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Sue Schade joins us to do a role play of merging Healthcare CIOs and some of the things each are looking to accomplish based on their perspective. Also, we look at the growing demands of the healthcare consumer.

Transcript

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 Welcome to this Week in Health It where we discuss news, information, and emerging thought with leaders from cross healthcare industry. This is episode number 28. Today we discuss the CIO's role when m in your future. Uh, The consumer, the consumers are demanding more from healthcare. Today we look at, uh, where those specific areas are and what a C I O might do about it.

Uh, this podcast is brought to you by health lyrics. Are your strategies constrained by infrastructure or are you tied a knot of applications? We've been in your shoes. We've been moving health systems to the cloud since 2010. Find out how to leverage cloud to new levels of efficiency and productivity.

Visit health lyrics.com to schedule your free consultation. My name is Bill Russell. We're covering healthcare, c I o, writer advisor with the previously mentioned health lyrics. Before I get to our guest and update on our listener drive, we've exceeded 200 combined new subscribers. Between our YouTube and podcast outlets, which means we raised $2,000 for Hope Builders, which provides disadvantaged youth life skills and job training needed to achieve enduring personal and professional success.

I've hired their graduates. Their stories are really amazing. Uh, we have five more weeks where our sponsor will give $1,000 for every additional 100 subscribers. Join us by subscribing today and be a part of giving someone a. Uh, today's guest is, is, uh, not new to the show. Second, second time guest.

Today's guest is former Chime, c i o of the year, and now serves as a principal at, uh, Starbridge, advisors of Veteran C i o, Brigham and Women's University of Michigan Health System. Uh, interim at University Health, our university hospitals in Cleveland, Stony Brook in New York. And, uh, as I said, principal at Starbridge Advisors, the wonderful shade joins us.

Good morning, Sue, and uh, welcome back to the show. Thanks, Phil. Look forward to our conversation today. Yeah, I'm looking forward to it as well. I, uh, we were just actually before coming on the air, we were lamenting the fact that we don't have our huge teams of IT staff to run in and help us. We're, we're gonna, we're gonna struggle through some audio challenges today because we, we don't have those wonderful people, uh, around 'cause we're both actually working out of our homes today.

Um, so we might hear a dog bark in your background. We might see painters, uh, and our, our, the office right now is getting painted behind me, so if somebody walks by, just, just let me know. Um, so, um, so the last time you were on the show, February 2nd was, uh, was a long time ago. You were one of the early pioneers on the show.

Um, do you remember, do you remember what we talked about back then? It. That's a trick question. I do not . Whatever, whatever was current that day, that exactly. I don't remember. Yeah. Well that, that's why we call it this week in health. It, so it's, uh, man, I'll tell you, and the, the show has changed a little bit since the last time you were on, so, we'll, we'll get to that in a minute.

But one of the things that hasn't changed is we like to ask our guests, you know, what, what's something they're excited about or, or what they're working on today. So, uh, so what's, what's going on in your, uh, in your world right now? Uh, I'll mention a couple things. One thing I'm looking forward to is, um, a conference I'm gonna in DC next week, which is Health Impact East, and it's a kind of smaller size conference that's gonna have several focus areas.

I'm gonna participate on a panel around patient centered innovation and, uh, probably participate in a few other. Uh, meeting some new people and having some interesting conversations. Another thing I'm working on right now, I'm kind of excited about, uh, in fact had a call this morning with two colleagues is, uh, trying to figure out some offerings in the coaching space targeted specifically to women leaders at different points in their career.

So I'll just.

That potential. Uh, and I am coaching, uh, two new people as of recently, one in the, uh, career planning kind of mode, and another one who is a new C I O in their organization. And, um, dealing with all those kinds of things that you deal with when you are very experienced, but you come into an organization and a new and a, so couple things I'm.

That's fun. The coaching thing is, is interesting to me 'cause I've now, uh, been pulled into, uh, a couple contracts on that and I'm actually coaching a C E O. Uh, on technology decisions and directions, and it's, it's really fun. I mean, uh, it's, it is really challenging. I mean, you, you really have to come up to speed pretty quickly on, on the dynamics of the organization, right?

But, uh, just the nature of the number of people we talk to, the number of organizations, the amount of experience we have, um, we end up. Being able to have some, uh, very good conversations with people in executive positions. Guide them, coach them, uh, give them direction. What would you say is the distinction between coaching and consulting?

Oh, . Well, coaching is a one-on-one kind of relationship with someone and really looking at what their strengths and weaknesses are, what, what, uh, gaps they might have as a leader and how you help them to, um, grow and develop. Whereas consulting, you know, Consulting can be anything from a project to an assessment to, you know, and it can be a team of people, it can be with one, you know, I I, if it's with one leader, it's probably advisory services.

But yeah. Interesting question. And one, one of the things I, I've studied to people is, you know, the, the coach of a basketball team never gets on the floor, so, If you're asking, if you're asking me to do work and to get on the floor and to mix it up with your team and to do those kind of things, I mean, some of those things you can do like in timeouts and whatnot, but you, you're never taking any shots and you're never doing that kind of stuff.

