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.

We talk about tech debt all the time, but there's often in healthcare organizations, debt in a lot of different ways around from the perspective of work that our teams should be doing that they're not doing because there just aren't enough people and there aren't enough hours in the day.  (Intro) 📍

  📍

📍 Welcome to Newsday A this week Health Newsroom Show. My name is Bill Russell. I'm a former C I O 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 Newsday show partners and we have a lot of 'em this year, which I am really excited about. Cedar Sinai Accelerator. Clear sense crowd strike. Digital scientists, optimum Healthcare it, pure Storage Shore Test, Tao Site, Lumion and VMware. We appreciate them investing in our mission to develop the next generation of health leaders.

Now onto the show.

  (Main) 📍 all right. It's Newsday and today we are joined by Drex DeFord. I could just stop at Drex. I think. I think people know who you are by now. You have the best stage name in all of health IT, by the way.

I mean, it is funny I will go to conferences or I'll go to meetings and things and people will say, I know you because I've seen you

on this week. So it's funny and

it's funny how much they feel like they know you and you've never met them. Yeah. They're like, oh, you have a couple kids and your company has that dog captain and they just know so much cuz Yeah,

you must get it a lot because you reveal a lot in the interview process, the way that you do interviews, the things that you talk about.

So are you saying I overshare? Is that

what no. I think it's a good thing. It's not bad at all.

Oh, man. Well, we have a bunch of stories in front of us, but when we get together, I like to just talk about some things that are on my mind.

You're with CrowdStrike, so I would be remiss if I didn't ask you about cybersecurity? What's going on in the world of cybersecurity right now?

Well, it just turns out that this week we issued our Global Threat report for 2023, and there's a lot of great information in there, and you can go to crowdstrike.com and just put in a couple of pieces of information down.

You're gonna give us a little bit of a teaser here, right?

I mean, I'll give you a couple of quick things which I think are kind of interesting. So we've talked in the past about breakout time, which is the time from the time a bad guy compromises the first machine until they move to the second machine.

And at that point, your odds of, getting ransomware or having data exfiltrated skyrockets. So breakout time last year was like 98 minutes to go from the first machine to the second machine. This year it's gone from 98 minutes to 84 minutes. So again, this pressure to kind of be able to do whatever's you're gonna do, find the bad guy in your system and shut them out inside of 60 minutes, becomes more and more critical.

So, an interesting statistic.

Did you see that Wall Street Journal article where hackers are struggling, the economy? It just cracks me up. The hackers are struggling right now. So they're doing layoffs essentially. What's the title of the article?

Yeah, if you think about adversaries as high-tech businesses who are gonna make a lot of decisions based on roi, they apparently are doing things like laying off call center workers who are like war dialing people, trying to get them to give them information that lets them into their machine or, gets them to give them a password or something like that.

So, yeah, I think the things that aren't working. Discarded pretty quickly and the things that are working get extra resources put against them. So it's interesting to kind of see how it's working.

I have a new carrier for my phone and I'm not gonna share which one cause I don't wanna overshare.

I know how you security people are. But the interesting thing with this one over my last one, They have crowdsourced scam calls, so I could essentially mark a call as this one that just came in, was a scam call, and then through their network. Now, when I receive a call from a likely scammer, it says likely scammer.

Yeah, it's interesting. The idea behind CrowdStrike certainly is the same idea, right? As crowdsourcing. We have sensors across 21,000 customers all over the world, and when we see something bad happen at one customer's site, one thing that turns into an investigation that turns out to be something bad might be happening.

All the other 21,000 customers get community immunity from that. So that crowdsourcing idea is really important to what we do, but I see it in a lot of places now. One customer has a bad experience or like you said, on the phone, gets a bad phone call. Everybody gets

immunity from that because of the way that the carrier's working now, so I see it all the time too. Suspected spam. Suspected spam. Course, I don't answer my phone unless I know your number anyway.

Well, and that is primarily my approach, but it's interesting to me and it's definitely something I wanna recommend for my parents cuz when you get to a certain age, you just want to have a phone call and you just have to know that the people on the other side of that are not always friendly.

Right, I want to talk to you about sometimes we go through the news stories, sometimes we just talk about what I'm hearing in the industry and one of the things I'm hearing in the industry is, Significant cost reductions, right. Layoffs and that kind of stuff. As a leader, have you ever taken an organization through significant cuts or have most of your time spent during the heyday of healthcare?

