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Sarah Richardson: The reason we were so successful during the pandemic is 'cause we did one thing at a time, right?

We period. If you want me to do all five of those things in a year instead of three years, then give me the resources to get it done.

Bill Russell: 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. Newstay discusses the breaking news in healthcare with industry experts

Now, let's jump right in.

(Main) It is Newsday and everybody's sporting a hat on this week's Newsday. It's me, Drex, and Sarah. We're gonna do our version of a Newsday round table. Yeah. And looking forward to it. Boston hat. We've got a warrior hat. We've got a this week health yellow hat. You guys were in Boston last week what did you learn at the 2 29 round table?

Some really brilliant connections. We had dinner together, all of us together one night, and that was a ton of fun. And then I know that Sarah and I and some folks Kate went to the Boston Minnesota ball game on Saturday afternoon, so we were able to kind of do some cool stuff. But how'd the CIO table go, Sarah?

Sarah Richardson: I'm gonna go backwards and say loved going to Fenway Park. It had been on the list of places to visit. We get rained out, we go across the way, watch the derby. Saw some more of our friendlies over there. So that situation, I'm sorry, where'd you go? Across

Bill Russell: the street. You went to a bar, didn't you? We did.

Sarah Richardson: I mean, we're in Boston.

Here's what I wasn't expecting that some of the biggest health systems in America talking about. Budgetary constraints, talent management and governance because they're in that crunch time and being able to apply the fiduciary expertise, the decision making capabilities, and keeping the people engaged during those hardest times.

It's not something none of us have ever seen or done before, but when you're seeing it in full force, the differentiator in today's world. Is the fact that the technology is actually there to accelerate and help us with those aspects of what is happening. So for the first time in about 20 years, we're actually seeing the technology delivering the solutions that are letting us keep up with the pressures that are occurring from every other dynamic in our industry.

Alright,

The health systems have gone berserk in their thinking, You know, Just logic be damned. I don't care how busy you think you are. We saw what you did in the pandemic. Like we thought this was gonna be a problem. But I think it's starting to play itself out now where leadership teams across the country are just saying, yeah I don't care.

We have to get a lot of stuff done. We expect you to get an EHR implementation done. An ERP implementation done. By the way, if you could consolidate our PAC systems and, all these things that we know are three year projects and oh, by the way, you have three years to do all of them. We're hearing those kinds of requests come down and sometimes when I hear 'em I just sort of scratch my head like, how?

Sarah Richardson: Thank you. I love the playoffs. I watch all the games, by the way, 'cause it's just super exciting. Here's what a couple aspects from what you just shared, and this is where I get a little fired up on it as well. The reason we were so successful during the pandemic is 'cause we did one thing at a time, right?

We period. If you want me to do all five of those things in a year instead of three years, then give me the resources to get it done. And there is a business case that can be made for that. Okay, you want us to run on these cylinders, et cetera. But this is something that Drex and has been sharing forever.

It's that relentless prioritization. You can only do so many things. Well, and what I'm always fascinated by is that. Your CFO is the one who's always gonna be hardcore on, we have this much money, we have X, Y, Z to get things done. That dynamic is the same when it comes to pushing through the different initiatives that are in your health system.

So if you're known for delivering high patient outcomes, quality, et cetera, then the products that you're producing need to have that same ethos. The thing is, you gotta be able to have the structures to make it happen. So may not be a popular answer, but if you want me to do three things really well, then give me the runway, the latitude, people funding, whatever that looks like to make that a true statement.

Bill Russell: I'll push back on that answer just for fun. I agree with your answer, but I'll still push back on it later. Drex, what? What are your thoughts?

And a lot of it is just people seeing things and, saying, I wanna do this project, I wanna buy this thing, I want us to do this work. And there's not a great business plan tied to it. There's no ROI, we don't understand what the opex tail is gonna be over the years after the implementation.

We haven't set up the long-term budgeting about the benefits. So if it's somebody from the pharmacy coming with a project, and one of the ways, even if they try to justify it, they justify it as we're gonna eliminate. Two FTEs each year for the next three years by doing this we don't keep track of whether or not they actually did that.

We don't hold them accountable to those results. And the result of that is that there's a lot of things in these projects that it's just like, we can do that. And the cost Or the part of the organization that accrues the benefits, the cost accrues to the information services department. The cost and the pressure land there,

Bill Russell: but none of the benefits do.

Right.

Not only prioritizing the work for the information services department, but you know, how many times have we seen. Somebody coming with a project and the project gets approved and it turns out there's so many things going on in the lab that they can't really eat another project themselves, but they got it approved and then it starts to fail.