That's consulting, that's advising. But coaching is more along the lines of, you know, hey, what are the, what are the three to five technologies? We should be keeping an eye on this. Uh, we're thinking of. Creating new roles within it. What do you think of? I mean, it's, it really is coaching. It's, it's what you think.

Mm-hmm. does. It's, it's interesting. Yeah. So, uh, yeah. New directions, uh, for me. Definitely. And you've been doing it for a while. Um, so, okay. So we do three things on the show, uh, in the news, soundbites and social media close. So, uh, in the news, we each pick a story to discuss. Uh, I'll go first. And, uh, I'm, I'm always looking to have this conversation with somebody and it's hard because, uh, if you have it with an active c i o, they, they, a lot of 'em are in the middle of these kinds of acquisitions and they're not really free to, to talk about it.

So I wanted to. M a with someone. And since neither one of us are actively CIOs, we're working with CIOs, I thought it would be good to have this conversation with you. So I pulled the Kaufman Hall report. Uh, you can download it off the coffin hall.com, uh, website. Uh, they're an advisor, uh, advisory services to, uh, to health systems, and they have their 2017 in review year, uh, the year m and a shook the healthcare landscape.

So it's a little older report, but 2017 is not that long ago. Here's some of the things they, they came up with 15 transactions announced in 2017. Highest number in recent history, 10 transactions involve sellers with net revenues of a billion dollars or greater. Representing the largest. Number of mega deals ever recorded.

Uh, largest regional healthcare, uh, transaction is advocate in Aurora and Illinois, nearly 11 billion, uh, creating the 10th, largest not-for-profit. Um, and just an odd statistic, but Pennsylvania had 14 deals. Georgia had nine deals. Texas had eight deals. Uh, most active states. Um, I thought one of the more interesting things was, you know, in 2015 there was 112 transactions, but in, uh, 2017 there's 115, but the transaction transaction revenue has doubled.

So in the 112 transactions in 2015 represented 32 billion in revenue. Uh, the 115 transactions in 2017 represent 63 billion in revenue. So we're seeing, uh, a growth in those kinds of things and we can rattle off all the different. Health systems that are going through it. It's, it really, it's across the, uh, across the, the industry.

So, um, here's what I'd like to do with you. Um, I'd like to role play. So let's, let's say we're CIOs of two health systems that are coming together. You can be the, uh, you can be the larger health system because it matters. You'll, you'll be the larger health system. C i o I'll be from the mm-hmm. smaller system.

And let's discuss process thinking and approach to, to various stages, uh, of the merger. So, Here, here's a, a couple more assumptions. C i o, um, the c i o or it was not involved in the negotiations. I know you find that hard to believe, but it happens. , not at all , and there's been little to no due diligence as a result of that.

The mergers slated to take about six months from the time it's announced. Uh, but we both know that the regulatory environment, uh, Yeah, you can't bank on this, but typically it takes longer than six months to pull it off. Um, I know that the, the Providence Joe's merger I went through. A little over nine months, uh, closer to 10 months, uh, to pull off with a six month announcement.

So, uh, let's start with an announcement day. So, uh, this is pre-merger, it's announcement day. It's, it's announcing intentions. Uh, you're, you're the larger health system, so you get to go, go first. What's on your mind? What are some of the things you need, you think we need to do first? And, and what are some things you're gonna ensure that gets done?

Okay, great question. Uh, and it is not surprising that it may not be involved in the due diligence. Um, as I already commented when you said that, um, so obviously doing the IT due diligence and trying to tee that up has to be one of the first things. But even before that, I.

For the large organization, for the small organization, fully understand what are the business drivers, what is behind this merger, and they take different forms. Um, you talked about some of the bigger ones, but the scenario you're giving me here is probably the more typical, where there's a merger, a smaller organization coming into a larger organization.

Right. But to.

You need to think the whole is greater than the sum of its part. And what are we both bringing into this equation that we're gonna, that we're gonna wanna leverage. I think that's critical. Um, and you know, I think we've all been there. You start thinking about your roadmap and the order, which you would, by which you would integrate systems, assuming that's part of the plan.

Starting with on the review of the infrastructure and network, that's typically first then, so the organization can operate as one. You, you deal with all the financials, right? And last, if you get to it and you need to get it patient and, and clinician integration and workflow, you know, are you gonna, what are you gonna do to integrate clinical system?

Um, yeah. And always, always the focus on and. It depends on the makeup of the organization. I just heard about a, a merger yesterday that I had not yet read about in the news. So I think it's public, um, that it's happening. That was a very unique one, and I'm not sure how to have to think at this point about patient flow, but typically in a merger, you're, you're dealing with patient flow.

