This Week Health
Sue Schade

February 7, 2022: Clearly care has shifted and telehealth and virtual care is here to stay. How do we continue to make it work? Sue Schade from StarBridge Advisors joins Bill for the news. CHIME released a letter about facilitating a pathway to comprehensive permanent telehealth reform. Mayo Clinic’s hospital-at-home strategies freed up 3,300 beds. Over the past two years, healthcare organizations faced significant challenges. What are the top 7 challenges that IT leaders will face in 2022? And what does World Wide Technology predict for healthcare in 2022?

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Key Points:

00:00:00 - Intro

00:15:15 - Mayo’s important shift to hospital-at-home will free up beds for seriously high acute patients who don't have an alternative

00:25:05 - The number two challenge for IT leadership is skill set mismatch

Sue Schade blog

StarBridge Advisors

Stories: 

Transcript

Today on This Week in Health IT.

As much as I may complain about various health issues that I've been dealing with and needing to interact with the health systems, it's great to be on the other side and seeing how it works as a consumer. Everybody's making progress. No question about it.

It's Newsday. My name is bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week in Health IT. A channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH and Cedars-Sinai Accelerator, who are our Newsday show sponsors for investing in our mission to develop the next generation of health leaders.

All right. Today it is news day and we are joined by Sue Schade, Principal at StarBridge Advisors. Sue, welcome back to the show.

Thank you. Good to see you and all the best in 22.

've changed your wardrobe for:

Thanks. How about 22 for blue.

Blue in 22. I'm going to hold you to that. Hey, before we get going, are you going to any of the conferences we've got, I don't know how to pronounce it. It's V I VE. I call it ViVE too and then somebody yesterday said something different. I'm like, if somebody could call and I've heard Russ call it ViVE, so I've got to believe it's ViVE. So we have ViVE and we have H IMSS. Are you going to either of those?

Yeah. I'm

not planning to this year. To attend either one of them. We'll see in the fall.

People are asking me what are you hearing from CI I would say people are going to the ViVW event if they're speaking, if they have some sort of role that they're participating in, that they're going to be a part of. Same thing on HIMSS side, by the way. They're both very good at inviting people into be participants. And so people have an obligation, they feel the need to go and they are going.

The ViVE event feels like it has more of a pool from the CIO perspective because it's partnered with CHIME. And so the people who want to see their peers or feel like they haven't seen their peers in a while, are tending towards that one in Miami versus the other one, which is in Orlando. This will be an interesting year because I think this will define what HIMSS looks like going forward. I don't really want to talk about this per se, but that's just what I'm hearing. I'm getting that question a lot of who do you think is going to show up at which. I think for the tech buyer, I think you're going to see more of a leaning towards the ViVE event and less towards the HIMSS event.

I am going to both because I am in this world where I have to see who's at both and talk to whoever's at both. So my daughter and I will be there. You can look for us and we will be doing our, our normal short 10 minutes interview.

No I don't have to attend because I can just count on everything that I'll see in the media, including listening to your recaps right. No seriously, I know you have to attend and your recaps are really helpful to everybody who was not attending these events. Like the JP Morgan recently.

I'll tell you having the conversation with Rob DeMichiei afterwards. So I have my thoughts and then I get in front of him. A seasoned CFO after I sort of say, this is what I saw in the financials.

And then he sort of says, yeah, I know that's what you saw. This is what this means. And it's great to be to be educated by somebody who has lived in that world. Plus, he was at UPMC, so big payer, big provider. So he has both both sides of it. It was really interesting. All right, we've got a ton of stories.

st,:slation for implementation in:

And they're asking for bipartisanship on this for a handful of reasons, and they close letter with those reasons, which are essentially this is a strong tool in our tool bag. It's also something that has high customer satisfaction scores, and they believe that it is also just important, especially coming through a pandemic to recognize the value of something like telehealth to be available in the case of an emergency.

Like we just went through. All right, so let's talk about this a little bit. Telehealth. I would assume so many health system scientists and whatnot. There's nothing in this letter that I look at and I go I have a problem with, I would assume you're pretty close to the same boat on this.

Right. Totally agree. And was really happy to see this. I am looking at it. What about Hospital Association?

