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 Today on Newsday.

There are so many products. There are so many emerging technologies. There are so many things, shiny objects, that I feel like we've chased for a long time, where we come to the table with a solution. And then try and figure out what problem it can solve.  My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health. where we are dedicated to transforming healthcare, one connection at a time. Newsday discusses the breaking news in healthcare with industry experts

Now, let's jump right in.

(Main)  All right, it's Newsday and today we're joined by Melissa Pettigrew with Rackspace. Melissa, welcome to the show.

Thank you, Bill. Great to be here.

Looking forward to the conversation. We're going to talk a lot of different things. There's a lot of stuff going on in healthcare. Give us a little idea of your role at Rackspace.

My role at Rackspace is really to serve as a liaison between our product delivery team and our go to market and strategic teams. So I work really closely with a lot of the executives within our customers. To ensure that what we are doing and delivering aligns with their long term goals and strategy and communicating different product and delivery strategies with our internal teams.

So what are health systems doing with Rackspace? assume there's some movement to the cloud going on in healthcare.

Just a little bit. Yeah, cloud is definitely growing and on the rise in healthcare. And so my focus and the team I'm on is our healthcare private cloud business, where we focus on hosting the ecosystem of applications within healthcare.

We're the largest hoster of Epic. And so we host EPIC in our private cloud and surrounding applications that integrate with EPIC.

Wow. That takes us to our first story because that, we're going to talk effective change management is key to successful digital transformation. Let me give you a little excerpt in this article.

It highlights the significant challenges and failures in enterprise digital transformations, noting that despite widespread efforts, many companies only realize a fraction of their expected revenue and cost savings from these initiatives. The author emphasizes the importance of effective change management driven by skilled product leaders.

I think that's going to be a key part of this conversation. Product leaders who understand core product management disciplines, such Digital product mapping and strategic planning. She argues that successful digital transformation requires not only alignment across all levels of the organization, but also dedicated focus on cultivating internal advocacy through strategic communication and collaboration, ensuring that transformations align closely with business objectives and enhance productivity and brand loyalty. Change management is probably where you live, I would :imagine.

It is. A lot of what I do is working within our organization. And within our customers, managing all of the different layers and levels and groups of people to come together, to drive strategy develop products and really lead effectively.

And I've seen many different styles of change management.

Where does the breakdown occur? And it's so common. And I'm not even sure I could pinpoint one area, but curious from your perspective, where does the breakdown occur? Where we don't realize the desired results, where does it usually break down?

Yeah, that's a great question. I think there's a lot of different areas where breakdown can occur. But I think one of the most prevalent areas I see is this disconnect between Strategic alignment goals in the business, and then actual outcomes. And so, I think we see a lot especially in healthcare, where people really lean on technology to solve a problem, but the problem isn't clearly identified.

And I think it's that mistranslation or misinterpretation across different units. So technology people speak a very specific language. The business speaks a very specific language. Customers speak a very specific language. And I see the biggest breakdown in those groups being able to come together and actually translate, identifying a problem translating and communicating desired outcomes, and then actually creating this loop and this circle of feedback throughout the process, throughout any sort of change process that continues to return to what is our goal?

What problem are we trying to solve? Are we on track for those goals? And are we actually meeting those desired outcomes? And so I would argue one of the biggest challenges overall is the communication challenge.

mean, and the other thing that you pointed out was You know, beginning with the end in mind, it's really understanding.

This is the objective. This is where we're going to. This is what we want to accomplish. There's so many people in healthcare that have a desired outcome that they go in these five, 10, 15 different directions. And it's wait, this is what we're doing.

This is what we're trying to accomplish. We can do those things later. But this scope creep is going to kill us on these projects. I experienced that so often in healthcare. It was like cause you don't want to say no to the doctor and you don't want to say no to the administrator. You don't want to say everybody has their agenda for the project that you're trying to kick off.

And it can lead you into rabbit holes. And it's hard to keep these things steady. How do you keep them steady?

Yeah. Something you mentioned that I think is really important is, this idea of tentacles. And I'm curious if you have found those tentacles being creative because we, we approach a project with an end solution in mind.

And I've seen this a lot in healthcare.

There are so many products. There are so many emerging technologies. There are so many things, shiny objects, that I feel like we've chased for a long time, where we come to the table with a solution. And then try and figure out what problem it can solve.

And I think that is where some of that kind of scope creep comes from. Instead of really intentionally walking in with a challenge or a problem, evaluating what desired outcomes would be to solve this problem, and then going and seeking a solution or a technology. or a process that will help solve that.