Yeah. Yeah, I mean that's, that, that is good starting place. There's, there's so many things to do, um, that, you know, again, I I, I did go through this. So I was, I was part of a merger team, uh, bringing a $6 billion health system together with a $13 billion health system. Uh, which today is a 22 billion health system.

So, and again, went through the nine month process of all the planning and whatnot. And, and to be honest with you, you really have to slow things down. Uh, it's a day-to-day kind of thing. The first thing, uh, I found to be important, a, a again, I, now I'm the c i o of the smaller entity. Uh, communication is your first job.

Uh, For the CIO of the acquired entity. And the number one thing people wanna know is, what does this mean for my job? 'cause the larger entity, they're not as concerned 'cause they're like, Hey, we're the, you know, we're the big, we're in charge here. Um, now that may not be the stated intention, but yeah.

Everyone who's ever watched this from afar says the larger entity will take over. And to be honest with you, in, in our case it was stated note, uh, a merger of equals. And, uh, that was not the case. It never, it, it almost never is. I don't want to burst anyone's bubble or any c e o who happens to be listening to this saying, no, no, we're a merger of equals.

That's never the case. At some point, some entity sort of, the boards sort of make their way and it sort of figures out. So my team. Trying to figure out what does this mean for me? So I have to know the story. You talked about the business drivers. I have to know the story. Why is this good for the health system?

Why is it good for the community? And then eventually I have to tell the story of why is it good for them? And, um, you know, it's, it's interesting 'cause I, you don't want to overstate, you don't wanna overstate, um, you know, hey, there's a job for everybody, but literally there's enough work for everybody.

That's, that's, that's a given. Um, but there will be, there will be overlap in some areas. So you don't wanna over promise, but you don't wanna under promise. 'cause I've also seen people really thrive, uh, from the smaller entity into the larger entity and take on larger roles and really almost get found.

In the process, process and really, uh, escalate to good roles. So, uh, it's, it's not all doom and gloom like some people think if you take the right attitude and mindset into it, develop good relationships and do the job that you're capable of doing. Uh, and, and so that's the, that's the number one thing is, is communication.

Um, and the second thing I'm worried about on that first day is relationships. I'm trying to, um, figure out, okay, from a relationship standpoint, obviously you're the. You're the larger organization, c i o I wanna have a relationship with you. So, uh, if you don't reach out to me, I'm definitely reaching out to you.

Um, I need to, I need to know that leadership team on the other side. I need to, uh, I need to start helping my organization to understand who their counterparts are on the other side. Um, I'm reading as much as I can because again, you know, Some of the people who are doing mergers have been on this show.

You could listen to the c i o talk and get an idea of their philosophy and their direction. Um, so I'm reading as much stuff as I can to really understand their philosophy, um, so that when people ask me questions like, Hey, do you think they'll have regional CIOs? Do you think they'll keep you around as a C I O?

Do you think I could have some semblance of an answer? Like, you know, you know, historically they don't have regional CIOs. This might change. I don't know who know what it is. Um, so those are probably the, the first two things, to be honest. I slow it down a lot because the next set of questions people start asking is, uh, you know, technical questions, uh, security questions, clinical workflow questions.

Are we going to change our E H R? And you can't answer that thing for another nine months, probably. Um, because there's way too many things to consider here. How are the clinical organizations gonna come together? Is there gonna be a common clinical governance? Is there gonna be, um, how different are your EHRs?

Maybe you're on the same e h R, but different instances now. Um, Maybe they're very similar. There's, there's so many things. So let's talk about, let's talk through some of those actually. So you, you brought 'em up. Uh, technical security and clinical considerations. We'll come back to some more people stuff in a minute.

So, technical, clinical and security considerations. How, how are you thinking through, uh, those things? Um, early on in the process or even mid, mid process, let's say we're three months in, how are we starting to bring our teams together? Think about those things. What, what areas are are the most important

you, you know, you have to go back to the question of business drivers, and you know, typically in a merger there is an assumption that you're going to be able to reduce the cost, right? So you start with the foundational pieces in terms of your data centers, your network, uh, what opportunities do you have to consolidate on the infrastructure front as just, uh, merging those together and, and doing some level of, uh, consolidation?

Actually, can you drive any one organizations in. Migration. The other one may be, you know, not even thinking about that. Uh, there may be new data centers, you know, under, under construction, right? Physical, physical data centers. So, I mean, you just really, in the due diligence, have to start looking at what's the current state?

What's everybody planning to do, what do you need to stop, what do you need to start looking at, uh, that you might be doing together? You know, there's, I don't wanna minimize. , but it, you know, that's all part of the due diligence figuring that out. Yep. Absolutely. I, you know, the, um, there are some things that you're gonna need on on the first day.

It's really interesting to me. So on the first day you don't even have an agreement. You haven't even come together and people are already gonna start asking you like, Hey, how do we do shared calendaring? How do we do, yeah. How do we do shared calendaring? Yeah. How do we do conferencing? What's our conferencing solution?

