Sue Schade and David Muntz with Starbridge Advisors discuss everything from EHR implementations to IT governance in a fun back and forth on topics that will shape your 2020. Hope you enjoy.
Sue Schade and David Muntz with Starbridge Advisors discuss everything from EHR implementations to IT governance in a fun back and forth on topics that will shape your 2020. Hope you enjoy.
[0:00:05.6] BR: Welcome to This Week in Health IT Influencer where we discuss the influence of technology on health with the people who are making it happen. Today, second part of a two-part series where I talk to Sue Schade and David Muntz, with StarBridge Advisors. They are fantastic guests and we have had, if you’d listened to last week and I highly recommend you go back and listen to it if you haven’t, what we did is we played a little health IT Jeopardy. I gave them 10 topics, we broke them down, we go back and forth on major topics that are impacting health IT.
It’s a fantastic conversation so part one was last week. This week, part two. My name is Bill Russell, healthcare CIO coach and creator of This Week in Health IT, a set of podcast, videos, and collaboration events, dedicated to developing the next generation of health leaders.
This episode is sponsored by Health Lyrics. I coach health leaders on all things health IT. Coaching was instrumental in my success and it is the focus of my work at Health Lyrics. I’ve coached CEO’s of health systems, startups, CIO’s and CTO’s, as well. If you want to elevate your game in 2020, visit healthyrics.com to schedule your free consultation.
As I said last week, I recorded this in late 2019, prior to our studio move. My sound’s not that great but Sue and David sound great and you’re not going to have a problem hearing them and really not a problem hearing me as well. Again, we played a little health IT Jeopardy. I think It’s a fantastic episode. I hope you enjoy.
[0:01:23.7] BR: Back to you, IT operations, security. Let’s see, those three taken. Mentoring training, staffing, innovation, or experience.
[0:01:30.0] DM: Training.
[0:01:32.8] SS: Experiences are pretty broad.
[0:01:34.5] BR: It is.
[0:01:35.3] SS: Let’s go with training. Training for a hundred, whatever.
[0:01:38.8] BR: All right. Mentoring and training. Where are we at today in terms of developing the right skills for the next generation and developing that next generation of people? Because we all have a little bit of grey hair. Actually, we’ll go to CHIME next month and we’ll see a lot of gray hair, quite frankly.
[0:01:55.0] SS: Yeah.
[0:01:55.5] BR: What are we doing to mentor and train that next generation?
[0:01:58.2] SS: Okay, yes, we all have gray hair. Unfortunately, I’m not going to CHIME because of our go-live. And let me just say, this group all committed to developing the next generation and kudos Bill for what you’re doing with these podcasts and just your focusing and your new services. That even get at that more. That’s good.
What are we doing? You know, let me start on the negative first. It’s disappointing to see that training, budgets are still the still the first to cut when you go back to the budget conversation, you have to make some cuts. And then the grand scheme of things if you think about it, your training budget is probably small. It’s a small percentage of your IT budget when you’re looking at everything else you’re paying for it. Yet, it’s an easy cut. That’s unfortunate and I would hope that CIO’s would find a way that hang on to that and be creative about how they can use that money.
I think that – does this answer your question directly? I’m not sure. One of the things I’m excited about and why I love doing interims and being back in an organization, interacting with people and teams every day and helping solve problems and being part of it, is I see all these up and coming leaders, I see young people who are eager to learn from others and grow into their roles and into future roles and be promoted.
You know, I love hearing about the people who senior leaders have identified as you know, the next and how are we going to like convince them that they’re right for management how we can support them and move them into that kind of role. That’s encouraging. I think more and more, our generation leaders recognizing that we will not be here forever. We’ve got to be developing those folks, that’s positive and just you know, seeing that commitment. I’ll stop there in terms of where it’s at today. Let David comment.
[0:03:31.6] DM: Yeah. I love what you said. And by the way, you know Sue is one of the best mentors I know and she’s spent a lot of time doing that so she’s obviously giving back for so many reasons. And I think it’s because we’ve benefited from mentors and that is being taught directly or by observation and a lot of the lessons I learned was just from watching great leaders and not necessarily one on one but to the degree that you can get to do one on one, it’s fabulous.
I think one of the issues is whether or not we should look at where we are and where we’re going. And this issue of IT being a commodity or not, really impacts what it is that you’re trying to train for. Are you trying to train for a skill which might be more technically-oriented or you trying to train for leadership? Which helps you take advantage of the technical resources that you have and by the way, we need both and can’t ignore either if you want to be successful.