And because it's an IS project, it becomes IS' fault that it didn't work. So there's so many things that have to be sort of read into this prioritization governance conversation that we are chronically bad at at a lot of

Like, you've never been right about this since day one. You don't even track hours. You don't even know how many hours it's gonna take. Right. That's a good one. So if you don't get your. Policy order. Yeah. If you look at your crap together, don't go into the meeting and say, Hey, we can't do it.

We can't do it. We can't do it. It's like, you know what? Show me we can't do it. And the second is we're not owning the narrative as CIOs. And so, and I know that you guys both have owned the narrative, so I'm not pushing back on you per se, but I'm saying we give CIOs too much cover.

And the systems look like this. Well. To a certain extent, we have to own the narrative. We have to be able to tell the story of, you know what? This is where we're at today. This is where we could go tomorrow. This is what you're going to get for these things. And the second part of the narrative we need to own is we need to push back on the organization and essentially say, look, we're not the problem.

Every one of these projects is an operations project. You want me to roll out ERP? I need. Umpteen million hours from finance, from hr, from whatever. You want me to get on foundation? Great. I need this many clinical hours. getting on foundation from a technology perspective.

Yeah. Okay. No problem. That's not the problem. The problem is operations. the other part of the narrative I want to own is how much money we are wasting as a system because we're unwilling to lead. As a leadership team, we're unwilling to lead and get in front of the operational.

Therefore we have to write code to, we have to create some kind of

Drex DeFord: workaround to that Exactly. To make that work. And all of this is complexity. All of this, it just. Piles on itself. The more complex the environment is, the more complex it becomes. The more money that it takes to run and maintain it, the more likely it is that something's gonna break and go down.

I think

Sarah Curveball to you because you were Tivity and when you were Tivity, you guys were writing code, you were building apps, you were doing all sorts of things. Now it's healthcare adjacent it's health, not necessarily healthcare. And so. Somebody's gonna look at that and say, well, you don't have these challenges, but still, you guys looked at it and said, you know what?

We are going to go to a DevSecOps kind of operation and save money and go to those approaches. Why did you choose to go that route? Why did you choose to go with, I mean, you could have very easily gone the standard off the shelf. I'm just gonna go out with my checkbook and buy some stuff and put it together in a way it works.

Why didn't you do that?

Sarah Richardson: I'm gonna just rewind you for a quick second on that. That wasn't my first CIO job, by the way. I'd been through Optum, I've been through HCA, I've been through like, the big giant messy community governance community. Only to have the direction change six months later.

I had air cover for my CEO who hired me to do a full transformation turnaround plan with anything I needed to get it done. So long as it was well thought, well-planned, tied into the overall strategy and achieved all of the OKRs that we had on the books. And so it's exactly what we did. Very thoughtful about the approach.

Now, did we get a ton of. Pressure because the operational readiness, back to your point, it is the only part of the organization that tracks their capacity based on how their time is spent. At least in anywhere I've ever been, it is the only place that is that pedantic about how much time we spend on.

Capital versus opex because that's how our time gets built out and split. And most of our other parts of the organization, including product teams, don't typically run that way. So I know exactly how much capacity they have , for a network team for deployment.

Drex DeFord: So wait.

Sarah Richardson: Yeah. Like go have your EMR go all at that. Go have a couple of platform things.

Have a ninja team that does these little tiny dev projects everywhere. I did that. Even at HCA, the division structure didn't lend itself to having coding teams. Guess what, instead, a couple developers, you could go in and solve all kinds of many problems all the time. Did Marty

Bill Russell: know you were doing that?

You He did. And

Sarah Richardson: he did know I did that, and he would let me because I produced results. I mean, if you do everything you're supposed to do, you get a little bit of leeway to go do the other things that you want to be able to do. So this is gonna go back to. The other view of the universe, it's important, and this came up at Tivity and everywhere I've ever been, is we were only maybe two and a half, 3% of, total cost, which is not much.

And it showed that healthcare had a lower perception of innovation than the post office.

Sarah Richardson: Yes. Woo. Yay. That's tough.

Bill Russell: That's, for us. It's

Drex DeFord: interesting too though, and I would say one other thing about that. And this came into a whole benchmarks conversation that we had during the summit last week.

There's a lot of it spend that's hidden in other places in the organization that you may not find just in the information services fund. Okay. Where is that hidden? Well, in those little black operations that are going on around the organization. Okay. I'll give you one,

Bill Russell: Area where, was hidden at St.

Sarah Richardson: cubes everywhere. I don't mean like physical cubes, I mean like cube software capabilities.

Bill Russell: Story for another time, but essentially we counted 'em all and then we realized, oh, they can be outside IT, that's fine.