Most of the time it was pretty good in 2008. I know we had a really significant downturn. Fortunately I was with the healthcare organization at the time that had really kind of recommitted themselves as that unfolded to not have layoffs. And so there was a lot of work around if somebody decided to depart the organization, do we backfill that position or not?

If we were going to reduce sewer services in one area or another, can we repurpose that individual into another job or another role? And give them additional training so that they can actually take on that new role. A lot of that kind of stuff. But I've never been in an organization that has kind of, like outright said, we're gonna lay off 10% of the workforce.

Well, there's two kinds of, I would say reactionary layoffs that happen, one. when you have a macroeconomic trend. 2008 was a macroeconomic trend that hit as a result of the was essentially it was the housing bubble. Yeah. Banking . Crisis, right.

Those things. And right now what we're having is what I think is a national, almost everybody I'm talking to, there's the traveling nurses, the cost of goods, the wage inflation and whatnot. There's a national pressure on health systems that I've never seen in my career throughout healthcare.

Now, the other kind, by the way, is your health system isn't performing, and invariably you can make those cuts and the reason you can make those cuts is you know that the rest of the industry is doing well, and eventually you're gonna come back, right. But when the whole industry's struggling, there's sort of a sense in which you realize, hey, this isn't isolated.

It's not us, it's the industry. What are we gonna do in this time, and the conversation I wanna have with you is, technology is oftentimes looked at as an opportunity to be more efficient. In healthcare, I've seen it over and over again where people present these projects, we're gonna do this project, it's gonna make us this much more efficient.

But the measurement is efficiency and they do the ROI based on efficiency. We're gonna, do these things. But at the end of the day, we never make any cuts. It's not like we cut anybody. So whatever that ROI is never gets realized. Now it gets realized in these people can do additional work or different work or that kinda stuff.

Sure. But we've never actually made those kinds of cuts as a result of those projects, I guess is now different, is now a time where we're actually looking at it saying, can technology actually replace hours?

We talk about tech debt all the time, but there's often in healthcare organizations, debt in a lot of different ways around from the perspective of work that our teams should be doing that they're not doing because there just aren't enough people and there aren't enough hours in the day.

And so when you add technology, often what you're doing is creating space for them to do the work that they should have been doing anyway. But they weren't prior to the technology insertion. Unless you're at the place where you're actually doing all the work and now you're adding new technology and the new technology actually just displaces workers, you're probably not gonna get that same kind of benefit.

The same thing applies, I think when you're doing big projects in a health system. You and I have been CIOs, you're doing big projects in a health system. For clinical or business or research operations, and they tell you as part of the r o I, when you're going through the governance process, that if we implement this technology, we're not going to need to add new people or we're going to be able to reduce our existing workforce.

As you said, often what happens is the technology is implemented, but there's never actually the reduction in workforce, and a lot of that just has to do with us not being great as healthcare executives and going back and looking at those projects and saying, did we actually take all the action that we said we were gonna take as part of the business plan, if we even had a business plan.

My CFO was proactive on that stuff, by the way. If I came in and said, here's the ROI and it's based on the reduction, they essentially made note of that. And then when they presented me by budget for the next year. It had the reductions built in. So for sure you got very careful about what you were presenting as an roi.

Absolutely, and this was a thing, that I saw for clinical business and research leaders, especially when we got discipline in the governance process and they started writing business plans and making these claims kind of thinking, nobody was ever gonna come back and ask him that question.

And then my CFO and my HR team started doing the same thing. That changed their whole attitude about how big, how, grand, their claims were about r o I for technology projects that they wanted to implement.

  📍 📍

  we'll get back to our show in just a minute. Having a child with cancer is one of the most painful and difficult situations a family can face in 2023 to celebrate five.

At this week, health, we're going to give back. We are partnering with Alex's Lemonade Stand all year long. We've got a goal to raise $50,000 from our community, and we are already up over $12,000 and we are asking you to join us. There are two ways that you can do that. One is you can just hit our website.

There's a banner at the top that says Alex's Lemonade Stand. Click on that and you can give directly at that lemonade stent. another way that you could do that is we have been doing drives and we've been doing drives all year long in January and February. Our drive for March is something that the team came up with and I'm really excited about. We are going to vibe.

