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 when we discussed news information emerging thought 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 the 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 [inaudible] dot 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 list are our.

Bill Russell:                   01:02               We’ve exceeded 200 combined new subscribers between our youtube and podcast outlets, which means we raised $2,000 for hope builders, which provides disadvantaged youth life skills and job training needed to achieve and during and personal and professional success. I’ve hired the 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 cio of the year and now serves as a principal at a star bridge. Advisors have 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 suits shade joins us. Good morning, sue, and a welcome back to the show.

Sue Schade:                  02:03               Thanks and look forward to our conversation 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 and key 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, uh, 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. It’s going to be painted behind me. So if somebody Fox pie just, just let me know. Um, so, uh, 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 what you remember what we talked about back then?

Sue Schade:                  02:55               I do not. Whatever was correct that I don’t remember.

Bill Russell:                   03:02               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. 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 his next week, which is health impact conference, that’s going to have several focus areas. I’m going to participate on a panel around patient centered innovation and probably a few other events as well. So looking forward to doing that, meeting some new people. And the other thing I’m working on right now, I’m kind of excited about of call this morning with two colleagues trying to figure out I’m offering in the coaching space or targeted to women leaders at different points in their career. So stay tuned on that. Coaching is something I’m passionate about. Um, and we’ll see what we can do is with that potential. Uh, and I am coaching to New People as of recently one in the career planning and another one, a new cio in their organization and dealing with other kinds of things that you deal with when you are very experienced that you come into an organization and a new culture and a new set of people and a couple of things I’m working on and excited about these days.

Bill Russell:                   04:39               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 a on technology decisions and directions and it’s really fun. I mean 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. Um, we ended up being able to have some very good conversations with people in executive positions, guide them, coach them, give them direction. What would you say is the distinction between coaching and consulting?

Sue Schade:                  05:21               Oh, coaching is a one on one kind of relationship with someone and really looking at what their strengths and weaknesses are, what, what a gap they might have as a leader and how you helped them to where it’s consulting, you know, this whole thing can be anything from two to, with one, you know, one thing question

Bill Russell:                   05:55               and one of the things I say to people is, you know, the, the coach of a basketball team ever 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, you know, 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 it was really is coaching? It’s what you think. It’s interesting. So, uh, yeah, new directions of 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’re a bigger 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 ceos, we’re working with CIS. I thought it would be good to have this conversation with you. So I pulled the Kaufman Hall report a, 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 2017 is not that long ago. Here’s some of the things they came up with. One hundred 15 transactions announced in 2017 highest number in recent history. 10 transactions involve sellers with net revenues of a billion dollars or greater, representing the largest number of mega deals ever recorded. A largest regional healthcare transaction is advocate in Aurora and Illinois. Nearly 11 billion, uh, creating the 10th largest not for profit. Um, and just an odd statistic, but Pennsylvania had 14 deals. Georgia had nine deals. Texas had eight deals, 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 it. So in the 112 transactions in 2015 represented $32, million in revenue, 115 transactions in 2017 represent $63, billion in revenue. 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.

Bill Russell:                   08:39               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 cio is of two health systems that are coming together. You can be the, you can be the larger health system because it matters. 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 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 and there has been little to no due diligence as a result of that. The merger slated to take about six months from the time it’s announced. 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 murder I went through, took a little over nine months, closer to 10 months to pull off with us six months announcement. So, uh, let’s start with an announcement day. So, uh, this is pre merger announcement day. 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, do 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 said that. So obviously doing the 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 in this case, me for the large orange, they 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 as more typical where there’s a merger or a smaller.

Sue Schade:                  10:51               It’s understand the business. I think that 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 gonna we’re gonna want 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 by which you would integrate systems, assuming that that’s part of the plant on the review of the infrastructure and network. That’s typically because the organization can operate as one you deal with all the financial and last, if you get to it and you need to get given patients and clinicians integration and workflow, you know, are you going to, what are you going to do the 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, 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. Not sure how they have to think at this point about patient flow, but typically in a merger, you’re, you’re dealing with patient flow.

Bill Russell:                   12:16               There’s so many things to do. I’m 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’ve found to be important. Again, I know I’m the CIO of the smaller entity, a communication as your first job 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 W, we’re in charge here. I’m now that may not be the stated intention, but I agree with everyone who’s ever watched this from afar says, the larger entity will take over.