And I think it’s really critical to try to give people a chance to do things. One of the things that I’ve seen is, and this is especially difficult for leaders and you know, I’ll just share some of my arrogance here. But I always figured if I could do something, I could do it better. That’s part of my reason for being a leader is a certain amount of righteous indignation with the status quo.
On the other hand, if I want to be successful as a leader, I had to give up my belief that I was the only one who could perform the function and when I learned to delegate and I mean, really delegate and accept that things weren’t going to be exactly like I wanted them, then I found that often times, they were better or different. And so, I think it’s both mentoring and then letting people do things on their own and so that delegation is probably one of the greatest ways to train people and you can do that as a leader and that allows you to being mentor because there will be lessons that everybody learns from that delegated responsibility.
[0:05:32.6] SS: If I can come back, one point I want to make is, we’re all continuous learners, right? We may have gray hairs. There’s so much we don’t know. There’s so much we still need to learn, you know? The number of times in a given day that I may say, “Okay. Educate me about that. Help me understand that enough so that we can work that through together.”
The other thing is that it is maybe connected to that. It is very two way. I mean, the things that we learn from others and that we learned from this next generation that’s coming up and they’re bringing some different approaches and styles to how they work and it’s very refreshing to be around them and learning from them. You know, I’m not talking that specific training and dollars and go to this class and this course which is all comes into play but just that continual learning environment. Everybody in the mix, learning from one another.
[0:06:21.1] DM: Sue, can I just jump on that? Because I love what you said, I just had lunch today and this came up. I was saying I am so grateful l to millennials because they do a much better job of teaching me about life-work balance. And you know, that’s one of the things – it’s not a question of is there work ethic? It’s that my view on life work balance is much different than theirs. You know, still learning a lot form the people I observe. The much younger people, which is refreshing.
[0:06:51.0] BR: Yeah. Two things on the younger generation: One is, I was just talking to somebody who receives a sabbatical after working for a company for 15 years, this is not a millennial and they said, “I’m only going to be able to take two weeks of the four weeks sabbatical.” I thought, “A millennial would never do that.” They wouldn’t even be here. But our generation is like, “We’re need it. We’ve got this implementation or we got this thing going for whatever reason.”
That’s the millennial, the different age groups and whatever they do, they act differently. They’re raised by different people.
The other thing is the conference, I forget his last name but Justin was an 18-year-old high school kid who stood in front of four or 5,000 people at the Health Catalyst Conference and I was just amazed by that, you know? I was in front of my high school class, I was nervous to stand in front of a small classroom. He was standing in front of 5,000 people talking about machine learning and AI and what he’s been able to do with the data and making that available.
And I thought, “You know, in this area of mentoring and training, there’s this identification of special skills and identification of talents that I think is one of the roles of the CIO.” I think sometimes people get pigeonholed in our organizations and it’s our job to see more what they can bring to the organization and to somehow release them from maybe what they’re doing and give them opportunities to grow and prosper.
Sue, you started so I’ll give you the last word on this.
[0:08:18.7] SS: This is like the next? Not sure I’m doing great with your format. Last word on this. You know. We ‘re all continual learners. We’ve got to invest in our people. They are our greatest asset. And you know, continue that commitment to the next generation of leaders that we all have.
[0:08:35.2] BR: All right, David, operations security, staffing, innovation or experience?
[0:08:41.0] DM: I guess security is probably the –
[0:08:43.3] BR: It’s IT operations and security.
[0:08:45.5] DM: Oh, and security? Okay.
Well, you know, again, I’ve said, one of the things is that you need to convert to a utility and associated with that is security and you’ve got to do a better job and you know, one of the things that I hear is all the time about people trying to balance all the old equipment with budget, you can’t afford to it.
You know, you can’t be secure if you can’t buy the newer version of the clinical device as it’s running on the old Windows platforms. But it’s still is the human element that is the most dangerous. And no matter what we do, the bad actors outside the institution are not nearly as dangerous than the people that we’re looking at inside.
And so, the breaches that I’ve seen or I’ve been involved in Really happen because our employees didn’t do what we expected. And so, when I was in the government, I’ve heard from one of the ladies who was the chief privacy officers said that – this has stuck with me. You have to create a culture of privacy and security and if you don’t, you won’t be successful and everybody has to own that responsibility.
We have to do much better job of doing what would be considered normal, it’s not just the training, it’s the background checks, it’s motivating people, recognizing people, being good leaders, good custodian, good servant leaders where you’re looking out. So that people don’t want to do harm to the organization and empowering everybody and that is every single individual to be an agent of security.