But we have to figure out a way to bring them into the fold in terms of, so did that make you

Drex DeFord: 5%? Or something like that.

Bill Russell: But so you added them in. brought them into the fold, but we did not add them into the but, but you're right. A hundred people, let's say, I don't know, Southern California, let's say 70, 80 grand a piece. That's like real money. So your point, it's point is, but there's also

Drex DeFord: software and there's other things that are going on out there too that. Don't accrue to the IT budget. So anyway,

Bill Russell: that just, all right, so the next conversation I wanna have with you guys, and let's be careful on this.

I don't think it really matters why it's happening. I think the question becomes, alright, you're starting off a new CIO or you're looking for a role. Talk to me about the interview process. Drex. If Sarah and I are doing the interview right now, we're bringing you into a medium sized health system, let's say, three and a half billion dollars regional, IDN, and we're interviewing you. What does that look like? I mean, what are your expectations? What are you asking? Do you care what happened to the last guy? Yeah.

Drex DeFord: You talked about owning the narrative, and I think about the interviews that I've gone through, like the first interview, and I think the first pass interview is often the execs that you're interviewing with maybe a group interview, they have sort of like a set of questions that they probably worked on with the HR guy or lady.

Not only about The department and the spend, and maybe what happened to the last guy, but I also wanna know about you and how you are as a teammate. How's the boss? How do you guys work together? How have you resolved some really major conflict recently? Tell me about that. Oftentimes I wound up in these interviews where I wound up, I was asking most of the questions and they were talking about their organization, and at the end of that first interview is usually when I, I mean. You get the,

Bill Russell: we're gonna need for you to come back. You get the feel. Sarah, I'm gonna change the question for you. Most of these start with the executive search firm. Right? So that's your first, your first conversation is with them. What does that conversation look like?

What are you trying to find out from the executive search firm,

But

Bill Russell: they're gatekeepers. They're gatekeepers for sure. They could keep your resume from getting and if

Sarah Richardson: they can, but that's also into the mix of why you build your network out around that space as well. But I tend to find out, and this is what I tell every recruiter, if after a couple rounds of conversations, if I am not your number one choice, I don't wanna be in the mix period.

Don't even waste my time because I'm not gonna help you be successful if you are not also interested in me being your number one candidate. And that can be an awkward conversation. But I've also been in scenarios where I said, am I the first choice? And they said no because of x. I said, remove me from the list.

A call from the one of the big recruiting firms, you're already a known quantity somewhere in that mix, and so utilize your relationship capital and your business acumen to really be the front runner for you in an opportunity.

Drex DeFord: Hey Bill, let me ask you a question. So part of this interview process. When you get in and you start asking questions as the interviewee is based on your previous experience and the stuff that you saw your previous organization not doing well, what are some of the questions you would ask when you go into these?

But I am an awful interviewer because i'm so jaded, so you can't go in. Like, I would go in I, there was an interview with a, major health system on the East Coast after I left St. Joe's. And I got to the interview round where you're gonna talk to like 15 people on site.

And the second interview I had was with the CMIO. And he put the plan together and he said, Hey, here's our plan. This is what you need to do with that kinda stuff. I said, well, would you like some comments on the plan?

He goes, no, not really. This is the plan. This is what you need to do and whatever. And I said, i'm sort of getting the vibe here that you just need somebody to carry out, a already perceived plan. He said, yeah, no, that's exactly what we need. I said, yeah, I'm not your guy. I'm not your guy, and I don't wanna waste anybody else's time because I.

The recruiter was so ticked off at me. I mean, I can't begin to tell you that. I mean, they were yelling at me over the phone, like, I can't you gotta get back in there. I can't believe. I'm like, why? Why waste everybody's time? So I'm not You've ruined my big payday. What's that? Yeah. You ruined, you've ruined my big payday.

I'm sure He ended up getting the placement and the person who went in there was perfect for that. Like here's what I credit the organization, and this is where I struggle the most is most organizations don't do the hard work of getting everybody who's gonna do the interview on the same page.

We are looking for this kind of person. Generally, what they're looking for is what they didn't have in their last marriage. This is like their second marriage or third marriage. And they're saying, well, my first person I was married to was this. We know we don't want that. Therefore we want this. No.

I don't understand how that works. Oh, you're gonna keep the old CIO around and hire a new CIO. What does that look like? Who does the CIO report into? I mean, that was one of my things one of my interviews where they were like, yeah, we're gonna keep the other guy around. I'm like, help me understand why you would do that.

It's like, well, it's like an insurance policy. I'm like, okay. Well, I, no, I've also, with recruiters, I've been told, Hey, stop returning your phone calls towards the end of the process, and I'm like, this is really weird. And we finally get 'em on the phone.