What I mean, the most common word we hear right now in tech sales is platform. We're bringing in platform. And so the challenge with the platform is it generally solves a bunch of problems. And so they come in and say, Oh, look, and, ServiceNow is a partner of ours. And I think they're a phenomenal product and solution, but they'll come in and the organization will bring ServiceNow in and say, it's going to solve this problem.

And then people realize it solves all these problems. And then all of a sudden you have these things going on in the organization. Most problems are not technology problems. They are for healthcare, at least. In other industries, I'm not sure I would say the same thing, but in healthcare at least, so many of them are data problems, process problems workflow problems, communication problems, that you have to solve before the technology problem, that before the technology can do what you want it to do, you have to solve all these other things, and that's really hard work, and that's where I think a lot of this stuff just breaks down.

I would agree. And I think starting with the process problem, I think that's where we've seen some of the biggest breakdown and challenges in adoption, valuable business outcomes, effective change management is that we haven't taken a step back to fix the root of the process problems. We find workarounds or we just ignore it.

And then it's just exacerbated as you bring more and more to the table to manage and lead with.

Who's the When you're talking about change management in a healthcare IT organization, who do you generally interact with? Is it the the person who's over that application? Is it the, I assume it's not the CIO.

The CIO has so many things to deal with. They're saying, okay, this project is this person. Is it the project manager? Is it the department lead? who is the right person to interact with in a healthcare organization?

Yeah, I think if health systems are organized correctly, there should always be a main stakeholder for a project or for a group that is ultimately responsible for driving the change management.

And that main stakeholder has to have those relationships. And the ability to go interact with all of the areas and dependencies for a project to be successful. So Bill, I think it differs depending on what type of work we're doing. There are different stakeholders. Sometimes that is the CIO. If we're doing more strategic roadmap and vision planning.

Sometimes it's the CIO if we're doing more executive level. Interaction and communication. Sometimes it is the VP of technology or application owner. And so I think that is something that organizations could do well as take a step back and look at for this area and the outcomes we want, who is the appropriate stakeholder to drive change, and sometimes that might not be a technology leader and might need to be someone that comes in from a different area that can communicate technology.

and business, and customer engagement.

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I want to come back to this product manager concept. So, sure on the inside, on the Rackspace side, you probably have product managers, people who oversee. This is a very common term in application development shops and lot of different organizations, but not as common in healthcare.

And back when I was a CIO, we were starting to move towards this product manager and treating even something like Epic with a product manager. Because a product manager looks release cycles and just features and functions and all those things. And what we were trying to do was to get the organization to think in terms of this is a product, the product manager will manage the release of all these things, and they were sort of at a higher level.

So they would be talking to the end users about what the requirements were. They'd be talking to their primary vendor who would be. Epic in that case and saying, Hey, look, we're going to start doing retail pharmacy. We need these kinds of features and this these kinds of things. You deal with product managers and then you deal with healthcare where we say for that one, it's the VP of apps for that one.

It's the product the project manager for that one. It's what's the difference in dealing with both sides? You feel like dealing with one side is just more coherent or it doesn't really matter.

Yeah, I don't think it really matters. Again, every organization, I think is going to be aligned a little bit different based on their ability, their capacity and what they have.

I think the critical piece to that and what I really liked about the article that she talked about is how to be an effective product manager and how to effectively manage a product portfolio, which was being able to understand all of these different components and lenses that go into being effective at that.

So, yeah, I think, the strategy you described where you're putting one person over Epic as a product, right? That makes a lot of sense for that application. And that person has to be effective, and to your point, managing all of these different areas. And so, yeah, within an organization, I think, again, the most important things to be effective in that role and to manage a product portfolio effectively is really that cross functional approach.

Collaboration because products don't operate in silos and they don't deliver in silos. And so being able to really understand how to create that cross functional collaboration being able to measure data she talks about, data driven measurement that is And I think something that product teams can enhance is really driving data and leveraging data to communicate and articulate that, yeah, we are on track and these outcomes are what we said we were going to deliver on.

And I think the one piece that she mentions at the end about an effective project manager or product manager is that, Continuing and continual refinement. So tell me a little bit about that in your experience, Bill. I guess when you were managing teams and products, how did you guys continue to refine effectively?

Cause I think that's important. And I think it's something we maybe don't focus on enough is constantly coming back and saying this worked well, or this didn't work well. Let's, change direction.

Now, Melissa, you've been in healthcare a long time. You realize we don't look back on anything.

