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A little Friday Riff on how I might be approaching the world as a Healthcare CIO. Here is what ChatGPT-4 has to say. The transcript is a podcast where the speaker is discussing the financial and cultural changes in healthcare over the last three years. They argue that healthcare has transformed, and the industry needs to consider whether they want to go back to the pre-pandemic period or transform into something new. The speaker, a former CIO of a hospital system, recommends that executives should have one foot in the present and one in the future. They should think about what the future will hold in terms of technology, competition, economic conditions, and their capabilities to compete for patients, improve quality, and reduce the cost of care. The speaker also emphasizes that leaders must innovate, ask crazy questions, and avoid being flatfooted, i.e., unprepared.


today in Health it a CIO's role in turbulent times. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health Set of Channels dedicated to Keeping Health IT staff current. And engaged. We wanna thank our show sponsors who are investing in developing the next generation of health leaders.

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All right. So, as you know, Fridays are my time to riff. I have a lot of conversations throughout the week and I sort of process them and I think about it. It's one of the reasons that this episode is so late. I've, I've had some really interesting conversations this week, and it is actually eight 30 on Friday morning.

So this is way late actually should have been produced last night. But, , you know, I I, I, the conversations are interesting. I, you know, as I said, I've had many conversations with C level IT executive. Throughout the week, but, but during the, , industry conferences, the level of discussion actually increases, and I wanted to take a moment and discuss what I'm hearing and seeing and suggest an approach for these executives.

Healthcare has changed financially and culturally over the last three years. I'm going to make that case in just a minute, but I wanna frame up the question ahead of that. Do we want it to change back to what it was or transform to something new? In other words, do we wanna go back to what it was pre pandemic and boy, those are the good old days kind of thing, or are, do we want to see something.

All right, so let me make the financial case for, , healthcare has changed. The financial case is much easier to make because it's backed up by numbers. Inflation. The cost of delivering care has risen. There's a cost of goods in the supply chain and the cost of labor and wage inflation. , many are telling me that they are taking on more Medicaid Medicare patients and the roles of commercially insured patients, it's declining.

They're also saying that, , commercial payers are pressing their upper hand in renegotiations. The result of this and other factors is that, , you know, costs are up and revenue is. And for a low margin business as healthcare is, , that is bad, right? So the case for culture is the rise in claims of burnout, , with polls showing as many as 90% of nurses considering a change in career or company.

90% labor unrest is growing. , the, the state of work conditions, both in terms of the demands on that clinical staff and. Of that clinical staff. The rise of those stories of violence in the EDS and other things is, , you know, is, is, is a challenge, right? It's a challenge for the nurses. It's a challenge for the physicians and it's rising.

All right? So the current situation is not sustainable. But again, I come back to the question is the goal to return to what life was pre pandemic? Clearly something has to. When I think about this situation, I place myself back in the CIO role for what used to be a large sized IDN, and ask myself what would I be doing in the face of significant cuts in operating and capital dollars in the near term, and a growing unrest among the frontline staff that is delivering the care.

And you know, also a rising host of alternatives to the services that we provide in our own community. You know, there's surgery centers now, cancer centers, orthopedic centers. Lab and imaging, even maternity services are all being offered outside the traditional hospital setting, and some of those represent a significant line of business force and significant profitability for the health system.

So I think first off, if I was flatfooted, meaning not prepared for this change in 2023, I would recalibrate my approach to being a cio. The reason is that when I entered healthcare in 2012, We were having strategy sessions on how to address the growing competition, an unsustainable, rising cost of care, lower margins,

and we had a weary eye on our competition and partner the payers. That means that these discussions have been going on for over a decade and they, I'm sure they started before I came into healthcare.

If I'm saying what happened, oh my gosh, what happened? I haven't been paying attention and therefore, really haven't been doing close to half of my job as a cio. I wrote in an article a long time ago that CIO's role is three things. One, keep the trains running on time, no outages, no breaches, and all that that entails.

Great team, good processes, right? Funding and tools. , the second thing was lay new track, new features and tools that help the organization to move the experience of the patient and clinician forward while improving outcomes and cost of care, the right investments and projects to make things better.

Okay, so keep things we have running on time and make things better. That's, that's a significant part of the CIO's job, but it doesn't end there. The third thing is to build. And that's the metaphor, right? So that is to innovate, to achieve new heights. Crazy things like eliminate all the keyboards in the clinics and you say, oh, that's not possible.

That's why it's called innovation. , be able to provide ever-increasing levels of care acuity in the home, right? Oh my gosh. We can't offer that level of Q Care in the home, right? That's why it's called innovation. We have to figure those things out, reduce the cost of care while delivering higher margins to healthcare.

Oh, is that even possible? This is where you ask the impossible and succeed every time you make some progress towards that goal, and every once in a while you make that 10 x improvement and you actually change the way things are done. It is that muscle that I find is not well formed in healthcare CIOs.

It's not that we don't talk about it or even make investments from time to time towards it, but it is more than just starting up an innovation arm and investing money in startups.

Every IT project is an operations project. Every operations project requires buy-in. That few in the organization can produce, and the CIO's uniquely positioned. To be at the center of all of these projects, an operations project requires excellent process and implementation skills. Communication has to be top tier.

It's not enough to identify really cool projects and technology. You have to be able to champion the project, gain a following, get the funding, rally the organization, show the results while not disrupting the culture or the operation, and then scale that solution.