With the team and we're bringing captain. Captain is my producer's service dog and Captain will be with us for the entire event. You're gonna see us around the event doing interviews, the drive is get your picture taken with Captain you and a bunch of your friends with Captain. Get the picture taken, go ahead and post it on social media and Twitter linked.

And tag us at this week. Health. When you do that, we're gonna count the number of people who are facing the camera in the picture, and for each person in the picture with Captain facing the camera, we're going to give $1 to Alex's lemonade stand. So with your help, we hope to raise a bunch of money for childhood cancer at the VI event, we hope that you'll be a part.

It's gonna be exciting. We have some partners that are a part of this with us and we really appreciate them stepping up to help us fund this. We hope to raise a ton of money. Shore Test is a phenomenal partner. Order is another one. And Artis site, great companies, great products. Check them out and we hope that you'll participate with us and we look forward to seeing you at the Vibe event. Now, back to the show.

  📍 All right, so how are we gonna keep up morale? So you and I have just been hired back in as CIOs. How are we gonna keep up morale of the team if we're gonna actually do cuts?

Yeah. Ultimately boils down to being really clear about the things that you're gonna do and the things that you're not gonna do. This idea of doing more with less has a missing component of that calculation, which is like, and we're gonna take out wasted processes or wasted work.

But that's the, isn't

that the job of the leader though? Doing more with. rarely works. Right? So it really has to be doing less with less.

Yeah. Doing less with less or more with more. Or figuring out how to take out waste so that you can actually do more with less. But you've gotta be really clear and really transparent about that work.

And if you're not this is where you get into the cycle of people are just working themselves into. Oblivion, they get burned out and they decide to leave and they take a lot of things with them because in that whole process, they didn't document well what it is that they were doing.

Sometimes you find out that person had sort of unintentionally set landmines that you're gonna step on later, whether it's in operations or security, or whatever the case may be. So, I think you have to be really clear and really transparent all the way up and down the line, not just with the staff, but with your executive team, your, your partners in the executive cabinet and the board too.

That this is what you can do and this is what you can't do given the resources that you have, and here's the risk that comes with some of those decisions.

Yeah. It's also a great opportunity. I mean, one of the things that people want to know is that they are part of the solution, that they're a co-creator.

The future that's being created. I remember actually we did this every year. Goodyear bad year, it didn't matter. I went to my team and I said at the beginning of the budget cycle, we've gotta cut a million or 2 million out of this budget. They got used to it, but you know, when I first, they're like, didn't you get this budget approved?

Yeah, I got this budget approved, but we still need to find a million to 2 million in savings. Maybe even three or four, depending on the size. And they would look at me like, what are we doing this for? I'm like, because our storage array's gonna fail our core router's gonna die and we're gonna need new ones.

Something's gonna happen this year. And invariably given the scale that we're at, it's gonna cost us a million, 2 million, 3 million dollars. So we've gotta find that in the budget so that we can do those things and we gamified it and it became a really fun project that happened within our IT organization.

Everybody went out looking for savings. We were a lean shop, so it wasn't a new cultural thing for them, and they essentially went out and I remember. One of the guys came back to me and is like, Hey, we could reconfigure these PDUs, power distribution units. These are fairly dumb devices in your data center.

He goes, we could reconfigure these PDUs and I think we could save probably 600,000 in the first year. I'm like, fantastic. And that's that inefficiency that you're talking about. We. Likely have inefficiency in the environment.

Yeah. In Toyota production Speak. Kaizen, the continuous performance improvement, right?

If you ultimately culturally build this into your team, it doesn't become a every quarter or twice a year when you kind of have to show up in a meeting and say, we gotta find a million dollars. This becomes a thing where the team sort of logically is working on this all the time, and when they see opportunities, Like, why do we have four of these?

Maybe we only need one of them. There's a couple of people we have to negotiate with over on the clinical side to not have four of these apps that do the same thing and only one of them app rationalization. Or it can be a lot of things like, the way that we have arranged our internal data center air conditioning units, backup power.

I mean, there's so many things that these folks are actually smart about and they see how this stuff is built and they know there's a better way. Sometimes they need a little bit of money to save a lot of money. And that's the other thing you've gotta, make it okay for them to ask. Right. Because it may be that you can't do it now, but it's a thing you can put in as a project that has obviously really good roi.

Gimme a hundred thousand dollars, I'll give you $600,000 back. That's a pretty good deal.

Yeah. When I think about those projects, the I think people need information as well, right? So they need to understand the cost of some things and whatnot.