Hospital Association is not on there. And I, do think that's an interesting one. I'm trying to think of why that would be. I'm sure they approached them. Yeah. I don't know. Maybe, when you talk to the providers, the actual people delivering care, they may still feel like there's work to do before they make this kind of recommendation. Although this recommendation doesn't indicate anything with regard to the actual telehealth technology or how it's integrated. The data flow or the usability. I mean, these three requests are pretty sound.

nt on asking for what through:

Two challenges with this. One is telehealth is everything from video visit to telephone call. And so we're essentially saying make it all work and that the challenge has always been how much fraud have we introduced. And I've done a couple of today's shows on the fraud that's been introduced for this.

It's not staggering. It's probably no more than exists in different practices and different things that are going on. But again, it, it does open it up for fraud. Especially you do a 10 minute phone call what's the record of that? What does it look like? There's definitely value to the to the patient to actually talk to a physician or a clinician of some kind.

And no, one's no, one's arguing that. So the fraud has always been the challenge. That's why we need the data and I really do see this being bipartisan. And this is one of those areas. I hope that becomes a foundation for, by bipartisan support of where healthcare could go. I also think, we have a clinical labor shortage and telehealth will probably be the answer to some of that in rural locations, in places where hospitals shut down. So this is. Yeah it's kinda funny. I sorta want to argue to just make this more interesting, but there's nothing.

There's nothing to argue. Yeah. Yeah. Can I give you a very concrete example if you want to make it a little bit more interesting? I'm a practitioner. I love to give examples. So I was supposed to go to my PCP yesterday for what I figured was I dunno, 10 minutes. And the requirement was that I get an H and P form filled out my blood pressure vitals prior to surgery in mid February. I'm I'm having cataract surgery. No big deal though. It stresses me out a little bit. And I'm thinking to myself, why do I need to drive over an hour to my PCP for that? Is there another way? No, it has to be the PCP. So on Friday I called the office to say, number one, we're going to have a huge snow storm. Number two it's really far.

And number three my husband's waiting on a PCR test. So I have to answer that question when I get there that I've been exposed to someone who is pending. PCR test. Turns out it was negative. So when I called them, they said, oh, we've already turned all of Monday into virtual because of the snowstorm and the expectation that people are going to have trouble getting here.

Great. That's what I want. So one takeaway from that call on Friday was it's just a given two years ago, that would have been the case. The snow storm would be turning and turning, and they'd be trying to figure out who can come in, who can't, what should we do? Cancel. Keep the clinic open, yada, yada, yada.

Now they can just go on Friday. Okay. Monday could still be really bad. Let's just turn them all into virtual. So check. Then I thought, okay, vitals, what am I got to do to take my vitals? Well, my husband has a blood pressure cuff because he's supposed to be taking his blood pressure on a regular basis. We have an oximeter that we got during COVID to check that if we needed to, and that does your pulse.

So I was like, I'm ready to go. When I got on the call, I had sent her, I had figured out how to electronically send her the form, the paper form that the cataract surgeon gave me to have my PCP fill out and we made it all work. And then she took the time to check in on me on all sorts of other things that we haven't talked about in awhile.

So I had a very positive virtual health experience. Comprehensive got my one thing done. I had my little devices here. So it's just come so far and it needs to continue. And that is not the high tech one in terms of virtual care. It was pretty straightforward.

uip you and your staff in the:

That's a bunch of our stories and I think this is going to be the trend that because we're going to our next story we're going to talk about is hospital at home strategies and whatnot, but I bought this crazy device, and I know I'm doing this video and audio with, I bought a Woop. That's literally the name of the thing. And so attracts a bunch of things. And I was talking to some, I was talking to somebody else who had it and essentially because it, it tracks so many aspects. What did it does? It has a, a higher level sensor than, than the Apple watch and whatnot. So it can do a bunch of things. And one of the people who had it, so they got a message that said, you may have COVID and sure enough, she did have COVID.

Because it was measuring a bunch of different devices in terms of their respiratory rate and sleep and a bunch of other things. And it said these are consistent with people who have COVID and it's those kinds of things that I think are gonna fundamentally change healthcare.

Okay. So I find my Woop says, Hey, you may have COVID what's the next obvious thing in the workflow? What'd you like to schedule an appointment to talk to a physician? Would you like a test sent to your home? Would you, I mean, there's so many obvious workflows that are being built out on this side, on the tech side that we could also really gravitate towards on the on the provider side, I think as well.

