This Week Health
Patty Hayward

June 13, 2022: Patty Hayward, Vice President, Strategy Healthcare and Life Sciences at Talkdesk joins Bill for the news. A gunman killed two doctors and two others at an Oklahoma medical building after blaming one of the physicians for causing him pain from a recent back surgery. How can we better prepare our hospitals for these unthinkable tragedies? Could solutions lie within more technological advances within the front doors of a hospital? What are the 3 main challenges with cloud adoption and how can we fix them? Hartford HealthCare's Vice President and CFO says some of the old care models are obsolete. And Cedars Sinai's real-time ER feedback platform uses quick text message surveys to help improve patient satisfaction.

Key Points:

  • While the cloud offers organizations greater speed and agility, rolling out its implementation can be difficult
  • Technology is like the three legs of the stool. You have the technologies. You have culture and you have process. 
  • Talkdesk

Stories:

Transcript

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.

It's funny to see the super overheated economy now towards, well, we're starting to trend towards some recessions. And so there's a lot of rethinking of how organizations are purchasing. How they're going to the cloud. How they're instituting different technologies. People are still looking for ways to automate. How do we overcome all of these different, almost head snapping changes that have occurred in the last year.

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

All right. It's news day. And today we are here with Patty Hayward with Talkdesk Patty. It's always great to catch up with you

Always great to catch up with you too, bill. Thanks for having me.

we are recording pretty early in the morning. Here you are on the east coast. You're. You're in Miami. I'm in I'm in Florida as well. Where are you headquartered out of? Where do you usually,

Normally I am in Scottsdale, Arizona. So this is a little early for.

Wow. Yeah, this would be like five o'clock in the morning for you. So we'll, we'll, we'll give you a little grace on, on a Sunday.

Actually. We're not going to give you grace on the topics we're going to, we're going to go after some some challenging topics today, but. We have we're gonna talk safety in hospitals is going to be one of our topics. That will be a tough one to talk about. We're going to talk about the main challenges in cloud adoption.

We'll talk somewhat about some old care models and then Cedars has done some interesting stuff on creating these feedback loops. And I want to talk to you about it cause that's one of the, one of your areas of expertise. So we are going to dive in with with a hard story to start with.

So Tulsa, Oklahoma hospital shooting gunman who killed four, had been a patient of a victim. Police. Chief says this we're pulling this from. All right. So let me give you some of the experts come in who killed two doctors and two others at the Oklahoma medical building Wednesday did. So after he blamed one of the physicians for causing him pain from a recent back surgery.

A police chief said on Thursday that shooter Michael Lewis, who please said killed himself after the rampage and Tulsa had just earlier that afternoon, legally purchased one of the firearms used in the slaughter and AR 15 style rifles, city police, chief Wendell Franklin said during a news conference, Louis entered the physician's office building at Tulsa St. Francis hospital campus late Wednesday afternoon. And I'm giving some of these details. Lend itself to the conversation. Lewis entered the physician office building at Tulsa St. Francis hospital campus late Wednesday afternoon and shut that his surgeon, Dr. Preston Phillips and three other people before fatally shooting himself said Franklin.

The other three victims were at the Natalie medical building. And they were Dr. Stephanie. Huson, H U S E N, receptionist, Amanda Glenn and patient William Love authority said officers found a letter on Lewis that made it clear that he came in with the intent to kill Dr. Phillips and anyone who got in his way.

Franklin said he blamed Dr. Phillips for the ongoing pain following surgery. Franklin said later calling the letter's contents at clear motive. The others Franklin said just in the way, and Louis got them. And unspecified number of other people were injured in the shooting, which happened in orthopedic offices of the Warren clinic on the building second floor officials said at the Thursday news conference.

All right. So this is a dangerous topic. We, we talk about the intersection of technology and. But it's also a topic we have to talk about. And the topic is safety and the safety of our medical practitioners in, in practicing medicine where they live. And the reason it's a dangerous topic is we're almost guaranteed to offend someone by something we say.

Take this in the, in the spirit that it's meant, which is we, we need to have dialogue about these things. And and we are going to try to keep the politics out of it as much as possible. Because I think simple solutions when somebody says, oh, just get rid of all guns. I have simple solutions, rarely or if somebody says, well, we just need to address mental health and, or, oh, we need to make these buildings more safe.

I mean, it's like, it's. It. Yes. Is the answer, but it's more complex. and so we're not going to go far enough in talking about guns as someone would like, we're not going to go far enough to talk about the issues that nurses are facing at the bedside with just increasing violence in general.

