A Hire Future in Healthcare Podcast
In this special 6-part series, we talk about the market forces that have impacted our healthcare systems, particularly over the last few years, and discuss ideas and strategies to continue to deliver quality of care with the right talent and technology to get us there.
Our guests include:
Conversations about the Growing Workforce Crisis in Healthcare
Mission-Driven Innovation: Technology and Patient-Centric Teams
With Michael Isaacs and Ben Wiederholt. Hosted by Joe Thurman.
Intro: Welcome to A Hire Future in Healthcare, where we're exploring obstacles and solutions to healthcare's growing workforce demands. Tune in to hear from thought leaders as they share their perspectives on strategy, technology, AI and people who are paving the way for transformative change. Joe: Hello everybody, welcome to another episode of A Higher Future in Healthcare. Today I'm joined by two amazing individuals, not only friends, but advisors and great thought leaders in healthcare. We have Michael Isaacs and Ben Wiederholt, and I'll let them introduce themselves, but it's going to be a fun conversation today as we dive into the conversation around technology, mission driven innovation, but ultimately thinking about how technology ties to patient-centric care. So hang in there, it's going to be a great conversation, but let's just start with introductions. I'll hand it off to you, Michael, to introduce yourself to our listeners. Michael: Well, thanks so much, Joe. I'm really excited to be here. So as you said, I'm Michael Isaacs. I've been working in healthcare and HR for more than 20 years, and currently I am the Head of People for Hopscotch Health, we're an organization that works in value-based care and focused on rural communities, and I'm really excited to be here. Joe: Yeah, that's awesome, Michael. I mean, and the work that you're doing is so valuable, right? Thinking about rural hospital systems and rural care in general and the future of that. And, you know, there's been some challenges in that space over the last few years, so I'm excited to dive into that and the work that's so necessary that you're doing there at Hopscotch with the team. So thanks for joining. Ben. Ben: Sure, Joe, thank you. It's great to be with you and with Michael. Appreciate the opportunity. Ben Wiederholt, I'm currently the president of Icarus Advising. I've had a healthcare career right around that 20-year mark, spanning from acute care to ambulatory, and my primary assignment right now is supporting an organization called the Community Health Provider Alliance as their interim CEO. It is an ACO made up of federally qualified health centers throughout the great state of Colorado. So great to be with you. Joe: Thanks, Ben. And equally, right, thinking about federally qualified health centers and the safety net that they are for our communities in healthcare, because innovation is essential to how we drive healthcare forward. And when we think of rural, when we think of the safety nets that exist that we need in our health system, I don't think that it's going to be sustainable without real innovation and without technology. So that's going to be, it's just going to be a great conversation. So let's just start with that, right? AI, VR, data, all of these things that are out there that are scary to any organization sometimes when we think of the ethics behind them or are they helping us or hurting us? When we think about healthcare and kind of the risk aversion naturally that exists within the industry, give me your take on the critical role that trust is going to play in the healthcare industry when we think about adoption of technology that can help us, right? And how we think about and view technology and all of these amazing things that are emerging. Let's just talk about that. Like the need for trust, how we can build it and how healthcare should view innovation. Michael: Yeah. So when I'm looking at technology on the HR side within recruitment and in particular talent acquisition, I always look at it as two sides of a coin because I'm like, yay, I have something that can help me. Oh no, what's it going to do while it's helping me? So for instance, you have your ATS that's all of a sudden going to sort through your resumes and pick your best candidates for you. But how does it really know what that best candidate is? And what are all those resumes that it just threw to the side and said you didn't really want to look at or something like that? So yeah, I think that there's the technology component that's there, but we have to put a lot of guardrails around that to make sure that we don't lose the human connection with that and that we don't just let things sort of run unfettered without us making sure that we're pretty tight on that. Joe: Totally. Yeah. Ben: And I’d like to build on that and just go a little bit deeper. You used the word trust, Joe. And I think that's so critical. I guess I'm influenced by, at the time this recording, football season is starting and there's a quote attributed to Vince Lombardi that says, “Winning isn't everything. It's the only thing.” I think in healthcare, you can substitute winning with trust. I think when it comes to when you think of how trust isn't everything, it's the only thing. It's really the foundation I would say that enables, whether it be an individual, whether it be a team, whether it be an organization, to be at their best. And healthcare organizations that really have that as the pillar and foundation have such a critical strategic advantage. I think healthcare organizations without trust can have some success. I would argue it's not going to be sustainable in the long term. And so if trust is the end goal, I think about transparency as an important means to get to that end, and that's where the intersection, I think, with technology becomes so important because technology can either enhance transparency and thus fuel greater trust or it could create some more barriers to transparency and when there's not transparency, that could erode trust. So it's a logic map where what role can technology play? How can it improve transparency? Because ultimately, trust is going to be a huge differentiator. Joe: Yeah, no, I mean, go Broncos. I'm going to throw that in there. But yeah, no, that is totally true. And I love that. I mean, sticking with and keeping with kind of sports and thinking about that, and the topic of this particular conversation being mission-driven innovation, right? Not innovation for the sake of innovation, not innovation because it exists and hey, there's a new tool that we could pull in or some new thing. When we think about trust, it's knowing that also