All right. Mayo clinic. Hospital at home strategies freed up 3,300 beds. Mayo clinic says. This is from Becker's hospital review. So short snippet from the NPR thing. So non life-threatening conditions can now be treated from the patient's home, allowing hospital beds to go to those in most need the strategy paid off from Mayo clinic. And now payers are interested in making hospital at home strategy commonplace. Did you actually hear the NPR report or just read this story?

I saw the becker story. I went to the link and saw some of the interview comments on the NPR story. I didn't listen. Couldn't find anything more about it in terms of the Mayo study. So I don't have more to offer on that, but I have to trust that it's accurate and it is significant. That's a shift. That's an important shift. You're freeing up beds right for seriously acute high acute patients that don't have alternatives.

Yeah. What was interesting is I was talking to a CIO and they had a problem in their market and the problem in their market was the long-term care facilities weren't taking any patients who had had COVID. These are patients that have been at the hospital, they're now ready for discharge, and they couldn't send them back to the long-term care facility. They, the longterm care facility was not owned by the hospital and the long-term care facility was not taking them. And the problem they had was they had turned their, essentially every space in the hospital into a ward of some kind and they have.

They literally had turned their lobby into a holding place for these patients that they can send anywhere. And one of the things they were exploring. Are there 10, we adopt these hospital at home strategies and send some of these recovering patients to their home with the same level of monitoring and, and those capabilities that you would normally find in a room.

And I've been in a hospital, I'm sure you've been in a hospital at some point. And there's like, there's those the day after the surgery and whatnot, where you're sort of sitting there and it's just observation and you're just like could this have been done in my home more than likely.

Can I go home? Can I go home?

And they they'd like to send you home. And if the technology is there, if the workflow is there, we can send people home. And I think that's, that's the hope here.

Yeah, absolutely. In reading the NPR interviews, there were patients to recovery at home. And in their own comfortable family setting they could get up and move around.

They're not confined to a hospital bed, just kind of describing anecdotally the benefits of a case that can be at home instead of in the hospital and the positives of it.

enges IT leaders will face in:

That is a great question. So competition for talent. The space that I'm in is at the senior leader level in terms of placing interims. We've got a number of interims right now. We're trying to place a CISO and a CTO as well.

That's hard positions to fill aren't they?

Oh, yeah. CISO in particular. In fact, I had a little bit of I don't know what I want to call it yesterday, so I'm still working on the CISO one. Let me just say that. They are very hard to fill. I think very high demands and people are still moving around a lot.

The great resignation I need to read up. Maybe you can enlighten me on the great resignation, like what the specific trends are. I mean, I see people at a certain age retiring maybe sooner than they had planned at this point. I see people kind of at all ages going I don't have to put up with

Maybe something I've been putting up with and I've got options and I can work somewhere else, remote for more money, et cetera, et cetera. There's a lot of movement. There's a lot of opportunities out there.

One thing that I see is an increase on LinkedIn, by leaders posting positions. And if you, if you just look at your newsfeed on LinkedIn, everybody is hiring and trying to find people and draw them in. Aaron Miri's got the picture of over the water in Florida. Like, okay, come work for this organization.

And we're doing all these fabulous things and oh, by the way, this is your view every night or something. Over the water. So getting creative, let's say in terms of the talent competition and certainly they need to, and they need to be flexible in terms of remote.

Yeah. Yeah. I've seen those posts from Aaron and I applaud him. I've also seen him from William Walters. He's on the space coast of Florida. They have a nice little friendly, match going o n. Do you want to work at, at this location? But the reality, the competition for talent is interesting to me. I talked to a CIO major health system which means over 10 billion, I think they're actually were 15 billion.

They have a 48 state hiring strategy now. They sold their IT building. They no longer have an IT space. They have sort of a, we work shared office space for people to go to. And you and I have talked about this before. I I'm looking for, I'm going to get to spend some time with him this week, actually this Thursday, and look forward to asking him about building culture. About retention.

Because the great thing about a 48 states strategy is you've just opened up your pool to a lot of, candidates. The downside is it's really hard to stay close to a 48 state strategy when you're connecting like this. There's a certain amount of distance that happens when I'm staring at a camera.

Even though I am looking at you from time to time, I have to make eye contact with the camera and all those things that go along with this. People get an offer, this, this part of what you were saying. People get an offer for more money, working at a different health system. And it's just different boxes of people that show up on their screen.

It really is almost like I work in virtual reality. If I don't have coffee with people, if I don't shake their hand, if I don't see them do I really work for that health system or am I just a cog in a wheel to keep the technology going for that health system. And so that's something that I get concerned about.