That is, that is happening. But we're going to talk about it from a safety standpoint. And as I said, violence is rising both verbal and fiscal against our care providers. The shooting is tragic. It represents an escalating problem in our country. The area we're going to focus in on.

We're not going to focus it on guns. we'll we'll focus in on what are our plans to protect the the staff. And I know it's interesting. This happened in a medical office building because we had procedures in the hospital for active shooter for all sorts of things, but we definitely had active shooter and we have protocols and they were practiced at every hospital.

this incident didn't happen in a hospital and it's a medical office building. I get that. And to be honest, I, I'm not sure that our procedures covered all locations. We practice medicine and I, I'm not sure what it mattered in this case either. Cause it, it only lasted a couple of minutes.

It's not like it was an active shooter kind of thing. It just person intent on feminine and doing something. I, I think clearly coming out of this, most health systems will look at their protocols and hopefully do that with professionals. It's almost like cybersecurity. We think we know all the different ways they're going to come in and then they get creative and, and other things pop up.

And in these kinds of things we think, well, it's only going to be a gun. Well, what if it isn't a gun? What if it's something else? What if it's a bomb? What if it's a whatever and those professionals. They S they stretch our thinking and our it's just their profession. Right. So they're constantly thinking about worst case scenario.

Somebody walks into a an ed and they're and they're intent on killing people. What are those scenarios we need to plan for? And and how do we get in front of that? But it's hard once a person has decided that death is a viable outcome for them. It's really hard to protect against that.

There's a lot of different ways they go. So that's that's why you involve the professionals. But to be honest with you in, in this case, I'm not sure even the in our health system was very vigilant in this specific area around guns. The danger at the bedside for nurses and that kind of stuff at minute.

I'm not sure how you. How do you think of all the scenarios and protect against all the scenarios?

I agree. I mean, I think you made a very good point of engaging outside professionals, whose job it is to think about these sorts of things. But I think it's also very difficult when you have a person intent on harm and intent on not leaving the situation alive as well.

Yeah. So, I mean, we at this point we have cameras everywhere in that. Yeah, right. So and I think this is a case for even more cameras in the hospital. now it's, it's hard to find them by cameras right now. The supply chain is just another issue is another issue. But if you came to me as the CIO and said, okay, what can we do with regard to this?

And, and my first thing would be, we need, we need eyes everywhere. And not only do we need eyes everywhere, we need eyes everywhere with artificial intelligence. Great. So I've interviewed the guys at Artisight. I had a couple of times, and they're able to put cameras in the clinical rooms and look at things and say, oh, that's a, that's a fault waiting to happen.

Or they, they need to wash their hands. Or they're able to identify all those things. My guess is if somebody walks in with an AR 15, they can train the artificial intelligence to identify that quicker. Than anything else and notify people because the notification, I mean, obviously this happened at minutes, but the notification is really critical to keep that person the right place in the hospital or not give them access to certain places and that kind of stuff.

so from a technology perspective, CIO, I'd say, all right, let's get, let's get cameras that are, that's connected to artificial intelligence. That's looking for those things and then let's get it in the hands of the people that can actually respond to do something. Very rapidly. I mean like automatic, that'd be automatic alerts to people.

We, we did this, way, way back, even before I started as CIO, there was an incident where a baby actually left the hospital. But now with the parents, right? So that's like the. Maybe it was retrieved and that kind of stuff. But after that, no one thought twice about putting cameras in there and all sorts of safety protocols and those kinds of things.

I think this is that, that wake up call that we, we need, we need early warning detection systems and that kind of stuff. And and that's, I mean, that's immediately where my mind goes as a technical.

Yeah, I think that's probably, when you think about all of the different ideas out there, that's seems almost like a no brainer. If you have technology that can instantly activate a alarm and notification of authorities that can come in and have.

Yeah. The harder one for me is we're hearing increased incidents at the bedside for nurses, especially experiencing violence. Again, simple, simple solutions that don't solve this issue. You have a politically polarized country. You have a culturally divisive country and you have people attributing certain activities to an ideology. When in fact the nurses just Hey, we'd like to give you a COVID. Oh, you're not it just goes, it's like it's gotten so politicized. It's like, I'm just trying to care for you.

Right. Intent is so important and people aren't taking those things into account or they are, but they're doing it in a different twisted way.