What's our, I mean, they start and you're sitting there going, Our security teams haven't even met each other yet. . Um, and actually this is where the cloud comes in. It's, it's interesting 'cause when you bring these two organizations together, you're like, well, we have this and we have this, but you haven't tied them together.

Sometimes it's almost safer to go to a cloud solution, a third party cloud solution and just say, you know what? Organizations do this all the time. They, they're still separate entities. We haven't done the due diligence on security. We don't these networks together. There's just too many. Too many variables, so, mm-hmm.

let's go ahead and let's go ahead and fire up Zoom like we're using right now. That's not an ad for them, it's just one of many or, or, you know, or Microsoft solution or whatever. Let's go ahead and fire that up in the cloud and we'll start using that for our video conferencing between, 'cause it works and I mean, right now there's so many cloud solutions that give you that, that base level of, of, uh, interoperability and connectivity.

Um, and then, and then you almost need to slow people down. Um, Because they wanna start talking. You know, are we gonna go to a single identity system? Are we gonna go to a single e h r? Are we gonna go to, um, you know, how are we going to bring these things together and just focus on the things you need to get done in order to get to that day?

The, the, the merger day? Um, 'cause really there's a whole bunch of things you can't even do until that the paperwork's done and signed. Um, right. And so there's part of me that says, Uh, you know, technical security and clinical. It's all people. It's all people and culture for those, for those six to nine months.

So let's talk about culture. How, well, actually, let's start here. Let's talk about our first conversation. You're the acquiring c i o on the, on the smaller entity, c i o. What are some things in our first conversation, what are some things you think you want to know from me and what are, what are some things I, I, and I'll tell you some of the things I would ask of you.

Okay, so I wanna get to this because I think this is so critical. Culture really matters and the people and the relationships that you've already talked a little bit about. So, uh, especially if you are, if you are the, the, uh, I've used the term big dog and, and maybe that's bad to say, but you know, you're the,

I've.

They, the, the c i o of the smaller entity thanked me for meeting with him at his location, like 40 miles from where I was and said, you know, for people to come down from the ivory tower because there was an academic character there. I mean, he was surprised that I came and met with him at his place. And, um, I just think those dynamics, like what you say, what words you use, you don't call it the right, you don't call yourself the big, any of those things, right?

You may be perceived as all those things, but from the beginning, I'd beginning to know you. I'd wanna know, um, Your style, you know, what you're doing with your team, what's important to you right now? What are your concerns, uh, today? What are your concerns going forward with the merger? It's all about the people skills, building that relationship and the rapport that we're gonna be working together and we don't know, right?

Bill, how's gonna shake out at the end of the day, what your role's gonna be, what my role's gonna be, what your people role's gonna be?

Threatening kind of relationship. Yeah. And by the way, that gesture of the, the acquiring the big dog, c i o, coming to the other location that I, I can't emphasize enough how big of a deal that is and what that communicates. Um mm-hmm. , it communicates a certain level of humility, a certain level awareness.

Um,

We can now start to introduce you to people in a pretty informal setting and, um, and start to put, because my team's less at ease than your team. I mean, they're, they're like, oh, we're the small entity and, and you coming down, meeting them, and I'm, I'm able to, to really start to, um, to just calm things down.

And that's the, the number one thing I'm doing on my end is just keeping people focused on the job at hand. Um, making sure that hopefully in IT organizations today, we don't have too many people that are completely indispensable, but making sure those people that have critical roles, uh, are, are not like spending half their day with resumes and, and on LinkedIn and whatnot, but actually focused in on their job.

And those kinds of things really help. The other thing that really helps is just, uh, an ongoing dialogue between you and I. So that, uh, I can get questions answered, you know, what, what does your data team look like? What does your analytic strategy look like? So that when my data team comes in and they go, you know, you know, how, how do they think about these things?

I can start to answer 'em until we get to that point where we're bringing the teams together. So, you know, one thing that I would add, especially because you said in this scenario, it was not involved in the due diligence. There, there is someone driving this merger from both of our organizations. There is a point person, and you as the C I o, need to be very close to them.

You need to understand everything that you can about what's gone on already, what are the issues, what are the concerns, so that when you walk into that situation for the first time and start talking c i o to c i o, you've that framework.

There, the, um, HR leads for each organization as they're starting to talk about and think about how might things change. You know, are they gonna be new operational models? What's it gonna be in terms of staffing, et cetera. Um, and you're never figuring that out independently as the c i o it, it's part of a larger organization discussion.

So let's, um, 'cause I, I need to bring, we could talk about this for the next 45 minutes, or. The, so let me close with this question, which is, we're bringing our teams together. What's, uh, how do you, how do you prepare your team for their first meeting? With our team? So we're gonna bring our infrastructure teams together, our innovation teams together, our data teams together, and we're gonna have, we're gonna have a common meeting.

How do you sort of prepare them? What's the, uh, I don't know. How, how do you make sure that that first meeting goes well? Well, I'll go back to what we've already talked about in terms of relationship and the dynamic between the larger and the smaller organizations, um, in prepping people and, and helping them understand and message.

