Sue Schade from Starbridge Advisors on The Healthcare CIOs Role in M&A

Sue Schade This Week in Health IT
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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.

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Bill Russell:                   00:11                Welcome to this week in health it where we discussed news information and emerging thought with leaders from across the healthcare industry. This is episode number 28. Today, we discussed the cio role when m and a is in your future, uh, plus the consumer and the consumers are demanding more from healthcare. Today. We look at where those specific areas are and what a cio might do about it. This podcast is brought to you by health lyrics. Are your strategies constrained by infrastructure or are you tied to 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, recovering healthcare cio, 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’ve raised $2,000 for hope builders, which provides disadvantaged youth life skills and job training needed to achieve in, during, and personal and professional success.

Bill Russell:                   01:18                I’ve hired their graduates. Their stories are really amazing. Uh, we have five more weeks where our sponsor, we’ll give $1,000 for every additional 100 subscribers. Join us by subscribing today and be a part of giving someone a second chance. Um, today’s guest is, is, uh, not new to the show. Second, second time guest. Today’s guest is former Chime cio of the year and now serves as a principal at a star bridge Advisors a veterans, Cio, Brigham and women’s University of Michigan Health System, uh, interim at university health are university hospitals in Cleveland, Stony Brook in New York. And as I said, principal at starbridge advisors, the wonderful sue’s shade joins us. Good morning, sue, and a welcome back to the show today.

Sue Schade:                  02:07                Thanks Bill. Good to be here and look forward to our conversations today

Bill Russell:                   02:08                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 it and help us where we’re going to, we’re going to struggle through some audio challenges today because we don’t have those wonderful people around because we’re both actually working out of our homes today. Um, so we might hear a dog bark and your background, we might see painters in our office right now is going to be 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 second was a, was a long time ago. You were one of the early pioneers on the show. Do you remember? Do you remember what we talked about back then?

Sue Schade:                  02:54                A trick question. I do not. Whatever was current that day,

Bill Russell:                   03:00                I don’t remember. That’s why we call it this week in health it. So it’s a man and the show has changed a little bit since the last time you were on it. 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 what they’re working on today. So, uh, so what’s, what’s going on in your, uh, in your world right now?

Sue Schade:                  03:23                Sure. A couple of things. One thing I’m looking forward to a conference I’m going to in DC next week, which is health impact, it’s a smaller size conference thats gonna have several focus areas. I’m going to participate on a panel around patient centered innovation probably participate in a few other events as well. So looking forward to doing that, meeting some new people and having some interesting conversations. Another thing I’m working on right now I’m kind of excited about in fact has a call this morning with two colleagues is trying to figure out, offering in the coaching space targeted specifically to women leaders at different points in their career, so to say stay tuned on that. Coaching is something I’m passionate about. Um, and we’ll see what we can do with, with that potential. And I am coaching a two new people as of recently one in the career planning kind of load and another one who is a new cio in their organization and dealing with all the kinds of things that you deal with when you are very experienced but you come into an organization and a new culture and a new set of people and a new set of challenges a couple of things I’m working on and excited about these days.

Bill Russell:                   04:40                Well that’s fine. I did the coaching thing is interesting to me because I’ve now been pulled into a couple of contracts on that and I’m actually coaching a CEO on technology decisions and directions and it’s. It’s really fun. I mean it’s. It is really challenging. I mean you, you really have to come up to speed pretty quickly on the dynamics of the organization, but just the nature of the number of people we talked to, the number of organizations, the amount of experience we have, we end up being able to have some very good conversations with people in executive positions. Guide them, coach them a give them direction. What would you say is the distinction between coaching and consulting?

Sue Schade:                  05:24                Coaching is a one on one kind of relationship with someone and really looking at what their strengths and weaknesses are, what gaps they might have as a leader and how you help them to grow and develope whereas consulting, you know, can be anything from a project to an assessment to you know it can be a team of people it can be one if it’s just one leader, its probably advisory services. Yeah.