It's like. Am I being held around so that they can finish negotiating with somebody else to make sure that they land them? And if they don't, I'm the fallback back to Sarah's like backup plan. Yeah.

Sarah Richardson: I'm not number one. Don't put me in the mix.

Like, you don't have to take the first one. If you are competent and good and believe in yourself and believe you can bring value, find the right organization that's a good fit, and be honest with yourself. Like what do you bring to the table and is the organization looking for that?

And, if there's a mix, if there's a gap, don't just go, wow, that's gonna look great on my resume and whatever. 'cause it may not look good on your resume when you get in there and it's not a good fit.

Sarah Richardson: Well, and you might be looking at a relo and two or three plus years, and that's not just, I mean, let's be honest, we're all over 50.

Like that doesn't sound like a whole lot of fun right now,

Bill Russell: well, is is relo necessary anymore?

Sarah Richardson: What? Yes. I mean, okay. I'm gonna hard, yes. If you are running a healthcare system, I certainly hope you are on site just about every single day because your responsibility is to the patient and the clinician, and they don't get to dial it in.

Sarah Richardson: And maybe I may ruffle some feathers saying that, but here's the deal. I, and this is where I'm like, I'm now that person. I'm over 50. I went into the hospital every day.

I spent days, hours. That a change of clothes in a toothbrush, because sometimes you don't get to go home when bad things happen. And that. Taught me so many things that were so important. I actually want to be close to that environment. And I've even tacked on to one of our upcoming city tour dinners, staying the day over and going rounding with the team and creating basically like an onsite interview as part of them showcasing what they're doing in their hospital, because I don't get to do that anymore.

And that's the industry we serve. So kind of need to be a part of it.

It doesn't have, it doesn't have to do with you being a bad CIO or a bad ciso. It's probably some other mechanical thing that's happened. A new CEO has come in, there's been a merger and acquisition. There's been some kind of change that has created the need for. Reorganization and you just are not part of it.

Even when it's really clear like why and how it happened and it didn't have anything to do with you. I can tell you I had conversations with. Three or four CIOs this week who were in transition and every one of them said it still felt personal. It still, it was still a punch in the gut. And even though I know it didn't have anything to do with me, it still hurt my feelings.

'cause there are so many other great opportunities. You have so much skill that you don't even realize that you have. Most of the CIOs, many of the CISOs could be chief operating officers or, presidents of hospitals today. They just haven't extended themselves into that space. Yeah go out and get it.

There's all kinds of great opportunity for you.

Sarah Richardson: Well, the reason that matters so much what you just said, Drex, is all three of us have lived that experience or been, adjacent to it. Heck, it's happened to me twice, but I've also been, on the receiving end in a good way of it.

Thank you for being the first phone a friend I had, or Thank you for helping me prepare for that next opportunity we've been there, and that empathy of just that career perspective, but us seeing the whole person makes such a difference, and I'm grateful that's one of the things that being a part of the 229 community offers, the people that are a part of it.

Bill Russell: We're gonna close on this. I will say this to CIOs direct is absolutely right on the a majority of the people I've talked to that are moving from one to another, that were pushed out or whatever. 90 plus percent of the time, it has nothing to do with you. It's a very political environment that you work in.

It's a lot like a football team. When they bring in a new GM or a new coach, they, they like to have their own team. Those kinds of things happen at this level. And really , the new coach might not even spend a minute getting to learn who you are, what you've done, that kinda stuff. They just wanna bring in their person.

When you go to a party and you start talking to somebody and they tell you their health story or whatever, or their kids' health story or, yeah. And I remember at least twice in the first, like six months I was there, somebody goes, oh yeah the sisters forgave our debt. Like our debt was blah, blah, blah.

This is good stuff. So, encourage people it, it does hurt. Lick your wounds like Drex talked about. But there's value in getting back in there and we're here to support you guys on that. So that's our news day. Our news day. We didn't cover a news story. It sort of feels to me like we're in the middle of the news.

We meet with people. It's the unwritten news story. Yeah. Yeah. I mean, we are meeting with people all the time. I'm not sure we need to read a news story. We can just tell you what's going on the front line, so. I wanna thank you guys and good luck warriors. And you're not a Red Sox fan, are you?

Drex DeFord: I'm a Red Sox fan. They're not, they're doing okay. I'm a Mariners fan and they're actually doing really well right now, so,

Sarah Richardson: go Dodgers.

Bill Russell: Oh, geez. Well, I'm not the, I'm a Cardinals fan, but that is not to be talked about. Oh, man. Hey, thanks for listening to everybody. That's all for now.

Thanks for listening. That's all for now