That's a lot to ask, but that's the role. But I digress. What would I be doing today? And I wanted to say something that won't be cliche and the answer is in the flat-footed comment. Right? Right. That can never be the position of the CIO ever. We need to have one foot in the present and one foot in the future.

Now that foot in the future can be one year out, can be three years out, can be 10 years out. And I realize we don't have four feet. We're unlimited time, but you have to spend my time in the future with yourself in a group of thought partners. What does our future hold? One, three, and 10 years. What technology will become mainstream during that time?

What capabilities will be required in order to compete for patients, improve quality, and reduce the cost of care?

What competitors will we have to consider in those timeframes? What will the economic condition be in that timeframe? How much money will we have to invest during that time? I've done this exercise on the show before, but it is the I believe, statements about the future. You may be right or wrong, but you won't be flatfooted.

You will considered the key variables and formed an opinion with the help of people within and outside of your organization.

You will be by definition in motion already thinking about what we are going to do if it's a bad economic situation or a good one. What we're gonna do if chat G P T turns out to be nothing or it turns out to be everything that people are saying, it's gonna be what we will do if CVS picks our community to pilot their next big push.

Hopefully you're also considering the crazy questions. How would I deliver the core IT services with 50% less staff? I know that's a crazy question, but if you're considering it, you're already in motion. You're already thinking about, you know, how do we be, , , more efficient. You know, and, there's even more relevant questions like, how can we deliver care with 30% less clinical or support staff?

That is a mind and a group of thinkers that are in motion. You can't be afraid of asking questions if you don't ask the extreme questions in order to not. You risk being really offensive when you have to do an 8% cut and the very people that you were trying not to offend have to sit across the table from their family and explain why they were let go.

I was always looking for cost savings in it always. From the day I received the final budget until the day I formulated the next year's budget, I was always looking for cost savings because for the cost of healthcare to go down, it either has to present innovation that drives out cost, or we have to take cost out of how we deliver the existing services.

And that was our mission as a Catholic healthcare. Our mission was to serve the community. It wasn't to serve ourselves. It wasn't to keep people employed. It was not to drive higher margins. It was to drive down the cost of care for those we were trying to minister to. I did a staff reduction every year in it while I was a cio.

Now, I know there are problems with that as well, but it also demonstrates an organization that wasn't. Holding onto our jobs for dear life while increasing the cost of care to the very communities we are trying to serve. This is the foothold that our emerging competitors are latching onto lower costs, better experience.

I would argue that healthcare is in the midst of a transformation and that this is not a blip. There's people who've been in the industry for a long time and they just go, oh, this is just another blip. We've been through this. If you've been in healthcare for 20 years, you could say, oh, this happened here.

This happened here. It's just a blip. It comes back to norm. I don't believe that's what's happening here. , this transformation will require us to lower our expenses in the near term while also improving our experience for those we serve and rely upon to pay our bills. There will be a growing cry for the government to step in and that hospitals represent critical infrastructure.

You can play that one out as well with your thought partners and ask the question, what will that mean for healthcare and our health system? Put your politics down and ask if that happens, will there be disruption to your community or your health system? And what will that mean?

And at the end of the day, I'm recommending an approach to not being caught flatfooted. So just do the exercise. Just ask the crazy question. Regardless of what your situation is today, you may be asked to do some draconian cuts to it. I would never lose sight of building an airplane or innovation. You can't cut your way to success.

That's been said often, and it is a little cliche, but it's so true. You always have to be innovating even with no money. Your time horizon does expand if you have no money, but you're always looking at innovation, right? So your time horizon for innovation may. But it's still a big part of the job. So if I were to step back into the CIO role, I would have one foot firmly planted in what we need to do today, regardless of what that is.

One foot still planted in the future and saying, how are we gonna move this forward? All right. That was a lot for Friday morning, by the way, that's not just for the cio, that's for everybody.

That's for the cto, that's for the cnio. Cmio. , one foot in one foot in the present, one foot in the future. What is your area gonna look like in the future? That could be for a department, , director, , you know, what does your group look like? Could your group be outsourced? I was looking at some of the things that chat G p T can do in terms of front-ending analytics platforms, and I thought, wow, that's interesting.

I wonder what that means for analysts. By the way, one of the largest groups of job descriptions we had in it was, , essentially a data analyst. What does that do for a data analyst when I'm just asking the ai, , as a front end for our data to say, Hey, , what's the latest, , census count?

And , what's, , this and that, and it, it's just developing those reports on the fly. Crazy, crazy to think about, but you have to think about those things. That's a leader. Leader has one foot firmly planted in the present, one foot in the future, and doesn't deny the. But explains what it could be and helps people to make that transition to the future.

All right, now, that's all for today. If you know of someone that might benefit from our channel, please forward them a note. They can subscribe on our website this You know, think about it. They could listen to this conversation. You guys can talk about it. They could be a thought partner on it and they could tell you, I think this guy's nuts.

And you can say, well, I think he's a little nuts too. But he has a point here and he is point there. , so great way to get the conversation started. They can subscribe on this week, or wherever you listen to podcast. , we wanna thank our channel sponsors who are investing in our mission to develop the next generation of health leaders, shortest and 📍 art site.

Check them out at this week, Thanks for listening. That's all for now.

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