Bill Russell:                   05:55                One of the things I say 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 kinds of things. I mean some of those things you can do like in timeouts and whatnot, but 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, Hey, what are the, what are the three to five technologies we should be keeping an eye on this? We’re thinking of creating new roles within it. What do you think? I mean it’s really as coaching. It’s what you think. It’s interesting. So, uh, yeah, new directions for me. Definitely. And you’ve been doing it for awhile.

Bill Russell:                   06:41                Um, so, okay, so we do three things on the show in the new sound bites and social media close. So, uh, in the news, we each pick a story to discuss. Uh, I’ll go first and I’m always looking to have this conversation with somebody and it’s hard because if you have it with an active cio, they, a lot of them are in the middle of these kinds of acquisitions and they’re not really free to talk about it. So I wanted to talk m and 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. You can download it off the Kaufman Hall Dot com, uh, website. Uh, they’re an advisor advisory services to um, to health systems and they have their 2017 in review year. Uh, the year MNA shook the healthcare landscape.

Bill Russell:                   07:34                So it’s a little older report, but 20, 17, it’s not that long ago. And here’s some of the things they came up with. 115 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. A largest regional healthcare transaction is advocate and Aurora and Illinois, nearly 11 billion creating the 10th largest not for profit. Um, and just an odd statistic, but Pennsylvania had 14 deals. Georgia had nine deals. Texas at eight deals a most active states. I thought one of the more interesting things was, you know, in 2015 there was 112 transactions, but in 2017 there’s 115. But the transaction transaction revenue has doubled. So in the 112 transactions in 2015 represented $32, billion in revenue, a 115 transactions in 2017 represent $63, million in revenue.

Bill Russell:                   08:33                So we’re seeing a growth in those kinds of things and we can rattle off all the different health systems that are going through it. It’s really, it’s across the, uh, across the, the industry. So, um, here’s what I’d like to do with you, 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 cio. I’ll be from the smaller system and let’s discuss process thinking and approach to various stages, uh, of the merger. So here’s a couple more assumptions. Cio, the CIO or it was not involved in the negotiations. I know you find it hard to believe, but it happens. There has been little to no due diligence as a result of that. The merger is slated to take about six months from the time it’s announced.

Bill Russell:                   09:28                Uh, but we both know that the regulatory environment, you can’t bank on this but typically takes longer than six months to pull it off. Um, I know that the providence St Joe’s merger I went through, took a little over nine months, closer to 10 months to pull off with six months 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 first. What’s on your mind? What are some of the things you need, you think we need to do first and what are some things you’re going to ensure that gets done?

Sue Schade:                  10:08                Great question, and it is not surprising that It may not be involved in the due diligence as I already commented, so obviously doing the it due diligence and trying to tee that up has to be one of the first thing, but even before that, I think it’s critical that cio in this case, me for the large organization fully understand what are the business drivers, what is behind this merger, and they take different forms. You talked about some of the bigger ones. That’s the scenario you’re giving me here is probably more typical where there’s a merger, a smaller organization coming into a larger organization right to understand the business first, an approach. You need to think that the whole is greater than the sum of its parts and what are we both bringing into this equation that we’re going want to elaborate. I think that’s critical and you know, I think we’ve all been there. You start thinking about your roadmap in the order which you would by which you would integrate systems, assuming that that’s part of the plan on the review of the infrastructure and network.

Sue Schade:                  11:24                That’s typically the organization can operate as one, you dealing with all the financials and last, if you get to it and you need to get given patients and clinicians integration and workflow, you know, are you, what are you gonna do to integrate clinical always, always with the focus on the patient now and again, it depends on, it depends on the makeup of the organization, but I just heard about a merger yesterday that I had not yet read about in the news. So I think it’s public that it’s happening. That was a very unique one and I’m not sure I’d have to think at this point about patient flow, but typically in a merger you’re, you’re dealing with patient flow.