And, and again, we have, we had protocols here, but a lot of times. The response isn't fast enough. I mean, it's typically if you're providing care there, there's no barrier between you and the patient.

There almost can't be a barrier between you and the patient. So as it escalates verbally, and those kinds of things, we train the nurses to walk away from those situations, make sure they're safe at all times and those kinds of things. And I like having this conversation because I want to remind people that if, if your health system doesn't have those conversations, have those protocols have that training potentially have the cameras in the room to identify when a, a nurse or even a doctor is is that. I believe a lot of this is on the health system to provide a safe environment for which to practice medicine.

I, I don't want to lay it all there. I mean, there's training there's responsibility. There's there will be a mental health aspect of this. There will be a. Control aspect of this as well. But I'm trying to, again, we're, we're just sort of having the conversation to say, hopefully this sparks ideas for the people who are in the health systems and they go, Hey bill, that's half an idea, but you know, I think our team can get together and complete that.

Yeah,

???? ???? All right. We'll get back to our show in just a minute. I want to tell you about the podcasts that I am the most excited about right now that I am listening to, as often as I possibly can under that is the town hall show that we launched on the community channel this week health community, and an Arizona Tuesdays and Thursdays. What I've done is I have essentially recruited these great. Hosts who are coming in and they're tapping people in their networks and having conversations with them about the things that are frontline kind of stuff. So it's, it's technical, deep dives, it's hot button issues. It's tactical challenges. it's all the stuff that is happening right there. Where you live on a daily basis. We have some braid hosts on this show. We have Charles Boise. Who's a, data scientist, Craig Richard, bill Lee, Milligan Reed, Stephan, who are all CEOs. We have Jake Lancaster Brett Oliver, who are CMIOs. We have mark Weisman who is a former CMIO and host of the CML podcast. And now a CIO. At title health and we also have the incomparable sushi shade who is fantastic. And I'm really excited about the fact that she's tapping into her network and having some great conversations as well. I'd love for you to tune into these episodes. I am learning a ton myself. You can subscribe on our community channel this week health community. You can do that on iTunes, on Spotify. On Google on Stitcher, you name it, we're out there and you can subscribe there and start having a listen to yourself. All right, let's get back to our show. ???? ???? let's hit a couple of these stories, the three main challenges with cloud adoption and how to fix them. This is a Becker's article and Becker's is usually. A summary of something else, right? So there there's summarizing a McKinsey article. Let me give you a couple of these things. While the cloud offers organizations greater speed and agility. Rolling out its implementation can be difficult. Here are three issues with cloud adoption.

According to a May 8th, McKinsey are. And the top ways to make the transformation seamless and successful long-term and then you have three bullet points. One issue with cloud adoption is the lack of focus on its business value to overcome this clearly define the business and it value and how it relates specifically to your organization. Do you want to talk about each one of these as we hit them? Or do you want me to hit all three and come back?

Let's let's start with that one. Cause that's a big one. I think I, I see this often where.

Well, let's do this, instead of saying I'm clear, clearly you need to define the business value. I don't know how to get millions of dollars to do something, to finding the ability to mystify. My question is what is the business?

That is a really good question. And I think too often people are not looking at the bigger picture when it comes to the business value. They're looking at the immediate issue that they need to solve, which is great.

And I think you definitely need to do that. You also need to go further to look at a larger plan and how it all comes together. I think especially when you're looking at adoption of. Of cloud technology. You can't just be the, well, we're going to save money from on-prem to cloud, you also need to look at how it integrates into your other systems.

How is everything coming together and how are we looking at governance of all of the different aspects of the new processes and procedures? I think that the, the larger plans tend to be a little bit. Thin when you're first thinking about things. So I think that flushing out all the processes and the procedures along with the business value and how that intersects is going to help really improve what that what that business plan looks like.

So here's the challenge with the business plans that I've looked at. And I had to put these plans together as well. And even some of my older ones I look at and I go, man, I missed that a little bit, but the business value, so. Most people are too simplistic and they say, well, we're going to move to the cloud and save money.

And if it doesn't save money, they don't move to the cloud. And if it does save money, they do move to the cloud. And the reality is you don't realize a business value of savings unless you do. Right. So I will be the first to tell you, you can automate the heck out of a cloud environment because it's programmable, it's literally designed to be automated.

Whereas a lot of your systems that you have in your data center are not, but what is the value of automation? Less people to do things. All right. So you have to take action on that and say, okay, we're going to move these people over here. And these people over here, we now have, instead of a team of 20 people overseeing these servers, we now have a team of five people overseeing these servers.