That’s the kind of oversimplified but extraordinarily difficult measure to reach.
[0:10:19.9] BR: Yeah, 25 million medical records have gone missing to the first half of this year. And that’s really not okay and as you state, I mean, it’s a lot, it’s due to us. It’s mistakes, it’s misconfigurations, it’s – it could even be people that are you know, it’s mistakes.
Majority of these are just flat out mistakes being made by health IT. It’s not nefarious actors who are hacking it and doing these sophisticated attacks, for the most part. At least that we know of, when you look at the top 10 issues, even the Equifax one, you just go, “Sun patch server.” You know, that’s the psychology in terms of where we’re at, where we’re going. Sue, IT operations and security, you know, where do you think we’re at?
[0:11:08.2] SS: Where we at?
[0:11:09.5] BR: Is the sigh your answer?
[0:11:12.2] SS: No, you know what? Okay, I need something smart. I was going to comment specifically about security and the importance of security culture. And I had that conversation just this week with people about you know, is there a security culture in this particular organization that there needs to be? And that has to start at the top.
I think David did a good job talking about some of the key components of security. But if your top executives are not totally bought in and understand the risks, you’re not going to get the support around policy, you’re not going to get the support on budget and be able to do the kinds of things that you need to do.
IT operations, what are you covering? All of infrastructure?
[0:11:48.8] BR: Yeah, let me frame this up. Are we seeing disaster recovery plans in place? Are we seeing [inaudible 0:11:54] process being followed? Are we seeing patch management? Are we still sort of behind in saying, “Well, we’re almost caught up to the patches we need to do?” And I’m not talking about clinical devices at this point because that’s a whole other can of worms and in some cases, supporting the health IT and in some cases, it does.
I’m just talking about the basic infrastructure, are we keeping up with the basic maintenance of that operation?
[0:12:19.6] SS: I think it’s really variable, I think there’s probably some very large organizations who are doing this very well and there’s whole lot of organizations that need help. That haven’t made the investments that they need to make. Don’t have the strength of the leadership in that space that we need.
There’s plenty of opportunity to raise that bar in many healthcare organizations is my sense.
[0:12:38.0] BR: All right. I’ll take the last word on this because when I came into the organization that I became CIO, we had eight outages in our data center over six weeks and that was a complete outage, the data center went down. That was just a result of, we had just insourced for pro after 10 years. We hired a whole bunch of people but we didn’t set up all the processes around it and all the procedures around it and the bottom line is if I become a CIO for a new organization tomorrow, I would reset their expectations for all the really cool stuff we’re going to do and I would say the first year is getting the operation right, getting people in the right roles, getting them trained, getting the procedures done because everything else is done on top of that.
And even though you don’t see them in a lot of organizations if it is done right you shouldn’t see it and you shouldn’t even think about.
But that foundation has to be – and I’ll tell you when you do mergers and acquisitions you almost start over. You almost say, “All right we are bringing these two together, let’s make sure that the two organization’s data talk. They know how to handle disaster coverage. They know how to handle basic operations.”
[0:13:40.1] SS: You wanted the last word. Can I say one other thing about this?
[0:13:42.8] BR: Sure.
[0:13:43.9] SS: You both know that the interim I am doing right now is as Chief Technology Officer and I tell people who know me well don’t last because I did not come up on the technical side of IT. Both of you are far more technical than I am. I came up on the application side. I started as a programmer a gazillion years ago. and I was hired in because they just want to keep everything moving along and supported this big Epic go-live from the infrastructure side.
They knew I wasn’t the techie, you know the technical wizard. I have to say, the deeper I get in it and the more I am working with my folks in these projects, the more appreciation I have for the complexity of what our technical staff does and the environments that they support. It is incredible.
And I know you guys know that but I feel like I have gotten a whole different view of it doing this work right now and I am impressed.
[0:14:32.5] BR: Fantastic, I forget who’s next. David are you next?
[0:14:35.8] DM: I’m happy to go next. I think so.
[0:14:37.9] BR: All right, so we have three topics left, staffing, innovation and more importantly we have 15 minutes left. Staffing, innovation and experience. Which one of those would you like to talk about?
[0:14:45.3] DM: I think innovation is probably the topic that gets so much focus right now and again, that’s my plea to people who are involved in it is to stay very practical and pragmatic. Again, say you are really involved in innovation and I use the word hobbyist earlier, you know the shiny new object is great but where does it fit? How does it align with the strategies?