Bill Russell:                   12:15                There’s so many things to do. I did go through this so I was part of a merger team bringing a $6,000,000,000 health system together with a $13,000,000,000 health system. Um, which today is a $22,000,000,000 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. A, it’s a day to day kind of thing. The first thing, uh, I found to be important again, now I’m the CIO of the smaller entity, a communication is your first job, uh, for the cio of the acquired entity. And the number one thing people want to know is what does this mean for my job? Because the larger entity, they’re not as concerned because they’re like, hey, we’re the, we’re the big, we’re in charge here. I’m now. That may not be the stated intention, but everyone who’s ever watched this from afar says the larger entity will take over.

Bill Russell:                   13:17                And to be honest with you, and in our case it was stated though it’s a merger of equals. And uh, that was not the case. It never, it almost never is. I don’t want to burst anyone’s bubble or any CEO 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 sorta the board sort of make their way and it’s sort of figures out. So my team is 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 because you don’t want to overstate, you don’t want to overstate, uh, 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.

Bill Russell:                   14:12                But there will, there will be overlap in some areas so you don’t want to over promise, but you don’t want to under promise because 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 and really, uh, escalate to good role. So 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 a. and so that’s the, that’s the number one thing is communication. And the second thing I’m about on that first day is relationships. I’m trying to figure out, okay, from a relationship standpoint, obviously you’re the, you’re the larger organization Cio, I want to have a relationship with you. So, uh, if you don’t reach out to me, I’m definitely reaching out to you.

Bill Russell:                   15:07                Um, I need to, I need to know that leadership team on the other side. I need to, 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, some of the people that are doing mergers have been on this show. You can listen to the cio 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 cio? 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 that, I don’t know who knows what it is.

Bill Russell:                   15:53                Um, so those are probably 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, a security questions, clinical workflow questions, are we going to change our EHR? 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 going to come together? Is there going to be a common clinical governance? Is there going to be, how different are your Ehrs? Maybe you’re on the same Ehr, but different instances now. Um, you know, maybe they’re very similar. There’s so many things. So let’s talk about, let’s talk through some of those actually. So you brought them up a technical security and clinical considerations. We’ll come back to some more people stuff in a minute. So technical, clinical and security considerations. How are you thinking through those things 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 the most important?

Sue Schade:                  17:08                You have to go back to the question of business drivers and typically in a merger there was an assumption that you’re going to be able to reduce, 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 a, merging those together and doing some level of consolidation? Actually can you drive any cost down You, you, you know, one of the organizations, maybe in the process of a cloud migration, the other one may be not even thinking about that a, there may be new data center, you know, under, under construction, right? Physical, physical data centers. So 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 when you need to start looking at that that you might be doing together? You know, there’s no rocket science but I don’t want to minimize, but you know, that’s all part of the due diligence. Figuring that out.

Bill Russell:                   18:24                There are some things that you’re going to need on the first day. It’s really interesting to me. So on the first day, you haven’t even come together and people are already going to start asking you like, hey, how do we do shared calendaring? How do we do? How do we do shared calendaring? Whats our conferencing solution? What’s our. I mean they start and you’re sitting there going, are our security teams haven’t even met each other yet? And actually this is where the cloud comes in. It’s interesting because 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’re still separate entities. We haven’t done the due diligence on security. We don’t want to just slap these networks together.

Bill Russell:                   19:13                There’s just too many, too many variables. So let’s go ahead and let’s go ahead and fire up zoom like we’re using right now. This is not an ad for them. It’s just one of many or, or you know, or a 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 because it works. I mean, right now there’s so many cloud solutions that give you that, that base level of interoperability and connectivity. Um, and then, and then you almost need to slow people down, um, because they want to start talking, you know, are we going to go to a single identity system or we’re going to go to a single Ehr, are we going to 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 merger day.