And by the way, if you think those numbers are silly, it's not silly. I mean, quite frankly, I mean, I could oversee a data center for a hospital. Thousands of servers from this computer myself at this point. I mean, it's getting, it's getting to the point. I remember, I remember when when Cisco first went to all this programmable and automated stuff and I went to one of my major clients was MasterCard at the time.

And all these teams had massive network teams that were doing this stuff. And MasterCard had like three people, three people for a worldwide network. Millions and millions and millions of dollars in value because they had automated the heck out of everything. And and these, these people weren't like sitting at their desk the whole time.

They could go out to lunch with me. They could, I mean, because they had alerts that were coming to them, they could respond to things and stuff. So anyway, but that leads to the second aspect of the business value, which is which is. Right. The ability to respond to the changing environment. And one of the things I was talking about with agility is when the business is growing, we have no problem.

Is it going and saying, Hey, we, we need more more capital. We need more dollars. We need grow the data center and we need more computers. And that kind of stuff we are about to enter. What I think is going to be a contractionary. Where health systems don't have as many pages because we don't have as much discretionary income we're heading into a recession.

And in those we think healthcare is recession proof, but at the end of the day, people stopped doing elective procedures and those kinds of things. So our volumes go down and whatnot, but at the end of the day, it never offers anything. Hey, the business Trank a little bit. Let me give you some of the overhead that we, we needed to run the business at this level back to you.

And if you do the cloud, right, if you do the negotiations, the contracts, right. And the architecture, right. You should be able to flex up and flex back down. And save the organization some money. Now, it doesn't happen on a dime. It doesn't happen like in may, it happens on contract renewal. And if you do it right, there should be an annual true-up, which brings down the cost overall cost of things.

So when we look at business value, if you just look at costs, you're going miss. If you look at agility, you're going to get closer to a, to a bigger picture. And then if you look at overall functionality, you're going to be able to deliver to the organization. You're going to be able to take it to the next level, which is to say, all right, what kind of organization are we trying to be?

Oh, we're trying to become a consumer driven organization and maybe consumers, the wrong word here, but a patient centric, whatever your terminology is as your health system. Okay. Well, the cloud gives you more opportunity to do that. We can plug in more tools. We can do more communication, back and forth.

We can do Twilio alerts, we can do all sorts of things. And if you build the complete case, Then, when you're sitting in front of the board, you might get away with, with a partial case to your boss, and then you go to the leadership team and it gets a little harder. And then you go to the board and it gets a little harder because typically when you're sitting in with the board, it's not just healthcare people.

I mean, I remember we had, we had one technologists. He, he would always grow me on that architecture, but then I had business people who are sitting there going what's the value to the business. They were always asked what's the value to to the delivery of care at St. Joe's. I think we need more comp comprehensive business value conversations around cloud.

So that's point number one. I mean, we, we hit that one pretty hard. Let's go. Let's go to the second one, having a short term, focus on the transition leads to being under plan, to avoid this situation, identify the business processes that need to transform with cloud adoption that could. To gain from the transition.

One of the biggest mistakes. I always tell people I made in our cloud transition. I assumed it would be behind me and the rest of the, I would have to convince the rest of the organization. It was the exact opposite. It revolted. They were disliked. No, we're not going to the cloud, the clouds evil. It's not secured.

It's too much latency and all this other stuff. And so we made so many mistakes there. We didn't put the the career paths in place. To move them from on-prem you have to move their career paths from on-prem to cloud. What does my life look like? That kind of stuff. So that's one of the things that we missed. What, what are those things you think are missed in the transition?

And I think that technology, when you think of the legs of the stool, right? I talk about the three legs of the stool. You have technologies. And you have culture and then you have process. And so you hit the culture piece there.

When you talked about you've got to educate people on what it means to them personally, because we're all sort of inherently selfish creatures of what is this going to do for me and my position. And so thinking about how their role is going to change and then looking at what the different processes that you are going to need to change, that will be impacted in order to get that return.

Because if you just try to. Up things and do things the way you've always done them. You're not going to succeed. So being able to go from, let's say your call center product is on-prem and you have to have be at a physical phone, being able to then go and allow people to work from home. To be able to flex, like you talked about that agility is huge when you have, when you are in the cloud, you have this ability to flex up and to flex down which is both are very important.