And so, I think one of the things that I look at and I am just going to try to pull digital health back in here. But if you are going to be a digital health system, then what you got to do is use innovation in a way that really pays homage to the name. And that is not to use real world-based metaphors to create new ways to do things. And I will say that I think a lot of people talk about innovation, a lot of people talk about automation but they use innovation as a way to describe it.
Innovation to me is not doing something that you’ve been doing in the physical world with the metaphor like we’re not going to take a piece of paper-based material and then automate it. What we are going to do is we are going to figure out a completely new way to use technology that we have never seen before. And I am going to use as simple as possible occurrence that. I was on a bus riding down the street, so I didn’t happen to pay attention to driving and I look at the window and this is right after flip phones were being replaced by smart phones and one of the most innovative ways I saw somebody using the telephone was a woman who is standing on a corner but she was holding her cellphone, which of course I use you know what they would do all these things that smart phones would do but she had turned the camera on and was brushing her hair and she had turned a cellphone into a compact.
And I thought, “Oh my gosh. Here is somebody that was using a device that wasn’t intended to be used for that purpose whatsoever in a way that I would have never thought about.” And I have always said that the real innovation comes not when you take the people who were brilliant and well-educated in a formal way. But if you can get technology out to the end users, they will do things with your programs that you never could have thought about or expected and they will figure out solutions to problems that you didn’t know you had. And so, part of innovation is creating something new. I think part of innovation is just pushing things forward so quickly that the users can then turn around and figure out a way to use them that we could not have done as IT professionals.
[0:17:21.3] BR: So, Sue or David on this because I really want to ask this question, which is where do you point innovation at? You know we have heard a lot of people talk about the route auto fax through AWS now looks for consent forms and then it does a fire. Because 60% of their faxes were consent forms and instead of somebody reading all of those and whatever, it now uses the machine learning and the technology, it finds the consent forms and then it pushes a fire callback through the API, back into the EHR and say consent form received and that’s a form of innovation.
Daniel Barchi was on talking about robotic process automation and how they’re using that around billing and how it’s really revolutionized what they are doing there. So that is one area. I was at Health Duo and heard Karen Martin and others talk about innovation around the consumer experience and those kind of things.
But I’ve also had conversations where people are saying, “Look, if looking very real like Walmart and CVS are absolutely planning to take away the front line of the hospital.” And I talk to certain people who say that represents 20 to 30% of our business, which is only going to leave us with X. Should we be pointing our innovation at those kinds of risks to the health system’s business model or should we be pointing at that the business model as it exists today?
And I will throw it out to both of you because I don’t think it is fair to point it at anyone of you because I am not sure I have a good answer for it.
[0:18:46.3] SS: Okay. I’ll take that first and also say that I use my phone as a compact that is a good idea, definitely. Good work. You know I think when you started asking this question, Bill, I was thinking where to focus innovation. I think three buckets for sure. There is how do we help the clinicians? How do we do better patient care and a more safe patient care? What does that mean?
Automation, efficiencies, you know where can we apply new tools? There is still an incredible amount of inefficiencies within health care and we know that and cost go with that and then the third bucket that’s outward facing, you know what I called digital health, consumers and patient engagement, etcetera. I think you got to try and plan all of those and depending on who is driving innovation for your organization, you may be focused on just clinicians or you may be focused more on outward facing consumer engagement.
I think you got to look at all of them. Your point about the industry and risking our health care business models I think is how you asked it, we should not be trying to protect a certain model right?
We need to have a more holistic view of health care and the health and ecosystem of health and trying to have some breakthroughs that go well beyond the models as we know them now, which is why okay I forgot, I am sure you know Bill because you are up on everything, The company that was formed and the tool is now the president of what did they name it?
[0:20:07.8] BR: Oh yeah. I’m sorry I forgot.
[0:20:09.9] SS: Okay, stump the host you know what I am talking about. You know they are looking at different models, right? We should not as healthcare providers, in my opinion, be threatened by the new models that are emerging out there. Because in the long run, what do we want? We want better help, we want more cost effective, we want safer health for everybody but you know I won’t go into politics, Bill. You’re welcome.
[0:20:31.8] BR: David asked me a political question on one of the shows the last time we were on so I am not going to.
[0:20:35.9] SS: You have the power of the edit.
[0:20:39.5] BR: Absolutely. Staffing, experience. I think we’ve touched on experience. So, let’s talk about staffing. One of the things I’m concerned about is just a – you know you talked about the IT utility. I think when [inaudible 0:20:51] was on the show he talked about the fact that CIO’s are going to be more procurers of technology as oppose to builders and those kind of things.