Um, what I would emphasize with people is that change is constant and we don't have all the answers. Um, your communication is critical. Uh, I subscribe to, you know, the approach that you tell people what you know when you can. Uh, you tell people if you don't know, if you don't have answers yet, you tell them you don't, and when you might, and if you have information that you can't yet share for whatever reason, you tell them, yeah, we do know that we made that decision, but.

Um, I'm the subscriber to the philosophy or to the belief that, uh, that lack of information that people make stuff up. That's how the rumors start, right? Yeah. It just goes round and round. So people aren't getting any regular proactive communication. They're gonna make stuff up and then, and then you just have to try to manage that.

What I, uh, would also, obviously with the advice of hr, how do you talk about, um, Future work, and on the one hand you can message, there's plenty of work for everybody. We know that. On the other hand, you have to say no guarantees as to whether there'll be change changes or staff reduction. You know, and HR tells you what to say and how to say it, what not to say.

The other thing, my message to individuals, because individuals get really worried at a time like this is twofold. One, open to the possibilities. Who knows what changes there's gonna be and what new opportunities, new jobs, new skills, you know, they can learn. So be open to the possibilities. The other thing I tell people is you own your own career.

So depending on what those possibilities are and those changes, if you like 'em, if you don't like 'em, if you wanna propose, you put me in this role instead. You know, every individual owns their own career. Yeah. And that's why you're a great, uh, career coach for people looking, uh, for some guidance in that area.

Uh, the, the thing, uh, bringing the teams together, there was a couple things that, um, I thought were non-negotiables. One is, uh, one of the leaders had to address the IT team, especially since there's no due diligence, it might feel lighted fact that there was no. Due diligence and that kind of stuff. So one of the leaders, uh, being there and saying, you know, technology is critical, digital is the future of healthcare.

All those things that we all know is true. Uh, just reinforcing that these two teams coming together, they also need to reinforce the message, which is we brought it together and the business drivers right? We brought it together because we believe. That the new entity will be stronger together than it was apart.

Um, which means we're looking to this group to figure out what things we're doing the best. And it might not be that the larger entity's doing everything the best, and it might not be, uh, that the, you know, and we want to take best of each and make something better. Um, and then, uh, you know, the, the, uh, The, the last thing to prepare my team for the conversation is to just set realistic expectations, and it is every healthcare IT organization has worse.

And so I, I don't, I don't want like this big deluge of people coming into my office like, do you know that they have these issues? It's like, of course they have these issues. It's a $13 billion organization. Do you know how hard it is to run our $6 billion organization? We have worked, they have worked.

The, the goal is, uh, you know, if people can be honest and removes something better, one. Things I would leave people with is, as the leader of the IT organization, you have to figure out a way to remove fear, um, from the equation. 'cause people do dumb things when they act out of fear and uh, and so that's where communication becomes key.

Again, I, I bet you're, I be, you're gonna transition can thing. Before we transition, um, uh, you know, and, and some of the people listening to this probably know that I write a weekly blog called Health It Connect. And um, I have written a couple blogs around the issues of, uh, mergers and acquisitions. One was merger mania, where I talked about, uh, making sure we're doing it right.

Another one was about culture, which gets at what we.

Um, and the other one was about, uh, corporate functions, but local service. And that challenge, whether it's a result of a merger or just a very large system that's grown, uh, making sure that you understand the unique needs of all the players within your organization. Yep. And it's a great blog and I, we'll be coming back to that in the, uh, soundbite section.

Now, unfortunately, which means we have this story, uh, your story, we're probably gonna shortchange a little bit 'cause we spent so much time on, on the merger, but that's fine. Tee it up for us. That's fine. Sure. So, um, the story that I found and wanna talk some about is called, uh, patients are losing their patients.

So two spellings patients are losing their patients seven ways healthcare consumers are demanding more. Um, this is an article written by Barbara Smith, a partner in, uh, Paragon Consulting. Partners and, um, I think it's just spot on. I'll go quickly, spot on as she, um, draws the analogy between, uh, entering into the healthcare environment from a patient perspective and, um, uh, in her case, A sporting event and everything surrounding a sporting event from a customer friendly perspective.

But all the seven areas, if I can just highlight them. Efficient patient workflow. We, you know, patient workflow. We talked about clinician's workflow, right? But patient workflow, workflow, ease and scheduling. Ease of access, transportation, parking, and electronic access, which having worked in some very, um, congested urban environments, I get that one fully.

Um, the fourth one is patient experience with wait times and other annoyances. Uh, fifth one is transparency and pricing. Uh, she's got an interesting analogy there about dropping off your car. You wouldn't drop your car off for service if you, what's. Yep. Uh, and quality metrics is fixed. Um, she points out you don't go to a restaurant probably now without checking a Yelp review.