Especially some people are really seasonal. You go to a real seasonal town. We sit here in Florida. There's oftentimes in the winter, you have a much heavier load than when you have the summer. And folks go back to their houses that are in the north part of the country. So you need to be able to flex up and flex down.

And in order to be able to do that, you need to look at your procedures and your processes that you're putting together in order to accomplish that, as well as your. Your work staff. Do you have folks that are seasonal or do you have folks that are more, more permanent fixtures in your organization?

I think thinking about all of those different things, as well as flows of how calls come in and where they're routed and all of those different aspects, that's just one example of something you could do differently if you're cloud-based versus if you're on.

Yep. And, and their last point is avoid having a business as usual approach to the cloud ones transformed instead to find the underlying services required, to ensure that the workloads can be hosted as efficiently and effectively as possible.

And yeah, I'm just going to say yes to that so that we can at least at least hit one more story. Because we were, we're doing a three stories here today. Usually we do a few more of that, but I want to hit the Cedars one with you. So Cedars-Sinai real-time ER, feedback performs a platform helps improve patient satisfied.

And this is interesting. So this is a healthcare it news articles. So you have the problem that proposal, whatever. So the problem is the staff wanted their patients to feel supported and heard. So instead of relying solely on post-discharge post transfer insights, they committed to collecting real-time feedback to better understand patient needs and quickly implement change to improve the patient expects.

So you usually have the caps. But that only paints a picture after the fact. And they're like, Hey, we want something ahead of time. So the proposal, knowing how busy the ed can be. We didn't want to have time. We didn't have time to integrate a complex platform that conflicted with our existing workflow.

He continued fortunately working with our vendor feed trail, our customer success managers, streamlined onboarding, and made recommendations. So new processes didn't interrupt our staff or patients. Implemented by monthly rotating initiatives to dig into specific aspects of the ed patient experience, such as care, communication, cleanliness, and weight experience to ensure they can see the patient expectations and receive the care they need.

They needed the project designed to include members from that. So they had a group, they brought together, the surveys have allowed us to create direct dialogue with the patients and their experiences. All right. So instead of waiting for the H cap scores and the caps feedback and that kind of stuff, they're saying, Hey, we want to know what's going on real time, because then we can do something about it.

Say creating some sort of a survey mechanism that's that's done in the flow. Of the in the ed workflow that exists. This is the area of where, where I love talking to you feedback from the consumer is, is, is so, so critical. I don't want to talk about that. We all know it's critical. The question is, how do we get it?

What are some ways we get that feedback into the workflow that we can respond.

I love the fact that they're they're, they're thinking of a modern platform. We all have cell phones. We, we all answer our text messages, especially if something comes out and, and you're sitting in a, in the ER.

Probably bored waiting or in pain or something waiting for for, to be seen, to have conversations with clinicians, to be able to provide that real-time feedback and to have a mechanism to to, to take that feedback and do adjustments that you can do or deliver then education to them or. The reason why you're waiting so long or, Hey, here's some educational material to consume while you're waiting.

Those sorts of things are pretty satisfying. They would be to me as a consumer to understand, because I think so much of what's happening. With with the cues that you see in the ER, are based on things that are happening in the moment, right? There's, they're, they're very busy because maybe they had a trauma come in and that consumed a large portion of the staff.

Well, if, if you don't have something that is life-threatening, you're going to be a little more understanding when you have something like that happening. So being able to. Give information out in real time. I always think about it like at the airport. It's always awful when you have things that are delayed, but you want more information.

You want more feedback? You want to understand why you want to understand? Okay. Well, what's the next option for me, those sorts of things, to be able to provide something like that in real time. That's pretty cool. I love the fact that Cedars is trying new things and they're looking at ways to have real time feedback and to incorporate that information. And they're being very purposeful in what they're attacking, which I think is also really.

Yeah. So as you said, I mean, the mechanism mayors is text message and to the things they share here, which I think are really key is they share short, relevant surveys at the key point during the visit short and relevant.

And I had to create surveys when I was a CIO and. Yeah, everybody thinks they can create a survey. So I brought in, I brought in a professional cause this, well, this is when I first started. I want to get as much feedback from the physicians as possible. So I brought them in, in a professional actually a college professor who.

Really understood how to do surveys, taught, taught classes on it and that kind of stuff. And I learned a ton about doing surveys. I mean, short short is nice. There are times where it's appropriate for open-ended questions, there's times where it's not appropriate for. And and there's a whole science behind this.