Bill Russell:                   20:01                Um, because really there’s a whole bunch of things you can’t even do until that the paperwork’s done and signed. And so there’s part of me that says a 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 it actually. Let’s start here. Let’s talk about our first conversation. You’re the acquiring cio on the, on the smaller entities, cio. What are some things in our first conversation, what are some things that you think you want to know from me and what are, what are some things I had, and I’ll tell you some of the things I would ask of you.

Sue Schade:                  20:45                I want to get to this because I think it is so critical culture really matters and the people and the relationships that you’ve already talked a little bit about. So 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 the big dog here, due to perception, right? I’ve, I’ve been, I’ve been told in one situation, um, they, the, the cio, he thanked me for meeting with him at his location 40 miles from where I was and said, you know, for people to come down from the ivory tower because it was an academic character there. I mean, he was surprised that I came and met with him and his place. And, um, I just think those dynamics, like what you say, what would you use? You don’t call it the ivory tower, right? You don’t call yourself the big dog. Any of those things, right?

Sue Schade:                  21:40                You may be perceived as all those things, but from the beginning I’ve been getting to know you. I’d want to know your style. You know, what you’re doing with your team, what’s important to you right now? What are your concerns today? What are you concerned going forward with the merger it’s all the about people skills building that relationship and the rapport that we’re going to be working together and we don’t know, right? Bill how it’s going to shake out at the end of the day what your role is gonna be and what my role is gonna be, what your peoples roles are gonna be or what my people’s roles are going to be. So you just have to say for the greater good, this mergers going on, we all serve patients, right? That’s what we’re about and we’re going to figure out how to do this together. It has to be a partnership and it shouldn’t be a threatening kind of realized

Bill Russell:                   22:34                And by the way that geusture of coming to the other location that I can’t emphasize enough how big of a deal that is. And what that communicates, it communicates a certain level of humility, a certain level of awareness. Plus if you come to my location, 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 there were the small entity and you coming down meeting them and I’m able to really start to, um, to calm things down. And that’s the number one thing I’m doing on my end is just keeping people focused on the job at hand. I’m making sure that hopefully in it organizations today we don’t have too many people that are completely indispensable, but making sure that those people that have critical roles, uh, are, are not like spending half their day with resumes and on Linkedin and whatnot, but actually focusing on their job and those kinds of things really helped. The other thing that really helps, it’s just an ongoing dialogue between you. I, so that I can get questions answered. You know, what, what is your data team look like? What is your analytic strategy look like? So that when my data team comes in and they go, you know, how, how do they think about these things, I could start to answer them until we get to that point where we’re bringing the teams together.

Sue Schade:                  24:02                So one thing that I would add, especially because you said in the senario, it was not involved in the due diligence. there is Someone driving this merger from both of our organizations, there is a point person and you as the cio needs 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 cio to cio, you’ve got that big framework and you’ve got that context. The other thing is the people component is so critical. You’ve got to be right there with the HR leads for each organization as they’re starting to talk about and think about how might things change. Now, are they gonna be a new operational model what’s it gonna mean for for staffing etc. and you’re never figuring that out independently as a cio. It part of a larger organization.

Bill Russell:                   25:00                So let’s, um, cause I, I need to bring, and we can talk about this for the next 45 minutes or next two days really.

Bill Russell:                   25:08                the. So let me close with this question, which is we’re bringing our teams together. What’s a, how do you, how do you prepare your team for their first meeting with our team? So we’re going to bring our infrastructure teams together or innovation teams together, our data teams together, and we’re going to have, we’re going to have a common meaning. How do you sort of prepare them? What’s the, I don’t know, how do you make sure that that first meeting goes well?