We get dinged by the way, whenever we have this conversation and they say, man, we could see you guys have a little bit of gray hair. Cause you're talking like old people, not like people who are adopting this virtual world and everybody should be remote. And I'm like, yeah. I just don't think that's thinking through all the ramifications of everybody going through remote.

Okay. Yeah, we do have gray hair. So we have been there for a while. And, and I tell ya if there's a generational thing about how can you manage people remotely, you have to be together. I don't subscribe to that at all. To me, it's about the human connection. Right. And building the culture and the teamwork and getting to know people and certainly in this virtual world, we'll can still do all those things.

It's harder. There is value to that connection. And I don't know what they're in, what the answer is. I'll tell you, I had my own kind of personal meltdown over the holidays. And I think that two years of what we have lived with in lacking that human connection kind of came crashing down on me.

And we can't deny that that's important. It's the human connection. It's building that culture and that is going to be hard. And it has been hard. Organizations are figuring on all sorts of ways to do it. I would say one other thing. I did have experience, I was at Ernst and Young for a year. Ernst and Young, obviously I'm dating myself right now, but any of those big consulting firms they're national and international.

So you didn't know everybody except the people that were in your office. Right? So I was in the Dallas practice. But I didn't know when people in Dallas practice cause they were out of clients. But as an organizational consultants, nationally and internationally, they would find ways for people to connect and to build that culture.

That's very different than if you are, let's say a health system in the name of part of the country and you have a 48 state strategy. You don't have offices and groups in every state, right. You have individual. Right. So I won't pretend that I have the answers on this because I haven't had to do this other than my work at Boston children's last year, where we were all remote all the time. And I met just a couple of my leaders in person.

Well, this is, this is a story. I tell people when they went and when we have this conversation, I'm like, look, I've moved a bunch of times. I've moved from the east coast to Missouri, from Missouri to California, from California to Florida, and then a couple other places.

And there's friends within the neighborhood. And we see those people and we have drinks with those people. We play cards with those people and we know, we interact with those people. And then there's friends we've had in that same, same thing. We had that same interaction with them with a different community in each one of those locations I'm talking about.

But now that I live in Florida, how many of those people do you think I have a close relationship with from California, Missouri and Bethlehem, Pennsylvania. But how many of those people do you think I still have a close relationship with? Only those that I'm really working hard to make sure I have a relationship with them.

Yes. But you know what? You have to work at it. But also now that we've just adapted these, I say Zoom, that's what we use, but whatever tool you use, I mean, I can sit down some Sunday night with a couple that was our best friends in Ann Arbor that we went to dinner with every month and say, let's just catch up. Right? I mean.

I agree. It is possible. And maybe this is me just needing to to adapt and change. So that's why I'm looking forward to having some of these conversations and we'll see where they go. Number two challenge for leadership for IT leadership is skillset mismatch. There's a belief that technology is moving very rapidly.

And I don't know that this, this skillset mismatch was probably on the same list for the last 10 years. Right? So at one point we had data centers full of computers and then virtualization had, we had to upskill all those people to understand a virtual world. Then we moved to the cloud and we had to upskill everybody to figure out how to work in the cloud.

And now we have a new set of tools, especially on the data side, AI machine learning. Some of the, some of the other tools that are available in the cloud. And so I would, I would assume that this is a constant battle skillset skillset mismatch and skillset upskilling over over, over time. Do you have any particular strategy that has worked for you in that area?

My philosophy that I've always said to people is be open to the possibilities. So as you need to get retrained to adapt and work with the new, be open to that, but particular strategies, no, just cross training and ongoing education, but no silver bullet.

Yeah. I mean, my, my strategy is to make sure you hire people that are always learning. That attitude. That belief, because if you don't, it's, it's an uphill battle. And if they're not willing to learn what's next, they're going to hold onto what you already have. And so they'll hold things back.

The third thing, maintaining a hybrid environment, which speaks to some of that thing. Some of what we've already talked about, which is adapting to that. Number four was combatting cyber criminals. Cyber criminals is interesting to me because we think we're coming through a major part of this, but I have a feeling we're just at the beginning of this and we're going to see some really sophisticated attacks coming our way. I mean, right now they're getting in pretty easily with some emails and whatnot. Taking control of the computer and then essentially going laterally across the horizontally across the network.