This is the third time I'm saying this week. So people are gonna hear it for the third time potentially. But when we started our Apparat project, our number of applications went up by like a hundred after the first three months of the project.

And I'm like I thought we were rationalizing applications like we found them. Like they're everywhere. Yeah. And so our number of applications actually went up, but as a matter of course, they don't necessarily know how much that's costing for those applications to be running or to keep running.

And a lot of times they don't think in those terms. So how do we get them visibility into the inefficient? I think we inherently understand inefficiency of four applications doing the same things across six hospitals. But we know it's a problem, but we don't know the scope or scale of that problem.

How do we. , get the team involved at that level where they understand the measured impact that it can have.

Yeah. A lot of it ultimately boils down to storytelling, right? So for us in the monthly all hands, there was always time set aside for. Cost saving storytelling, right?

And so our kaizen, our, it was Kaizen time, right? Absolutely love it. Performance improvement time. And folks who had led one of these projects and saved money and simplified, better organized, took out waste, whatever the case may be. And all of this leads to also simpler is easier to operate.

Simpler is easier to secure. Knowing what you have means that you're more likely to be able to secure it and run it well. And so all of these things had other benefits besides just the cost saving benefits, but sometimes it was just removing crazy makers taking something that took 25 steps and, turned it into 10 steps or that turned it into 24 steps.

Like whatever tiny additional benefit you could get. Having folks tell those stories and how they found it and how they thought about going through the improvement process and all of that helps everybody else start to think about, oh, I've got something like that. Maybe I can do this project and stand up front and tell everybody the great work that we're doing too.

So it's a culture change, but a lot of it's driven through storytelling, I think.

  📍 📍   📍 We'll get back to our show in just a minute. We have a great webinar coming up for you in April. We just finished our March. On April 6th at 1:00 PM Easter time, the first Thursday of every month, we're gonna have our leadership series. This one is on CSO priorities for 2023. Chief Information Security Officers, we have a great panel.

We have Eric Decker within our mountain, Shauna Hofer with St. Luke's Health System out of Boise, Idaho, and Vic Aurora with Hospital four Special Surgery. And we are gonna delve into what are the priorities for security? What are we seeing? What are the new threat? What is top of mind for this group? If you wanna be a part of these webinars and we would love to have you be a part of them, go ahead and sign up.

You can go to our website this week, health.com, top right hand corner, you'll see our webinar. And when you get to that page, go ahead and fill out your information. Don't forget to put a question in there. one of the things that we do, I think that is pretty distinct is we. like for today's webinar, we had 50 some odd questions that we utilized, in order to make sure that the conversation is the conversation that you want us to have with these executives.

So really appreciate you guys being a part of it and look forward to seeing you on that webinar. Now, back to the show. 📍

  📍 📍

All right. We're actually recording this pretty early, it's March 9th, I think this is gonna air on March 21. So people are be like, why aren't you talking about ViVE? So we might as well talk about ViVE. It's conference season.

So we have Vive and HIMSS within a month of each other. At least they spaced them out a little bit this year. That's extremely helpful. They're a week in the gap. Maybe.

I think there's a week in the gap.

Oh, there's at least a week.

There's almost three weeks. Okay. Yeah. Three weeks two full weeks.

For sure.

Okay. That's what I'm thinking. Okay. Full weeks. Yeah. Will you be at both or just one? I'll be at both. We'll be at ViVE in Nashville. I'm looking forward to it. I think, a lot of friends are coming. I think the first year's conference was successful enough, right. For many people to come back. I think the interesting part too is I see a lot of organizations who are really taking advantage of the hosted buyer version of this is how you actually get the pass to the conference. Yeah. Which saves them a lot of money and is probably good all the way around because they get to learn about things that they otherwise wouldn't know about.

And the vendor partners get a chance to talk to organizations that might be cold accounts for them.

Most valuable thing that Vive put together was the hosted buyer.

Yeah, it's interesting that It's not a new concept. I think maybe the way they've done it, there is a little bit of a new idea.

The idea of inviting folks to a conference and then kind of locking the doors and saying for, two of your days you have to meet with vendors isn't really new. But I think the ViVE guys have kind of gone through a process of like, executive attendees get to say, They wanna talk to these companies and companies get to say, we want to talk to these executives and there's a matchmaking service.