Sue Schade:                  25:34                Well, I will go back to what we’ve already talked about in terms of relationships of the dynamic within the larger and the smaller organizations impacting people and helping them understand and message. What I would emphasize with people is that change is constant and we dont have all the answers communication is critical. Uh, I subscribed to the probes that you tell people what you know, when you can 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, we do know that we made that decision, but we can’t go public yet the philosophy or belief that, uh, that lack of information that people make stuff up thats how all the rumors start right. It just goes round and round So people aren’t getting any regular proper commuincation their gonna make stuff up and then, and then you just have to try to manage that. What I would also obviously with the advice of hr, how do talked about future work and on the one hand you can message there is 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.

Sue Schade:                  27:00                You know, 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 possibility, who knows what changes is going to be and what new opportunities, new job, new skills, you know, they can learn. So be open to the possibilities. Other thing I tell people is you own your own career. So depending on what those possibilities are and those changes, if you like them, if you don’t like them, if you want to propose you put me in this role instead, you know, every individual owns their own career,

Bill Russell:                   27:41                And that’s why you’re a great career coach for people looking for some guidance in that area. The thing bringing the teams together. There was a couple of things that I thought were non negotiables. One is one of the leaders had to address the it team, especially since there’s no due diligence. It might feel slighted. The 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’s 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. Then 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 entities doing everything the best that it might not be a, that we want to take best of each and make something better.

Bill Russell:                   28:45                Um, and then, uh, you know, the, the, uh, the last thing to prepare my team for the conversation is to just set realistic expectations. And it is every healthcare it organization has warts. 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? And it’s like, of course they have these issues. It’s a $13 billion dollar organization. Do you know how hard it is to run our $6,000,000,000 organization? We have warts. They have warts. The goal is, uh, you know, if people can be honest and you can remove the fear from the situation and we can develop something better. And that’s really one of the key things I would leave people with is as the leader of the it organization, you have to figure out a way to remove fear from the equation because people do dumb things when they act out of fear. And uh, and so that’s where communication comes key.

Sue Schade:                  29:52                I bet you’re gonna transition, can I say one other thing before we transition a, you know and some of the people listening probably know that I write a weekly blog called Health IT connect and I have written a couple blogs around the issues of mergers and acquisitions. One was merger mania where I talked about, uh, making sure we’re doing it by certifications, one was about culture, which gets at what we’re talking about, in terms of the dynamics between people and it’s really about respect. Um, and the other one was about 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.

Bill Russell:                   30:42                Yeah, it’s a great blog and I we’ll be coming back to that in the sound bites. No, now unfortunately, which means we have this story. Your story, we’re probably going to short change a little bit because we spent so much time on, on the merger, but tee it up for us. Okay,

Sue Schade:                  30:58                sure. So, um, the story that I found and want to talk about it’s called a patients are losing their patience, so two spellings, patients are losing their patience Several ways healthcare consumers are demanding more. Um, it’s an article written by Barbara Smith, partner in paraban consulting partner and I think it’s just spot on, I’ll go quickly spot on as she draws the analogy between a 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 patients workflow, ease of scheduling, ease of access to transportation, parking and electronic access, which having worked in some very congested urban environments, I get that one fully. The fourth one is patient experience with wait times and other annoyances. A fifth one is transparency in pricing.

Sue Schade:                  32:11                She’s got an interesting analogy there about dropping off your car. You wouldn’t drop your car off for service if you didn’t know what you were getting into. Right. What’s this gonna cost me and quality metrics as sixth, she points out, you don’t go to a restaurant probably now with a checking, a yelp review. Right? So what do you know about the organizations that’s going to be doing care? And her last one is about speed of report which has to do with getting results to patients timely manner. And as I read this article I was thinking, Bill, is I think cios all of us know we need to be doing this a lot from the executives in the c suite. The question is how, how do Cios address it and where do they start? So I’ll throw that. I’ve got some thoughts on that. I’ll throw that to you

Bill Russell:                   33:06                Wow I’m being asked the question, because I agree with you. I think this is spot on. Patient workflow scheduling, ease of access, wait times, other annoyances experienced, transparency and pricing, quality metrics and access to the report and the data. These are, these are, it’s a pretty good. Um, and how would I start? I’d start by, uh, creating that, uh, again, I keep saying creating the narrative for creating the story 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 extent that you can start collecting stories, a good, bad or indifferent from your patients that talk about their experience in terms of workflow. We’ve been asked this question 10 times we’ve been bounced around or somebody with a chronic condition that, you know, whatever the organization can respond to that they can look at it and go, yeah, that shouldn’t be true of our organization.