there's a thoughtfulness behind it. There's intentionality behind why we're innovating and why we're doing something. And so every great team is driven by a North Star or a mission. And so just talk to me as leaders in healthcare. When you think about innovation, when you think about that it's all about people, that's our world, but just innovation in general, how do you make sure that you're anchoring back to the mission? And I know both of you and I spent a number of hours talking to you about what you do and you're both so mission-driven. So I think it's going to just be, I think you're the right two people to ask about this. But how does that tie back when you're thinking about moving the organization forward? How do you compare? Is it going to tie to the mission or not? Ben: Sure. I mean, you're right. Innovation can really help foster that sort of mindset and ethic of curiosity. A lot of organizations who have that DNA of being mission-driven, not in all cases are nonprofit, but oftentimes can be nonprofit organizations. So that requires a different level of agility and creativity and needed efficiency. Certainly, there's lots of really inspirational mission-driven for-profit organizations as well. But that common theme of the mission-driven component connected, I think, to innovation just creates an environment where people can really feel like they belong. Because I think healthcare most effectively happens when there is a team-based environment. Everybody can identify what role that they play in that team. And that sense of innovation just creates sort of an aura of openness. And I think conversely, a lack of that can really foster narrow-mindedness and small-minded thinking. It can create a lot of subjectivity and can kind of box people out from identifying what were their voices and how they can make a meaningful contribution. Michael: Yeah. I think it's really interesting how different organizations have charted different paths but have the same core and that same mission. Because I have found myself in the venture capital and private equity area of healthcare. There's no difference with that connection to mission. But what I've noticed is that the companies that find their way over to those areas, they do have a very, very strong tie both to mission and to that innovation component. And it's that component of innovation. Where I am right now, I honestly see the organization that I'm with as a potential industry disruptor. The one that I was with before was as well. And I think because of that, you have this connection of people who are very mission-driven, who are going to come together in that teamwork, that cross-functionality, Ben, that you were just talking about. And it does create that diversity and being able to drive towards those wonderful goals. And it's really interesting to see that it can happen both within the FQHD world, the nonprofit world that you are in right now, as well as sort of the exact opposite world that I'm in as well. Joe: Yeah. Now, it's so interesting when we think of the core clear mission of being in the healthcare sector and how it all ties to patient outcomes, patient experience. Everything that we're trying to do is to provide care. So what excites the two of you about innovation as you see it emerging and as it connects to your ability in your respective roles to impact the care that's provided, patient outcomes? If you look into your crystal ball, what excites you about when we say innovation and the technology that's emerging and how it's going to impact patients? Michael: Yeah. For me, there's been a few times during my career that there have been times where I've been able to institute a technology solution that I've really seen it translate, a technology solution on the people side. And I've actually seen it translate to patient care. And those have always been really exciting times for me. I think some of them have been personality assessments where I'm like, oh, wow, I really have a fit for a job better than I've ever been able to do before. Joe, you and I have been talking obviously about helping our hiring managers be able to identify talent in different ways that they haven't been able to. I sort of look at it as the barbells in my organization where I have really, really my executive team that wants to put people through the ringer, so to speak, or at the other side, entry level managers who need help identifying that. So how do we help these two ends of that spectrum? And so when I see that technology that can really be put in place to make those results happen, those are the exciting times for me. And it hasn't happened often, but there's a couple of times during my career that it's happening. It's really exciting to see. Ben: Yeah, I’m really aligned with what you're saying, Michael, I think sometimes we forget that in the $4 trillion industry of health care and all the different stakeholders that it ultimately comes down to people. And it is the privilege to interact with other fellow human beings, some of the most defining moments of their life. And so in order to support those people who have that opportunity to have that interaction with the people, it's really that, like you're saying, how to support and find different ways to connect with the leaders in that organization and the ability to really build that strong team. And I'll go back to part of the earlier conversation around the importance of team. I think it connects to why different solutions around talent management are so important. So it can be really hardwired into a unique competency for an organization. Because if you think about outcomes, they best happen in that team environment. And you can have a superstar, but they're not going to be able to have the same impact on a patient's experience or their quality of care than you can if you have superstars across a team. If you don't have a strong talent management platform and solution, you still might be able to find one superstar. Visually impaired squirrels find nuts. But your likelihood of finding a full team of superstars is dramatically reduced. And so it's that systems thinking around health care is all about people caring for people. And how do we create those systems to increase the likelihood that it's the entire team that's surrounding that person is that right fit, the best people for that organization to achieve its goals. Joe: Yeah. I mean, both of you have been talking about kind of team and kind of that, I mean, the cross functional nature of everything that is health care. All of us on this call have a lot of conversations around diversity and the impacts on culturally competent care, the impacts of the communities that we