So, ultimately no one feels like they're wasting their time and hopefully that turns out really to be the case for this, but I'm looking forward to it. Besides that, all the great presentations, I think there's gonna be some really interesting insights, there's always good press release, reveal new stuff that's happening and all of that.

So it'll be fun.

I'm gonna get on the main stage for the first time. Oh, you are? I am on that Monday the opening kickoff. I'm interviewing two executives from AWS and I'll be on that main stage, so I will be completely terrified. If you're wondering. People are like, well, you speak for a living.

I'm in my office. It's me and you, Drex. It's a conversation. So my approach going into it is gonna be to trick my mind into thinking this is just another interview.

Yeah. Here's the thing. For everybody that's listening, when Bill is on stage, if you have his cell phone number, make sure you blow up his cell phone cuz there's nothing more aggravating when you're on the main stage than to have your phone just start going off.

Just going off. So let's make sure, let's crowdsource to that.

Yeah, that would be fun. So, I'm noticing that it seems like for the first time that we're seeing a differentiation in the attendees. So, I think there will be some overlap, but I'm looking at the health system attendees and whatnot.

The CIOs seem to be going to the ViVE event not exclusively. I mean, there's a couple CIOs going to the other event but then I'm seeing CSOs. I'm seeing CMIOs. And some other, especially the clinical side, still going to HIMSS.

I see some of the innovation folks going to ViVE too, which makes more sense because of the early stage company presence.

Speaking of that and one of the earlier topics we were talking about, I'm hearing more and more health systems that are either pulling in their horns or slowing down their investment strategies and their innovation, development company kind of work. Are you hearing the same thing?

I am hearing the same thing, yes. They're slowing it down or they are making it very focused and they're putting it through the same kind of lens that they're putting their projects through, which is like

a lot more rigor, a lot more discipline. Yeah. Maybe that's how I should say it, right?

It was sort of a little loosey goosey, and I feel like they've really tightened up on it now.

Yeah. And that'll be interesting, but that's indicative of what's going on in the market, right? So if we, sure. I've interviewed some VC and private equity people at the health conference and they were essentially saying to me.

Yeah, this happens every now and then. Our criteria shifts now, we're looking for essentially profitability, revenue solid fundamentals. Whereas prior to that, they were looking for growth, and they might get back to that again, but solid fundamentals is what they're looking for right now.

It's interesting to think with digital health too. Early on, and that's not that many years ago really, but kind of early on in the cycle, a lot of the decisions about what to invest in and what kind of companies to create and grow were largely focused on anecdotes and kind of emotion. And now there's some data for what's effective or what's not really effective, what's really making an impact on clinical outcomes or business outcomes.

Once you get data, it turns out maybe your emotional decisions or your anecdotal decisions turned out to be an outlier. So the data is definitely also impacting who's investing in what and what organizations are buying. are, There are more facts there now than there ever has been.

Well, I'm looking forward to seeing you at the ViVE Conference and the HIMSS conference. The fact that they've broken off actually creates two manageable conferences as opposed to one very unmanageable conference where we could go and never see each other.

I'm interested to see how big.

HIMSS will be this year. As far as number of attendees, I was shocked how big it was last year. Yeah, I was too. Chicago's an interesting place for it. Of course. It's a little bit of a different city from the perspective of the conference center is down there on that end of town and all the hotels are up on this end of town, and so there's not a great walk to the conference center and then walk back to the hotel.

Kind of arrangement as there is in Orlando or Vegas. So, it'll be interesting to see how it all works in Chicago this year.

Yeah, looking forward to it. Drex, as always, great to catch up with you. Appreciate your time.

Same here. Thank you. See you soon.

  📍 And that is the news. If I were a CIO today, I think what I would do is I'd have every team member listening to a show just like this one, and trying to have conversations with them after the show about what they've learned.

and what we can apply to our health system. If you wanna support this week Health, one of the ways you can do that is you can recommend our channels to a peer or to one of your staff members. We have two channels this week, health Newsroom, and this week Health Conference. You can check them out anywhere you listen to podcasts, which is a lot of places apple, Google, , overcast, Spotify, you name it, you could find it there. You could also find us on. And of course you could go to our website this week, health.com, and we want to thank our new state partners again, a lot of 'em, and we appreciate their participation in this show.

Cedar Sinai Accelerator Clear Sense CrowdStrike, digital Scientists, optimum Pure Storage. Sure. Test Tao, site Lumion and VMware who have 📍 invested in our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.