Bill Russell:                   34:05                I don’t want that to be true of our organization. And then they can mobilize around it. So I always start with the story. The scheduling one sort of cracks me up. My story around that is we had, and I’ve shared this before in our, uh, our portal, we had this list of things and we had, you know, the medical record number one and scheduled and was like number six. And when we talked to the patients, scheduling was number one. Scheduling is so difficult, a scheduling, referrals and, and that whole process, um, and we, all, we, all we had to do was talk to patients. They gave us the list and we said, as much as the internal anecdotal was, no, no, this is the most important thing. We’re like, no, look, we talked to. 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’s a spot on this. So what? What are some areas are. What are some of your thoughts on this, on this list of the seven areas for patient experience improvements.

Sue Schade:                  35:24                Well you know, you talk about scheduling and how hard it is, but that’s a critical one. Let me take it from the point of view of the question I askesd you and what I think it takes to get this, this done. You know, one of my philosophies is that you have to leverage your core products as much as you can, so your core ehr vendors have offering that. You need to be looking at do some of these things and it’s very possible that as the cio of what you’re dealing with is people in the ambulatory or people on strategy are finding niche products and saying, let’s go try all these things to answer some of these solutions. You don’t want to be in that position where your in react mode to all thsose niche products but, 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 driving some of this in terms of your digital health strategy, so you need to partner with them as the cio 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 has to be integrated. Um, those are the, those are the key points. I guess one other thing I would say, is there anything else on your plate? This may be like, oh yeah, we’ll get to that when we get to it. But then you find yourself falling behind the competition in your market. So figure out a way to take some steps in some of these areas with focused teams. Um, so they, you get moving on it.

Bill Russell:                   37:05                It’s interesting you brought up the, you know becasue some of our vendors have very extensive amount of offerings and I find ceos fall into two camps. There’s the, and some people that both of us are in contact with and really respect, have taken your approach and said, yes, you know, our vendor, we’re double paying for a lot of this stuff because we have all these different solutions and lets consolidate around this, this our ehr providers solution because it’s already integrated and works well. That’s one school of thought and it’s a, it’s a very valid, very good rule, a school of thought because it’s highly efficient to go that route. And then there’s the other route and I find some players going in this route where they go, you know, what we need to differentiate and if we just go to the market with my chart, we’re not going to be able to differentiate because everybody else in our markets using my chart.

Bill Russell:                   38:01                Um, and so they’re looking to free themselves a little bit. And so they’re putting new layers in between so that they can innovate, not necessarily a big teams of developers with small teams and whatnot. And we had somebody on the show talked about that of how they, uh, you know, with a team of, I think three or four developers, they were able to build on top of epics, Api, a completely different experience for their community. And so there’s, there’s two paths to go and they’re not necessarily mutually exclusive. Um, but yeah, I, it’s amazing to me, I was shocked you walk into healthcare and we did the inventory, and we’re like we have 1800 applications and, and that just, that just boggled my mind that it was that many applications and then you realize that’s the norm across the industry because we’ve allowed it for proliferate I guess.

Bill Russell:                   39:02                Um. Alright. So this is the new section for you and we haven’t done it this way since you were on in February. So a soundbite section. One, two, three minute answers, five questions. Um, so we’re just going to put you on the hot seat. The timeline is more of a guideline than, than, than a rule. But I’m, I’m not going to have a buzzer over here if you’re wondering. All right, so first question, first question, you served for several different health systems as cio, what do you think distinguishes the best performing it shops from others? So you’ve seen a lot of them. What, what, what’s the characteristics of the best ones?