Bill Russell:                   13:16               And to be honest with you, in, in our case it was stated, no, a, a merger of equals. And uh, that was not the case. It never, 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, 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               Um, 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 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 worried 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 wouldn’t 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 tend because again, you know, some of, some of the people that are doing murders 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 so that when people ask me questions like, Hey, do you think they’ll have regional cio? 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 cio. This might change. I don’t know who knows what it is. 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 a tactical questions, a security questions, clinical workflow questions, are we going to change our EHR? And you can’t answer that thing for another

Bill Russell:                   16:14               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, um, how different are your Ehr? 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:                  17:07               You have to go back to the question and you know, typically in a merger there was an assumption that you’re going to be able to 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 a, merging those together and doing some level of consolidation actually, can you, you, you, you know, one of the organizations may be in the process of 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 has 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? You might be there together, you know, there’s no rocket science to it. I don’t want to minimize, you know, that’s all part of the due diligence during that out

Bill Russell:                   18:23               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 don’t even have an agreement, 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? Do we do conferences with 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.

Bill Russell:                   19:07               They’re still separate entities. We haven’t done the due diligence on security. We don’t want to just slap these networks together. 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 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, um, because really there’s a whole bunch of things you can’t even do until that the paperwork’s done and signed in.

Bill Russell:                   20:10               So there’s part of me that says, uh, you know, technical security and clinical, it’s all people. It’s all people in 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. I’m the on the smaller entity cio. What are some things in our first conversation, what are some things you think you want to know and what are, what are some things I, and I’ll tell you some of the things I would ask of you,

Sue Schade:                  20:44               so critical culture really, really matters and the people and the relationships that you’ve already talked a little bit about. So Ashley, 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 near the larger end, the big dog, there’s the perception I’ve, I’ve been, I’ve been told in one situation I’m the CIO for meeting with him at his location like 40 miles from where I was and said, you know, for people to come down from the ivory tower because it wasn’t academic character there. I mean, he was surprised that I came and met with him and his life. 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’d be 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 people feel building that relationship and the rapport that we’re going to be working together and we don’t know, right? Fill us in the shake out. At the end of the day, what your role is, what your people are, what 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:                   22:28               gesture coming to the other locations 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 they’re, they’re like, oh, we’re the small entity and 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 it organization to say 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 help though the thing that really helps. It’s just an ongoing dialogue between you and I so that I can get questions answered. You know, what, what is your data team looks 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 can start to answer them until we get to that point where we’re bringing the teams together, so

Sue Schade:                  24:05               one thing that I would add, 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 he was the cio needs to be very close to that. You need to understand everything that you can about what’s gone on already. One of the issues when you walk into that situation for the first time and started talking 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 organization as they’re starting to talk about and think about how am I think I mean new operational model and you’re never figuring out independently as a cio is part of a larger organization.

Bill Russell:                   25:00               So let’s break and we can talk about this for the next 45 minutes or two days. Really 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 between the larger and the smaller organizations in helping them understand. What I would emphasize with people is that change is constant and we don’t have all the answers. You communication and critical. Uh, I subscribe to that. You tell people what you know when you can, you tell people if you don’t know you don’t have answers yet, and if you have information that for whatever reason you tell them yes, we do know that we’ve made that decision. But I think the philosophy or belief that, uh, that lack of information people make, that’s all the rumors start, right? It just goes round and round and then, and then you just have to try to manage that. What I would also obviously with the advice of hr, how do you about future work and on the one hand you can message this planning work for everybody.

Sue Schade:                  26:52               We know that you have to say no guarantees as to whether there’ll be changes or staff reduction in hr tells you what to say and 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. The other thing I tell people is you own your own career, so depending on what those possibilities are in those changes, if you like them, if you don’t like them, if you want to propose, he put me in this role and said, you know, every individual owns their own career.