We don't do, we say we're going to get this ROI, and we don't go back and measure, and we say we're going to go back and look at these things, and we don't. I will say that the thing I like the most about the product is that And by the way, thank you for disagreeing with me. Not many people come on the show and disagree with me, which I appreciate greatly, but the reason we were going in the product manager direction was we could let's not take Epic as an example, cause that's a true product, but We had a tap to log in kind of thing. And there was a product manager who was over that entire product set. And so that person was constantly talking to the physicians. Hey, how's it working? What's not working? What's clunky? Those kinds of things. And so they would come back and they would decide.

What those releases were, and we got to be a little bit like Apple in that, Apple has a big day once a year where they say, here's all the things you said you want, we're releasing these things. And and that was the big release, and some, and you were making decisions all along the way, we're going to release this, we're not.

And I find that one of the problems with healthcare is we just slow drip these releases out to people and they don't see the change that's actually happening. And I find even if you do a quarterly or semi annually saying, okay, we're going to do a release. Of this product. And it's going to have these things in it.

It tends to be from a communication standpoint and from an organizational change management standpoint, it tends to have more impact like, Oh, the big release is coming out on July 1st for tap and go, we're going to have this. We're going to have this, we're going to have this. We experience it all every year with Apple, and I don't know if you have Apple devices, but we look forward to the new phone coming out in September.

We look forward to the new iOS coming out in June. And they've just gotten into these cycles, and their team internally also has gotten into work rhythms that allow them to organize better and make sure that they're making progress. I didn't answer your question on purpose because we're healthcare. We never look back, and we never We

don't look back. It was interesting because right at the beginning of this article, we're referring to there's a statement that, the reason transformation hasn't taken hold and been so effective is that business outcomes, like we're still missing the mark on It's Business outcomes.

And that's your point, do we need to look back more? How do we document more effectively business outcomes? But not only document them, it's that, to your point, how do we evangelize and get excitement around, hey, this is all the great stuff we're doing to where the end users are actually seeing the value and understanding What is new and different?

And the business is seeing the value in those outcomes too. So, so why are we not putting more focus on that? Is it, we're too busy? Is it, we as IT leaders don't know how to speak business? Is it, we don't have a seat at the table, right? What are these challenges and how do we look at them?

So the second story I was going to do, and we're getting close to the end here, but is the six big issues facing CIOs in the next six months, and there's a sentence in here, digital transformation remains a priority.

albeit hindered by budget constraints and legacy systems. IT budget pressures are leading CIOs to either maintain foundational approach or explore advanced technologies like generative AI and whatnot. But the first part of that is digital transformation is a priority, but it's hindered by budget constraints.

And part of the reason it's hindered by budget constraints, and this is starting to change, by the way, I was sort of tongue in cheek saying we'd never look back. More and more CIOs are saying to me in our 229 project meetings, They're saying, Hey, we're being forced or we're trying to be more responsible with the money we've been given and to show the ROI.

We're really trying to put those two, three year models together and then go back and revisit them and make sure. One of the reasons we don't have money right now is we forgot to finish the story. We wrote a half a story. And said, yeah, the technology got implemented. We never finished the story to say, Oh, and it improved outcomes.

It decreased our mortality rate. We never finished the story. So the next time we go to ask for money, they're like you're not going to finish this story. I don't care what you're saying. We're never going to know if it does that.

And so there's a credibility gap that sort of gets created. CIOs have recognized that they're starting to fill that gap. , there's in some senses, there's a lack of financial acumen to actually do those effectively. And second, there's they're just so busy. There's so many projects. I just interviewed a CIO who said he just started a new organization.

He said, we have to put governance in place. It's just, they are overwhelming IT and they have no idea they're doing it. Just that,

that, yeah, that data point. Yeah. Too, that, it the impression is that it can do 10 times more than they actually are capable of. And so that's, again, finish the story, being able to really take what it has done. And accomplished and translated in a way that the business understands that, that they see the value of, right? That's how CIOs can defend budgets and actually have a seat at the table to ask for more or have a seat at the table to say, We accomplished all of these things with this IT initiative.

So that opens the door for us to spend over here. So I like that financial acumen and really storytelling I think is going to be critical as we see, the pace of technology accelerating and the ask of IT to do more, we have to get better at these things.

Melissa, it's been fantastic. I appreciate you coming on the show and. having this discussion. Hopefully, they'll let you come back and do it. PV did it last time, and you're here this time. I don't know if they're planning to have a different person every time, but it'd be great to keep in touch and do this again.

Absolutely. Thank you for having me, Bill.

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