We're starting to get more sophisticated on our side, but I think they're going to start getting more sophisticated on their side as well. Technology shortages. Number what is that number five. And so we still have supply chain issues specifically around chips and microchips. And so projects could be impacted by that.

You could have any, any types of hardware projects could be impacted. We know that the automotive industry has been impacted with. Some of the some of the big players, essentially not being able to produce as many cars as they would like because of chip shortages. And so that's going to need to be a tool in our tool bag.

Burnout is number six and number seven challenge is driving change. Any of those you want to comment on?

Not in particular. I think that there's been a lot about burnout. We've talked about it a little bit already in terms of the talent competition and the importance of culture.

I think that. And driving change. What we're seeing within healthcare and technology is just incredible push towards more digital health solutions. And I think the leaders who are going to be most effective and successful are going to be extremely creative in how they address both of these and the thing I love about listening to the podcasts you do is hearing so many different health IT leaders and their strategies and the approaches that they're taking. So we've got we've got a lot of good people in this industry who are pushing it forward.

Ts healthcare predictions for:All right. So what does:

And so their entry into this market will also drive the disruptors are driving this consumerism, this belief that we can have healthcare the way we want to have healthcare. And it's almost comes back to that story. You just told Hey, I, I don't want to get in the snow and drive.

I'd like to do a virtual call. Are we adapting fast enough to this change? Are we going to see the CVSs of the world and the Walmarts of the world you know start to make, make headway here?

So when you say we you're talking about health systems?

I'm talking about health systems.

Yes and no. I mean, I kind of, as much as I may complain about various health issues that I've been dealing with and needing to interact with the health systems, it's great to be on the other side and and seeing how it works as a consumer. Everybody's making progress. No question about it in terms of the health systems.

I mean my interaction with the health system for this most recent appointment, some other virtual health, the push scheduling. Definitely turned my phone off today for this recording, because I'm getting all these texts saying these orders are in now. We need to schedule you dah, dah, dah.

So the engagement is there. And they're trying to make it as easy as possible. There are issues, but they're trying. At the same time in terms of the retail pharmacies, if you interact with the retail pharmacies for anything right now, like COVID testing and trying to schedule a test or when we got our booster, they all have a long way to go in my opinion. In terms of making it friendly and easy. CVS is probably ahead of Walgreens with the minute clinic strategy and space carved out specifically for men and clinics and many in many pharmacies, but a lot more to do in terms of making it really accessible, easy to use, and a lot less frustrating for consumers, but it's all moving along.

The other point, if I may, in this part of the article it talked about with nearly 40% of patients. 40% stating they have no brand loyalty to their healthcare organization. What are health systems doing to avoid being left behind in the importance of the unified self service digital experience?

health system for care since.:

Can you get some screening tests that you need as part of your annual coming up and. She was emphasizing convenience. And where can you go on the south shore in Massachusetts? And I've already figured that that the south shore Massachusetts is kind of owned by the competitor health system to where I go.

And so should I go there w ith my records? So it's probably a generational thing in terms of that loyalty. If I was far younger and didn't have that much going on to track from a health perspective, I may be much more willing to just go anywhere that's convenient. I think I'm willing to give up on some of that.

I agree with you, it's generational, but I think every generation gets older. And so even though the young, younger generation will be the first to tell you, I don't have a primary care doctor. But you know, when they turn 55, my guess is they may have somebody that they want to see on a regular basis who they trust.

And a primary care may be virtual, in 30 years or so, but they, they may want to have that person who sort of coordinates their care, who acts as a quarterback, who takes the information in and says, yeah based on what you're telling me, you're going to want to see this person.

And we don't really care where you go, because you're paying me for primary care. And I'm going to get your record from Mass General. I'm gonna get your records from wherever. I don't know where you go up there, but yeah.

I worked at Brigham. Is that a clue?

Yeah, no, that would be a little bit of, that would be a little bit of a clue. Let me move us through this a little bit. Virtual care, 3.0. And there's an interesting thing in here. Combined with CMS's continued expansion of reimbursable, remote patient monitoring services, more than 75% of organizations feel RPM adoption will be on par or surpass inpatient monitoring in the next five years.

Now, when you hear that stat, obviously you have to click on it and you look at it and you say, oh, it was a study done by viva link, which of course does connects up remote patient monitoring. And they don't give you really any of this statistics. Like they give you percentages, but they don't tell you how many hospitals or clinics they talk to in this.