Right? So what do you know about the organization that's gonna be doing here? And her last one is about free the report, which has to do with getting, um, results to patients and in a timely manner. Uh, and you know,

You know, I think CIOs, all of us know we need to be doing this, and we're hearing it a lot from the executives, uh, in the csuite. The question is how, how do, how do CIOs address and where do start? So I'll throw that. I've got some thoughts on that. Wow. I'm, I'm being asked the question. Um, you know, it's interesting because I agree with you.

I think this is spot on. Uh, patient workflow, scheduling, uh, ease of access, uh, uh, wait times, other annoyances, uh, experience transparency and pricing, quality metrics and, and, uh, access to the report and the data. These, these are, it's a pretty good. Um, and I, I, how would I start? I'd start by, uh, creating that, uh, again, I keep saying creating the narrative, but.

That the organization can sort of, sort of rally around. I find that, um, people don't rally around PowerPoints. They rally around stories and to the, to the extent that you can start collecting stories, uh, good, bad or indifferent from your patients that talk about their experience in terms of work workflow.

We've been asked this question 10 times. We've been bounced around or somebody with a chronic condition that, you know, whatever I. The organization can respond to that. They can look at it and go, yeah, that shouldn't be true of our organization. I don't want that to be true of our organization. And then they can mobilize around it.

So I, I always start. With the story, the scheduling one sort of cracks me up. My story around that is we, we had, and I've shared this before in our, um, our portal, we had this list of things and we had, you know, the medical record was number one and scheduling was like number six. And when we talked to the patients, scheduling was number one.

Scheduling is so difficult. Uh, scheduling referrals and, and that whole process. Um, And what all we, all we had to do was talk to patients. They gave us the list and we said, uh, as much as the internal anecdotal was, no, no, this is the most important thing. We're like, no, look, we talked to, we, we actually conducted a study.

We talked to a thousand patients, and this is what they're telling us is most important to them. So no one in the organization can now. Create a false narrative that says, no, no, they care more about this medical record. No, no. What they care about is access scheduling work. They really do care about these things and I think, I think she is, uh, spot on on this.

So what, what are some areas, or what are some of your thoughts on this, on this list of the seven areas for patient, uh, experience improvements. Well, I, you know, you, you talk about scheduling and how hard it's, but that's a critical one. Um,

let me take it from the, let take the point of view, the question I asked you and what do I, what, what I think it takes to get this done. Um, you know, one of my philosophies is that you have to leverage your core products as much as you can. So your core e h r vendors have offering.

And possible

ambulatory.

Finding niche products and saying, let's go try all these things to answer some of these solutions. Uh, , you don't want me in that position where you're in react mode to all those niche products. So you also have to be partnering with all those folks, whoever's in charge of ambulatory, whoever's in charge of patient engagement or patient experience.

Oftentimes the strategy people are, are driving some of this in terms of your digital health strategy. So you need part partner with them as the c i o help drive it. And make sure that they understand everything that can be done with your core products that are already there before you start adding in these niche products that then have to be integrated.

Um, those are the, those are the key points. I guess one other thing I would say is, Else on your plate. This may be like, oh.

In some of these areas, the focus team. Um, so they get moving on it. Yeah. It's, it's, it's interesting you, you brought up the, you know, 'cause some of our vendors have very, uh, extensive amount of offerings and I find CIOs fall into two camps. There's the, uh, and, and some people that both of us are in contact with and really respect.

Taken your approach and said, yes, you know our Ven, we're double paying for a lot of this stuff 'cause we have all these different solutions and let's consolidate around this, this our E H R providers solution. It works well. Um, that's, that's one school of thought. And it's a, it's a very valid, very good rule, uh, school of thought.

'cause it's, it's highly efficient to go that right route. And then there's the, the other route, um, and I find some players going in this route where they go, you know what? We need to differentiate. If we just go to the market with MyChart, we're not gonna be able to differentiate, 'cause everybody else in our market's using MyChart.

Um, and so they're looking to free themselves a little bit and so they're putting, you know, new layers in between so that they can, uh, innovate not necessarily with big teams and developers, with small teams and and whatnot. And we had, uh, Somebody on the show who talked about that of how they, uh, you know, with a team of, uh, I think three or four developers, they were able to build on top of epic's, um, APIs, a completely different experience for their community.

And so there's, there's two paths to go and it's, they're not necessarily mutually exclusive, right? Um, but yeah, I, it, it's amazing to me. I was shocked. You walk into healthcare and, and we did the inventory and we're like, we have 1800 applications, and, and that just, that just, it boggled my mind that it was that many applications and then you realize that's the norm across the industry because we've, we've allowed it to sort of, Proliferate, I guess.

Yep. Um, alright, so this is the new section for you. We haven't done it this way, uh, since you were on in February. So, uh, soundbite section one to three minute answers, five questions. Um, so we're just gonna put you on the hot seat. Um, the, the timeline's more of a. Guideline than, than, than a rule. But, um, I'm not gonna have a buzzer over here if you're wondering.