Bill Russell:                   27:41               A 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 nonnegotiable is 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 health care. All those things that we all know is true. Just reinforcing that these two teams coming together, they also need to reinforce the message, which is we brought it together and the business drivers, right? We brought it together because we believe that the new entity will be stronger together than it was part. Um, which means we’re looking to this group to figure out what things we’re doing the best that it might not be, that the larger entities doing everything the best, it might not be a, that the, you know, 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 worse. And so I, I don’t, I don’t want like this big deluge of people coming into my office, like, do you know that they had these issues? And it’s like, of course they had these issues. It’s a $13,000,000,000 organization. Do you know how hard it is to run our $6,000,000,000 organization? We have works. They have words. 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 your, um, from the equation because people, dumb things when they act out of fear. And, uh, and so that’s where communication comes. Again.

Sue Schade:                  29:52               Can I say one other thing

Bill Russell:                   29:53               please,

Sue Schade:                  29:55               before we transition? Um, uh, you know, and some of the people listening to this 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 another one was about culture, which gets at what we’re talking about, the dynamic between people and 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, uh, making sure that you understand the unique needs of all the players within your organization.

Bill Russell:                   30:42               No, it’s a great blog and I won’t be coming back to that in the sound. 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 teed up for us. Okay.

Sue Schade:                  30:59               So the story that I know about, it’s called patients are losing their patients, so patients are losing their patients. Then in ways health care consumers are demanding more. Um, it’s an article written by Barbara Smith, partner Paragon consulting partner, and um,

Sue Schade:                  31:22               I think it’s just spot on, spot on as she draws analogy between a entering into the healthcare environment from a patient perspective. And um, uh, in her case I’m a sporting events 40 events from a customer friendly perspective, but the seven areas, if I can just highlight them, efficient patient workflow, we, you know, patient work, but we’ve talked about clinician’s workflow, right? But patients or even scheduling, ease of access to transportation, parking and electronic access, which having worked in some theory, I’m congested urban environment, I’d get that one fully. The fourth one is patient with wait times and other annoyances. A fifth one is transparency and pricing. 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 the cost and quality metrics as sick? 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 here? And her last one is about the report which has to do with getting results to patients timely manner. And as I, as I read this article, you know, I think Cio’s, no, we need to be doing this and we’re hearing it a lot from the executives in the c suite. The question is how does cio is addressed 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               because I agree with you. I think this is spot on. Patient workflow scheduling, ease of access, transparency and pricing, quality metrics and access to the report and the data. These are, these are pretty good. Um, how would I start? I’d start by, uh, creating that again, I keep saying creating the narrative for the story that the organization can rally around. I find that people don’t rally around powerpoints, they rally around stories and to the extent that you can start collecting stories, 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. I don’t want that to be true of our organization.

Bill Russell:                   34:08               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 was number one and schedule and was like number six. And when we talked to the patients, scheduling was number one. Scheduling is so difficult, a scheduling, referrals 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 none, 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, no, they care more about this medical record, know what they care about is access scheduling work. They really do care about these things. I think. I think she’s spot on 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               but that’s a critical one.

Sue Schade:                  35:31               Let me take it from the point of view. The question I asked you and what it takes to get 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 is the cio of what you’re dealing with. His people in the ambulatory strategy are finding niche product and saying, let’s go try all these things to answer some of these solutions. You don’t want me in that position where you’re in react mode, this product, so you also have to be partnering with all of 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 he needs 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 everything 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. Focus team. Um, so they, you get moving on it.

Bill Russell:                   37:05               It’s interesting you brought up some of our vendors have very extensive amount of offerings that I find ceos fall into two camps. There’s the people that both of us are in contact with and really respect, have taken your approach and said, yes, our event, we’re double paying for a lot of this stuff because we have all these different solutions and less consolidate around this, this our EHR providers solution because it doesn’t really 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, 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:                   38:02               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 with 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 is 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’re walk into healthcare and we did the like we have 1800 applications and, and 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 to proliferate I guess. Um. Alright, so this is the new section for you.

Bill Russell:                   39:05               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. Um, the timeline is more of a guideline than, than, than a rule, but I’m not going to have a buzzer over here if you’re wondering. All. Alright. 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:                  39:43               You know, it’s basic, it’s basic governance and I’m always amazed how many organizations don’t have good ip governance and alignment with the business and uh, engagement, appropriate levels of engagement by the senior leaders and I think from an Ip perspective, running it, running the business prophecies and standards. And again, unfortunately, uh, on top of that, I would just say it’s all about the people and the culture and the, the, the people skills of the, of the, of the leader.