But regardless it's maybe not 75%, but I bet you, if we did pull aside a lot of healthcare leaders at this point, they would say, look from a technology perspective. There's a lot of things we're doing today, remotely that we didn't think we'd be doing five years ago. So to think that remote patient monitoring will be on par in the home in five years to where it is in the in the hospital today is probably not that far fetched.

We had another article we're not going to get to, and it talks about virtual care 3.0. And really thinking through workflows that could flow beyond well beyond the health system and they're centered around the consumer. So it's, it's remote patient monitoring from the home it's remote patient monitoring from devices that are always connected to them.

It's more touch points. It's a different way of thinking, but I'm always connected to my healthcare provider, always providing them information. And somehow they're calling that information so that if there's any anomalies, instead of healthcare being reactive and requiring me to recognize when I'm having a problem, they might be able to be proactive and connect with me. And let me know that I'm having a problem.

Yeah. My comment on this is that statistic more than 75% of organizations feel that RPM adoption will be on par surpassing patient monitoring. What jumps out at me, Bill is the type of monitoring. I mean, we're not talking about the level of ICU, inpatient monitoring.

We're talking about a different kind of monitoring, but at scale and more patient. Versus that, and I'm not a clinician to define this. Well, the kind of monitoring that's happening in an ICU situation, in a hospital for a smaller number of patients. So I'd make that comparison.

Yeah. And so we talked to John Halamka in the first episode on the conference channel on the keynote show this year.

And he talked about this. They do have higher level of acuity care that they're now doing Mayo and Kaiser are doing out of the home, but he also said there's a vetting process that goes on before somebody even gets close to that program because not every home is conducive to that kind of monitoring and part of it's connectivity, but part of it's just, Hey, are they better off not being in that home and being in the hospital? And they do that evaluation and I forget the numbers, but it was, that's a good free, a number don't qualify for their higher acuity care out of the home because of any number of factors that exist within the home itself.

Well, that gets into social determinants of health and what's the home situation.

Yep. Absolutely. In this WWT article. I don't want to shortchange it, but we're, we're really out of time. They talk about cybersecurity. They talked about cloud and smart hospitals. I think all of those are significant trends. The smart hospital trend, I think, is one to keep an eye on. And most CIOs I'm talking to are the automation piece. Again, huge, absolutely huge robotic proces automation is huge. And then I talked to a healthcare leader yesterday when we they're actually using lots of robots. I sorta laughed.

She's like, look, we have, we have robots. They're moving around. They're literally moving around our hospital all the time. And it wouldn't be the first time. I mean, I've, I've seen them at UCF. I saw their robots sorta carting things around the hospital, but these are getting more sophisticated, smarter interacting with people, helping people to make decisions in the hospital.

Essentially stopping them and saying, do you need directions? Sort of a, a row like an R2D2 robot saying, Hey, do you need directions? And where can I help you get to? And not only telling them where to go, but Hey, I'll take you there. And the robot turned around and goes down the hall and you follow the robot.

I love it. I love it. So are these multiple hospitals or are you talking to some that have like really invested and have a lot of robotics?

There's a lot of pilots going on. I would say, I would say that way, because we're not used to robot yet. We've got to figure out how humans are gonna interact with robots. Do they feel comfortable with them or are they going to see them and like run away. It's just scientific method. We have a theory that if we put robots in the parking lot, who can give you directions that people will use them. Well, let's find out if that theory is true. I don't know.

Yeah. Okay. Well, we adapt. We adapt to change. We've adapted rapidly to change in the last two years. Sometimes we adapt more slowly.

Absolutely, but we do change over time. Sue thank you again for coming on the show. I look forward to staying in touch and hearing about the work at Starbridge Advisers and hearing about your blog. Your blog is still going right?

It is. I took a break in January and I posted some previous blogs on leadership and coaching, but I'll be writing this week. New content. Yes. Too long I shouldn't say too long, seven years. Haven't pivoted to the podcast world cause you're willing to talk to me once in a while, but yeah. sueshade.com. I'm still blogging weekly.

Seven years. That takes some commitment. The hardest thing I do is my daily show cause it's not hard. It's just one article and and people are like, bill, it's only seven minutes, 10 minutes. How hard can it be? It's like, yeah. It's, it's harder than you think.

It takes time. We do it for a reason. Right?

Absolutely. Hey Sue, thank you again. Appreciate it.

Good to see you. Thank you.

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