Um, alright. First question. Does that speed dating? No, it's not. Uh, first question, you served, uh, for several different health systems as c I O. What do you think distinguishes the best performing it shops from others? So you've seen a lot of 'em. What, what, what's the characteristics of the best ones? Okay.

You know, it's basic. It's basic, um, governance organizations.

It's effective alignment with the business and, uh, engagement, appropriate levels of engagement by the senior leaders as sponsors on your major initiatives. And I think from an IT perspective, running it, running the business, it's about core processes and standards. And, and again, you'll see organizations that, that struggle with a lot of those basics, unfortunately.

On top of that, I would just say it's all about the people and the culture and, um, you know, the, the, the people skills of the, of the, of the leaders. Yeah. The, yeah, that's a great answer. I mean, the leadership team, the processes, and. Uh, the governance and it's interesting how many organizations are stumbling because of poor or lack of governance, and it's just such a, such a great place to start.

Uh, second question for you. So, um, this is, uh, it goes back a little ways, but I sat in one of your presentations on Lean and it really was exceptional. Um, I'd love to Thank you. Take that, uh, and do that presentation again. That was really good. So, if, if you were stepping into a health system that wasn't practicing lean principles today, I assume you would want them to give us sort of a, a quick roadmap of how you would get that program off the ground.

Sure. Um, so first off, it's not. Not. And I think if you go into an organization as a lean leader and think you can just, you know, make certain things happen, um, you're not gonna be able to, you have to read the people, you have to look at the culture, and you have to have some champions that'll work with you from the beginning.

People who have that experience have that way of thinking. Um, and then you start with what problems are there to solve? Where are some of the gaps? Because those are gonna lead you towards. Uh, where you have opportunities to apply lead thinking. Um, when I, uh, brought this in at, uh, university Hospitals in Cleveland, when I was there in 16 for eight months as an interrupt, um, I covered the whiteboard in my office.

Key metrics, processes, some of the gaps. And I just started creating what eventually became a visual board that we put out in the open area. Uh, along those lines, what were the key metrics that we needed to watch? What were the key initiatives that we needed to monitor together, et cetera. So I started early on planting the seed with the people who I knew would partner with me.

Um, and then they have to. And own it. So those are some of the key tips. I did write a blog about this too called, uh, lessons from an Aspiring Lean Leader. And it's probably a lot of the key points that you might have heard in that presentation. So yeah, it's another one. Uh, and I'm not sure how CIOs run their organization, uh, without lean principles.

I, I realize it's not one size fits all, but it's, it's, right. So it's, it's so good. And so. Uh, third question for you. Much that's been made really about having a seat at the table for the c I O. Um, I, I'd just like to hear your, your thoughts on the right reporting structure, uh, or critical relationships that the healthcare c i o needs to foster in order to be effective.

Mm-hmm. and, uh, a couple points. One, um, if you can't and don't report to the c e o, I think the c o O is probably. eSuite leader to report to because the c o o sees everything ultimately from an operational perspective, and it sees everything as well. I, I have found that good alignment when I, um, the C F O.

Uh, has a much broader role than they did at one point. They're not discount the dollars they have, uh, a strategy role. They're often the point person for mergers and acquisitions. Um, you know, they're looking at, you know, new revenue opportunities as well as how to cut costs. Um, so important partner, if you don't report to the C F O to closely with the C obviously.

The, um, uh, the three person leadership team of the C I O C M O and C N O are really critical. Um, those have to be good relationships and C M O and the C N O have to have a very strong relationship. And I have learned from, um, my husband who is a minister, you can't fix a relationship that you're not in.

And if your C M O and c o don't get along, remember that one. Right? Um, and don't get triangles into relationships either. So if the CMO and c o don't get along well, which sometimes happens in organizations, it's very hard for you to have that strong person team, but do what you can to make that work. The last thing I would say is there's all these new roles that are coming and, um, you know, the chief digital Officer officer innovation.

For a later thing. Um, if you go into an organization and those roles are there, figure out how to work with those people, um, and partner with them if they're not there. Figure out how much of that is gonna be your role as the Yeah. It really, I mean, it is such a collaborative role in a convener kind of role that it's, uh, you, you really are, it's a relationship role.

In fact, I. One person, uh, say to me, you know, did you get into this because you love technology? I'm like, I got into technology 'cause I love technology, but you don't become a c I O 'cause you love technology. You, that's not the role. Uh, it's, it's, it's a people and a leadership role and that's, that's what it is.

Um, yeah. Uh, I'd love to touch on, touch on this subject, uh, from you. 'cause I have two daughters and you helped me to think through this. So, career advice for a female recent college graduate. Who wants to work in health it and eventually be the chime c i o of the year. What, what, what career advice are you giving, uh, that person?

Well, career advice. Um, as early as you can find role models and mentors, you know, that's important. Um, I. Really like the article, the Confidence Gap that was in the Atlantic in 2014. I've used some of my presentations. Um, it's a lot of data. It's quite a long article, but I think it, it helps, um, everyone, women in particular, um, frame some of the issues that women face, uh, around confidence.