If you want to get feedback, isn't just a simple. Hey, short, short surveys is the best survey. But there, there is a way of, I tell you, we, we parsed the words in the question over and over again, before we sent that survey out, it was like, well, if you ask it this way, you're going to get this kind of response.

Is that the kind of responsibility I'm like, no, no, I want this kind of response. Like, well then you have to change these words to say this. Wow. So you can see how surveys can really steer the response. You really have to think through the wording where it's delivered, how it's delivered. There's a whole aspect of that.

And I don't want to keep saying we should bring in professionals, but I don't know. Maybe I'll find somebody and interview them on putting together. Good, good surveys.

Turbines are really, really hard. We've done a lot of them in our work here in, our research. And I always think I'm asking one question. I speak to the professionals because we do work with professionals on those. and I always ended up changing the question that I'm asking based on their advice.

It's amazing. So last couple of minutes here. What's what's top of mind, what's going on? What's going on in your world?

Oh gosh. I think that the world is, is, is changing a lot right now. And I think if you are. Standing still, you're going to get past, I think the economy has really shifted dramatically right now. I think in the last. 90 days we've seen some big shifts. So I, I know everybody's thinking differently. We were, everybody was very worried before about hiring and hiring and hiring.

And I think everybody's starting to sit back a little bit too. So it's, it's funny to see sort of the super overheated economy now towards, well, we're starting to trend towards some recessions. And so there's a lot of rethinking of how. Organizations are purchasing how they're going to the cloud, how they're instituting different technologies.

I think people are still looking for ways to automate And I think that's really important. So then working with a lot of organizations on how do we overcome all of these different, almost head snapping changes that have occurred in the last year, because as well as I do in healthcare, it, we don't see.

Processes or, or buying cycles and then finish them in a couple of months, they happen over a period of 12 to 18 months. And so to have these kinds of big shifts has been, has been quite challenging, I think for a lot of organizations in, in their planning.

Yeah. It's interesting. Over the last week or so I've heard of a fair number of organizations that are not slowing down hiring, but actually doing some reductions. And I was like, wow, that's the first time I've heard that. And then the other thing is I'm talking to my team. So I'm an economist. By training. Right? So I have my economics degree and I read a lot of books on economics and that kind of stuff.

And I'm looking at this, I'm going like we're already in a recession. We'll wait until the numbers actually say we're in a recession, but we're already in a recession. And there's, there's so many factors that are going into it. But at the end of the day this is where we're heading. We have supply chain issues.

I talked, I talked to a health system that had a 22 month wait time. To get switches and routers because of the chip shortage and supply chain issues. And I'm like, yeah, I'm just looking at all these things going, okay. We're, we're heading into a, recessionary period and I just showed my team, our planning for next year.

And they're like, You're planning for growth. And because now the news is starting to catch up with, Hey, this is going to be a bad economy and that kind of stuff. It's like, we shouldn't plan for growth. We should hunker down and do the same thing. But retraction that a lot of times is an opportunity and the opportunity, the opportunity is all these ha baked ideas and half-baked solutions and these solutions that aren't well integrated and that kind of stuff, their, their messages fall down and you'll see them go away. They won't have revenue, they, whatever. And so you have this, this natural when, when the economy retracts, you see a whole bunch of stuff go away and the noise goes.

A lot of that noise will go away and then it becomes more obvious what the, where the value is. And I'm like if we believe in our product, we believe in our solution, we believe in what we're doing. I don't think it's inappropriate to plan for growth going into next year. But recognizing it's a different world than it was just six months.

Exactly. and you better be more spot on, like you just said with what your value propositions are and what your returns are going to be and how you're going to get to those returns. So I think that that is all extremely relevant because there is still is need for a lot of solutions. We still need to continue to move forward with a lot of digitizing of the the health system, et cetera.

But I think. Word purposeful keeps coming to mind and making sure that all of the different projects that you're working on, they're actually helping to shore up the business to deal with all of the things that are coming down the path, as far as I think we're still going to be dealing with a lack of talent.

I still think we're going to be dealing with consumerism, pushing and, and changing the way that we do business. All of those things are still happening because there still are a lot of competitors that are in the market and everybody's going to be fighting that much harder for the dollar.

Amen. Good, good place to end. Patty is always great to catch up with you. I'm sorry. You're in Florida. We're not going to see each other. We're only two hours, but two hours is two hours. But thanks. Thanks again for your time this morning. Really appreciate it.

All right, bill. Thanks very much.

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