Sue Schade:                  39:44                You know, it’s basic, it’s basic, it’s governance and I’m always amazed how many organizations don’t have good it governance it’s effective alignment with the business and uh, engagement, appropriate levels of engagement by the senior leader that sponsers on a major initiative and I think from an It perspective, running it, running the business, is about core processes and standards and again, there will be organizations that struggle with a lot of those basics unfortunately a on top of that, I would just say it’s all about the people and the culture and the people skills of the, of the, of the leader.

Bill Russell:                   40:29                Yeah. Yeah, that’s a great answer. I mean, the leadership team, the processes and the governance, 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. A 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 take that and do that presentation again. It 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.

Sue Schade:                  41:13                Sure. So first off, it’s not one size fits all and I think if you go into an organization as a lean leader and thank you can, you know, make certain things happen. 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 will 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 going to lead you towards where you have opportunities to apply new thinking, um, when I brought this in at university hospitals in Cleveland when I was there in 16 for eight months as an interim, I covered the whiteboard in my office with key metrics, processes, some of the gaps and I just started creating what eventually became a visual for them to put out in the open area. Along those lines, what were the key metrics that we needed to watch? What were the key initiatives that we needed to manage together? So I started early on planting the seed with the people who I knew would partner with me and then they have to take it on and own it. So those are some of the key steps. I did write a blog about this too, called a lessons from an aspiring lean leader. And it’s probably a lot of the key points that you might’ve heard of that presentation

Bill Russell:                   42:48                And I’m not sure how cios run their organization without lean principles. I realized it’s not one size fits all, but it’s so good and so basic. Third question for you what’s the main really about having a seat at the table for the CIO. Um, I just like to hear your thoughts on the right reporting structure, uh, or critical relationships with the healthcare cio needs to foster in order to be effective

Sue Schade:                  43:18                A couple points, one if you can’t and don’t report to the CEO I think the COO is probably the best other VP leader to report to because the COO sees everthing ultimately from an operational perspective and it sees everything as well. I have found that good alignment when I reported to the coo, the CFO has a much broader role than they did at one point. They’re not just counting the dollars. They have scheduke they’re often the point person for mergers and acquisitions. they’re ooking at new revenue opportunities as well as how to cut costs so important partner, if you don’t report to the CFO to work closely with the CFO, obviously for Ehr implementations or optimization. The, the, um, uh, the three person leadership team of the CIO, Cmo, Cno are really critical. Both have to be good relationships and Cmo, Cno have to have a very strong relationship. And I have learned from my husband who is a minister. You can’t fix the relationship you’re not in and if your CMO and CNO don’t get along. Remember that. And don’t get triangled into relationships either so if the CMO, CNO, don’t get along well, which sometimes happens in organizations is very hard for you to have that strong three person team, but do what you can to make that work. The last thing I will say is there’s all these new roles that are coming in, you know, the chief digital officer, the chief analytics officer or the chief innovation officer for a later thing. Um, if you go into an organization and those roles are there, figure out how to work with those people and partner with them, if they’re not there, figure out how much of that is going to be your role as cio.

Bill Russell:                   45:16                It’s such a collaborative role and a convener role.It’s a relationship role. In fact, I had one person say to me, did you get into this because you love technology. I’m like, I got into technology because I love technology, but you don’t become a cio because you love technology. That’s not the role it’s a people and a leadership role. And that’s, that’s what it is. And I’d love to touch on this subject from you because 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 cio of the year. What, what, what career advice are you giving that person?

Sue Schade:                  46:04                As early as you can find role models and mentors. I really liked the article, the confidence gap that was in the Atlantic in 2014. I’ve used some of my presentation, a lot of data for quite a long article, but I think it helps every women in particular bring some of the issues that women face around confidence and I would also emphasize that there is no right path and the choices that you make are your choices and they have to be right for you and your family. So it’s your path. And don’t let anybody tell you what that path needs to be.