And I would also emphasize that there is no right path. That you make are your choices and they have to be right for you, uh, and your family. So, um,

you know, it's your path in the long run. And, and don't let anybody tell you what that path needs to be. You know, the one thing I've been talking to people about, um, and I forget, uh, who was on the show that we were talking about this, but . , it's, uh, it's interesting that when, um, a, a female executive and a male executive look at the role of the c i o, the male executive just says, well, I have two of the 10 qualities.

I, I'm pretty sure I could do the job. Where a female goes, well, I only have six of the 10 qualities I need to develop the other four before I can do the c i o. And it's such an interesting, um, mind gap that somebody who has six of the qualities and somebody who has two. The person who who has two thinks they're more qualified than the somebody who has six doesn't think they should put their name in the ring.

And we, we almost need to keep encouraging people to say, you know what? Let someone else, if you want the role, let someone else decide you're not ready for the role. Put your name in. What'd you say? What? Yeah, put your question there. Just put, just put your name forward. I mean, it's, it's like, right, right, right.

Um, yeah, I, I totally agree. And the article, the confidence gap, uh, and I think there's a book too, gets at a lot of that, um, from a data and research perspective, but also how women, um, need to put themselves forward and overcome that and that they can. Um, la last question. So you do write the weekly blog. I don't know where you find the time, but I appreciate that you write the weekly blog@uhsushe.com.

Um, a couple of questions on that. Uh, you know, it's a personal blog. When, when, when did you start it and why is the first question, and then, uh, given that it's your blog and brand, did you ever have concerns from your employers or did they. Uh, restrictions on you, uh, in, in terms of writing? When did I start?

I started in June of 2014, so I've had four years now a weekly blog. Um, and the discipline , uh, I was at University of Michigan at the time as the c i O for the hospitals and health centers. And when I had the idea as part of my whole social media push, um, and wanting to share and teach and. Why I do it.

Um, I approached the social media coordinator in the PR department and she was like, oh, perfect. I'd love more leaders to do this, so yes, let's do it. So they helped me set up the whole framework and kind of get started. Um, and uh, so it was under the University of Michigan at the time as a professional blog, but it was mine.

Um, I, when I write, when I wrote them, I always thought, there's four audiences. There's my staff, and the blog does not replace messaging from me as a C I O. If they read my blog, great, but how's the staff gonna respond to anything? How would any employee at University of Michigan Health System respond to anything?

And then the world of CIOs and IT leaders who are an audience and then everybody else. So as I wrote, I thought, who am I? Who am I talking to and how are they gonna relate to this? To your question about any concerns I, um, told at the time what I said was, and I did it when I was at my interim role as well.

Um, I would use my judgment if I thought something I'm covering is. Gonna be problematic or expose us in some way as an organization, and I will take it to the right people. So I did one on a security culture and I took it to compliance and legal, and I said, I don't think I'm exposing anything here about us.

That's problematic, but please double check. Was I did on an incident lessons I wanted, make sure again,

I left Michigan transition.

Michigan Banner. The other thing is, if I touch on a political subject, which, you know, I do sometimes, um, I always am careful about how I approach that, and there's a healthcare spin to it somewhere. Somewhere in there. Yeah. And the, the reality is, if you're gonna put yourself out there, if you're gonna write, uh, some people are gonna like it.

Some people are not gonna like it. And that's just the, the nature of the internet. Would you encourage other CIOs to, uh, pick up this practice? If they, um, are so inclined. But I would encourage them to find whatever form they can that they're comfortable with to share and teach others, because we have a lot to offer as we continue to learn as leaders.

Yep, absolutely. Uh, we've, uh, gone a little long. I apologize for that. Uh, Sue, thanks for coming on the show. Uh, uh, we've already mentioned some of them, but what's the best way for people, for, uh, people to follow you? Um, Best way, mention my blog, s shade.com. I'm on Twitter. SG shade is the handle. Um, I would say also, um, you can follow Starbridge Advisors.

Uh, we have a blog called you from the bridge. We're active on LinkedIn and Twitter as well. So any of those ways for, uh, following and getting good content that we try to share. You are a, uh, you are one of my social media, um, you know, pioneers who I'm, I'm trying to emulate. So, uh, awesome. I've, I've got a couple ways you could follow, uh, follow me at the patient, c i o, my writing on the Health Eric's website.

Don't forget the show on this at this week in h i t on Twitter. Check out the website this week in health it.com and, uh, catch all the videos on the YouTube channel. Easiest way to get there. We're still not at a point where we can, uh, get our own vanity url. So it's this week in health it.com/video. Uh, we'll redirect you over to YouTube and we are now up over, uh, 200 videos, uh, on there and, uh, uh, and growing every day.

So, uh, please come back every Friday for more news information and commentary from industry influencers. That's all for now.

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