Well procurers of technology and sitting in front of cloud base service consoles and spinning things up and down is a different skill than potentially what we have within health IT today. What can we do within our health IT organizations to prepare people for what’s coming next? And is that our responsibility as CIO’s of the organization? And if it is our responsibility, what are we going to do? David I’ll start with you.
[0:21:24.1] DM: By the way, I do think training is actually a reward for the people in IT. It is an incredible motivator and so professional development seems to be a way to attract and retain people. And so, I couldn’t agree more that doing that is important and it is important for selfish reasons the ones that I mentioned. If you want to keep people and what I used to tell people that word for me and I found it very effective and I highly recommend it is that, “every year that you stay at this organization, I will find a way to make sure that you get some kind of professional development. And next year your resume would be so good that you wouldn’t leave because the year after that will be that much better.”
And the idea is that I want to make you prepared for the next job but I want that next job to be inside my organization and so it is not enough to change just the staff. But you have to change the environment in which you are working and that is where you need to be looking for innovation and how you can use technologies that people haven’t thought about.
And you have to move people’s skills along. And it is true that there are a few people, a few percentage points of people who just don’t want to change. They want to keep doing the same things or the same skills that they want. But in general, I find that the vast, overwhelming majority of people want to be trained. They want to be challenged. They want you to ask them to get smarter the next year than they are this year. So, I think having those kind of people around you makes you better. And you know the idea is the smarter they get the smarter you need to be.
And so, as a CIO, I’ve always felt pushed because they would always bring topics that I wasn’t familiar with to me and I felt like that I will do it. You don’t need to outrun the bear. You just need to outrun your friend or your companion in this case. And so, the idea is I find that I probably get about 100 emails from employees every day and people go, “That’s ridiculous.” And it’s like, “Well, maybe it is ridiculous but it helps me look for trends.”
It also helps me look for what is new that I would have not anticipated had the staff not bought it to me or brought it to me and so I think those are interesting things to pay attention to.
[0:23:34.8] SS: One of the things that I would say about staffing is there is a huge difference in the staffing challenges and probably strategies in markets that we’ve all been in, right? You know I was on the Boston market for many years. You Bill were in the LA, Southern California market. David, Dallas market. You have been working with a client in the New York market.
Very, very different in terms of competition, being able to draw people. You know when an Epic implementation is done at one major system in the area, you know that you can get some of them onto yours if you are not that far. They don’t have to move houses and change kid’s schools, they are ready for the next one, right? But how many health care organizations and IT shops are not in those big markets, who are just in the very same need for talent and how do they find that talent and how do they retain that talent and how do they grow that talent?
I’m in a market like that right now. It is beautiful, I love seeing the mountains every day in Burlington, Vermont but it is a little far away and a little bit harder to recruit for. So those are really different staffing challenges that you have to look at. But you know what it comes down to with the culture of your organization, your commitment to your people or you’re investing in both time and money in training them and preparing them for the future, some of that is the same. But you have to recognize that you’ve got some different challenges.
[0:24:58.6] BR: Absolutely. Great conversation. I want to thank the two of you for coming on the show and trying out this new format. It is greatly appreciated. There is a ton of wisdom. And I can’t wait to share it with everybody and hopefully I will see you guys. Sue, we are not going to see you at CHIME. David are we going to see you at CHIME?
[0:25:14.1] DM: Oh yes, you will.
[0:25:15.4] BR: I am going to be careful at time specific things on the podcast because you never when it going to air so.
[0:25:21.5] SS: Timeless. Thanks for having us. I always enjoy talking with you Bill and of course working with David on anything.
[0:25:26.9] DM: And I share exactly the same sentiments about the two of you. So, thank you all.
[0:25:31.4] BR: Thank you.
[END OF INTERVIEW]
[0:25:32.4] BR: Again, I want to thank David and Sue for taking the time to join me in the conversation. So knowledgeable, so articulate, I really appreciate their support and their support on the show. When we recorded this, they were not channel sponsors for the podcast and now, StarBridge Advisors has become a channel sponsor for the show and I really appreciate that.
So special thanks to all of our channel sponsors who make this content possible, StarBridge Advisors, VMware, Galen Healthcare, Pro-Talent Advisers and Health Lyrics for choosing to invest in developing the next generation of health leaders. Please come back every Friday for more great interviews with influencers and don’t forget every Tuesday we take a look at the news, which is impacting health IT.
The show is a production of This Week in Health IT. For more great content, you can check out the website or the YouTube channel. If you find this show valuable, please share it with a peer. Shoot them an email let them know that you’re getting value out of it and that is greatly appreciated.
Thanks for listening. That is all for now.
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