Bill Russell:                   46:53                You know the one thing I’ve been talking to people about and I forget who was on the show that we were talking about this. But it’s interesting that when a female executive in a male executive look at the role of the cio, the male executive just says, well, I have two of the 10 qualities. I’m pretty sure I could do the job for a female goes, well, I only have six of the 10 qualities I need to develop the other four before I could be the cio. And it’s such an interesting, um, the mind gap that somebody who has six of the qualities and somebody has two to the person who has two thinks they’re more qualified than 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.

Sue Schade:                  47:43                Yeah. What’d you say? What?

Bill Russell:                   47:45                Yeah, just just put, just put your name forward. I mean it’s,

Sue Schade:                  47:51                I totally agree. And the article, the confidence gap and I think there’s a book too get that, a lot of that from a data and research perspective, but also how women need to put themselves forward and overcome that and that they can.

Bill Russell:                   48:09                Um, last question. So you do right. The weekly blog, I don’t know where you find the time, but I appreciate the weekly blog at 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 given that it’s your blog and brand, did you ever have concerns from your employers or did they ever put a restrictions on you in terms of writing?

Sue Schade:                  48:41                When did I start? I started in June of 2014, so I’ve had four years now of weekly blog and the discipline, uh, I was at University of Michigan at the time, the cio 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 give back why do it I approached the social media coordinator and the PR department. And she was like, oh, perfect, I’d love more leaders to do this. So yeah. 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 as a professional blog, but it was mine. Um, I, when I write what I wrote down, I always thought there’s four audiences, there’s my staff and the blog does not replaced messaging for me as a cio, to read my blog right? Or how the staff would respond to anything I wrote, how would any employee at University of Michigan health system respond to anything and then the world is Cio’s and it leaders or an audience and everybody else

Sue Schade:                  49:53                And so as I wrote, I thought, who am I, who am I talking to and how are they going to relate to this. to your question about any concern? 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 impose 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. There was another one I did on an incident and the lessons from it and I wanted to make sure, again, this is not exposing us, the way I am handling it is ok, but I did use my judgment a little and I told the leaders that I would, um, I did at a certain point when I left Michigan transition and so it is my branded blog and not under the Michigan Banner. The other thing is if I touch on a political subject, which, you know, I do sometimes, I always am careful about how I approached that and there’s a healthier spin to it somewhere, somewhere in there.

Bill Russell:                   51:12                And the reality id if you’re gonna put yourself out there, if you’re gonna write some people are gonna like it, some people are not gonna like it and that’s just the nature of the Internet. Would you encourage other CIOs to pick up this practice?

Sue Schade:                  51:22                If they are so inclined, but I would encourage them to find whatever form they can, that they’re comfortable wit to share and teach others because we have a lot to offer as we continue to learn as leaders.

Bill Russell:                   51:35                Absolutely. We’ve gone a little long. I apologize for that. Sue thanks for coming on the show. We already mentioned some of them, but what’s the best way for people to follow you

Sue Schade:                  51:49                Best way mentioned my blog. I’m on twitter @sueschade is the habdle um, I would say also you can follow Starbrigde Advisors or active on linkedin and twitter as well. So any of those ways for following and getting good content that we try to share,

Bill Russell:                   52:20                You are one of my social media pioneers that I’m trying to emulate. So I’ve got a couple of ways you could follow me @thepatientscio, my writing on the health lyrics website. Don’t forget the show @thisweekinhit on twitter. Check out the website and catch all the videos on the youtube channel. The easiest way to get there. We’re still not at a point where we can get our own vanity url, so it’s will redirect you over to youtube. And we are now up over 200 videos on there and um, uh, and growing every day. So please come back every Friday for more news, information and commentary from industry influencers. That’s all for now.


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