. That's I don't know if it's low hanging fruit, but let's go with low hanging fruit, Reid. We'll start with you. Low hanging fruit for automation.

Yep. Like just democratize the process in your organization. Maybe start with your IT department. So, we launched a challenge in January cause we have this, team of 550 people. Smart. They have access to automation tools and capabilities. And some of 'em are doing things already. Well, let's, maybe let's identify some challenges that we can tackle together and then learn as we go.

And then how would we like market this and scale this kind of more system wide? But just like leverage the expertise you already have and the automation that's probably already occurring that you're maybe not aware of and build from there.

Brad, low hanging automation. We've

actually seen some benefit by giving RPA into our HR recruiting world.

There's quite a few processes that we're fairly manual but it's just the same thing for every applicant that comes through the door. So, we've seen some quick wins there.

And Will, what about you?

How about test automation? We'll make it use automation just like operations?


Testing remote or process automation for testing? Let's see. It is 1 57. I'm trying to think if there's another question to get through here. No, I think we're, I think we're gonna be done. Gentlemen, I really do appreciate you filling in. Tricia, Julian appreciates you stepping in, as does Andy Crowder.

We. I appreciate you guys doing it last minute, and will we really appreciate you coming in from London? Yeah, live from London coming in. What time is it in London by the way?

It's seven o'clock, so I'm gonna go get some dinner now.

All right, sounds good. We're gonna let, we're gonna let will go to dinner in London and I really appreciate you guys being a part of this and thanks to everybody who came in and gave us these great questions. Really appreciate it. Thank you.

Have a good day.


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