Bill Russell:                   40:30               Yeah, the, yeah, that’s a great answer. I mean, the leadership team, the processes and the governance edited. 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. I’d love to take that and do that presentation again. That was really good. So if, if you were stepping into a health system that wasn’t practicing lean principles today, I assume you would want them to give us sort of a quick roadmap of how you would get that program off the ground.

Sue Schade:                  41:15               So, and I think if you go into an organization as a lean leader and thank you can just make certain things happen and you have to have some that will work with you from the beginning. People who have that experience have that way of thinking. Um, and then he start with what problems are there to solve. Whereas some of the gaps, because those are going to lead you towards where you have opportunities to apply me thinking 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 the metrics, some of the gaps and I just started creating what eventually became a visual for it 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 monitor 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 lessons from an aspiring leader and it’s probably a lot of the key points that you might’ve heard of that presentation. Another one

Bill Russell:                   42:47               without lean principles. I realize it’s not one size fits all, but it’s really about having a seat at the table for the cio. 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:                  43:16               One is probably the other is everything 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 discounting the dollars. They have a point person for mergers and acquisitions. I’m looking at new revenue opportunities as well. Um, so important partner, if you don’t report to the CFO to work closely with the CFO, obviously for Ehr implementations or optimization, the um, uh, the three person leadership team of the CIO, Cmo, and cfo are really critical of those, have to be good relationship and cmo. The 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 you don’t get along, remember that and don’t get tangled into relationship with either the Cmo, Cno, don’t get along well, but it’s very hard for you to do what you can to make that work. The last thing I will say is there’s all these new rules that are coming in. You know, the chief digital officer, the chief analytics officer, the chief innovation officer for a later thing.

Sue Schade:                  45:04               If you go into an organization and they’ll figure out how to work with and partner with them, if they’re not there, figure out how much of that it’s going to be your role as cio.

Bill Russell:                   45:16               It’s such a collaborative role and a convener 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 of people in 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 cio of the year. What what? What career advice are you giving that person?

Sue Schade:                  46:04               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, it helps women in particular, 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 for you and your family in the long run. And don’t let anybody tell me what that path.

Bill Russell:                   46:53               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 can do the cio. And it’s such an interesting, um, the mind gap that somebody who has six of the qualities and somebody goes to the person who has to thinks they’re more than somebody who has sex, doesn’t think they should put their name in the ring. And we, we almost need to keep encouraging people to say, you know what, let someone else, if you want the role, let someone else decide you’re not ready for the role. Put your name,

Sue Schade:                  47:44               what’d you say?

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, that gap and I think there’s a book to get that, a lot of that 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 [inaudible] dot com. I’m 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 for years now a 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 part of my whole social media and wanting to share and give back, why do it the social media coordinator and the PR department. And she was like, oh, perfect, I love leaders to do that. 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 box is not replaced messaging for me as a cio read my blog. Right. And how’s the staff?

Sue Schade:                  49:46               Why would any employee at University of Michigan Health System. And then the world is CIO’s and it leaders who are an audience and then everybody else. So as I wrote, I thought, who am I, who am I talking to and how are they going to relate to your question about any concern? I, um, told him 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 is going to be problematic or both in some way as an organization and I will take it to the right people. So I did one on a security 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 the wham. He did use my judgment and I fold the leaders that I would, um, I did at a certain point when I left Michigan transition. And so my brand is log and not under the Michigan Banner. Yeah. This thing is if I touched 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:                   51:10               And that’s just the nature of the Internet. Would you encourage others to pick up this practice?

Sue Schade:                  51:22               They are so inclined, but I would encourage them to find whatever form they can see other as we continue to learn.

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:                  51:51               mentioned my blog. I’m on twitter at the um, I would say also you can follow up 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:                   52:15               One of my social media I’m trying to emulate, so I’ve got a couple of ways you could follow me. Patient, Cio, my writing on the website. Don’t forget the show on this this week in hit on twitter. Check out the website this week in health 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 this week in health will redirect you over to youtube and we are now up over 200 videos a on there and, um, uh, and growing every day. So please come back every Friday for more news, information, commentary

Speaker 3:                    53:01               from industry influencers. That’s all for now.


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