support in different areas. And you talked about it, you touched on it early, Michael, with resume parsing innovation that some black box where you have no idea why it's selecting some and not selecting others. When we think about diversity and how we should view opportunities to innovate, to build better teams and ways that we should be pushing forward, a lot of our listeners are in the talent space and things like that. What advice would you give when people are leaning in? Because there's no shortage of new and exciting things to explore and look at in the technology world that might be out there. So what advice would you give to people when they're thinking about it, when they're thinking about bringing something to the team or trying to bring something into an organization with kind of diversity and team building and those types of things in mind? Any recommendations for talent leaders out there? Ben: Yeah. Well, I'm happy to start on this one. I think it's also don't forget about the scientific method and evidence-based practice and to help reduce disparities that happens if the individual and teams surrounding the person receiving the care reflects them. And so if that's scientifically proven, it's evidence-based, what can we do with intentionality around identifying the systems that are going to reduce the chance of bias to facilitate a more diverse team? As we talked about earlier, fostering innovation, so if there is open-mindedness, that there is a level of acceptance and curiosity around all perspectives so that everybody can find their place regardless of their background or experience to all contribute to create that plurality where there's just that whole sense of welcoming, belonging, and that's going to attract the diversity of people as well to be able to provide that care. Joe: Yeah, totally. Anything you want to add to that, Michael? Michael: Yeah, I mean, I definitely want to echo what Ben was saying. And I think a couple of key points there. One is being able to reflect the community that you're serving is so important. And I think that's always one of the goals that we have when we're recruiting within healthcare is being reflective of the community. But going back to something that you said, Joe, I think is really key as well when you're saying there's a technology that you can sort of buy off the shelf to solve the problems. No, it's the hard work every day. And it's understanding where people come from. And it's understanding that we work together to solve these problems. And it's an ongoing conversation. And that there's no system that you're going to put in, plug and play, and answer questions to meet your diversity reporting that's going to solve your company's diversity issues. That's not how it works, although a lot of places will tell you that. Joe: Yeah, put in the hard work. I mean, we tell that to customers all the time. We say we have not built the technology that takes the hard work out of building teams. Michael: Correct. That's where it is. Joe: Yeah. No, this has been awesome. Well, as we wrap up, the future of healthcare relies on a lot of people who are going to be new to the industry, whether that's people who are just coming out and new nurses, new CNAs, but also in talent and leadership, people coming from other industries to try to impact healthcare. So both of you being extremely experienced, what do you wish you would have known before starting your healthcare career? Or what's something that you live by or think about that keeps you going that you would just leave with someone who is either just entering into this space or transitioning into this space? Any small nugget that you could share that you wish you would have known before? Michael: Ask more questions. I didn't realize how much I didn't know and still don't know today, even though I've been doing this for 20 plus years. Probably that if I asked more questions along the way, people would spend more time and have unpacked things for me earlier on in my career. So I would just encourage those who are entering the field to reach out more, ask people for time and they'll give it to you. Joe: Love it. Go ahead, Ben. Close us out. Ben: Well, thanks, Joe, I mean, that's so perfectly said and it reminds me a couple hours ago, I was having a conversation with a new leader in the organization we hired and we were having this exact conversation I was sharing back. I was 25 years old. I was a vice president of a small community hospital because she's a younger leader in our organization. And we were talking about that tendency to want to be able to show how smart you are and how that can be such a fallacy and to be able to, like you said, so I'm like, have that curiosity, ask more questions. And the other thing I would add to that is really, I feel like leadership and service are synonymous and for people coming in to health care to really have that service orientation. And I think that, you know, it goes back to another phrase of people don't care about how much you know until they know how much you care. And I think that would be my greatest piece of wisdom to share that I wish I would have spent more time on earlier in my career. I wish I would spend more time on it now as I try to be a more effective leader myself just to care more and just in addition to what Michael said of asking more questions. Joe: That's awesome. And I think both of you live that, you know, I think that's how our relationship started with conversations and learning from each other with each other, like sharing. You're both awesome at that. How can people find either of you? Ben, how can someone find you or reach out to you if, you know, just to connect, like what's the best way to do that? Ben: Yes, LinkedIn's the best way. It's just simply Ben Wiederholt. It's W-I-E-D-E-R-H-O-L-T. Joe: Michael? Michael: Similarly, I'm on LinkedIn. I don't spell my name last name the same way as Ben does, but it's I-S-A-A-C-S. Joe: Awesome. No, this has been great. Michael, Ben, we really, really appreciate it. Again, I'm Joe Thurman, co-founder, CEO of IIA Healthcare, creators of interviewIA. This is A Hire Future in Healthcare. Thanks for joining and tune into the next episode. Take care. Michael: Thanks so much. Ben: Thank you, Joe. Thank you, Michael. Extro: A Higher Future in Healthcare is a production of IIA Healthcare, a healthcare technology company and creators of interviewIA, an interview platform for healthcare organizations to streamline their interview processes to deliver unparalleled candidate experiences and to create a true competitive advantage for delivering quality care. Learn more at www.iiahealthcare.com.
Fast-Forwarding Healthcare: Market-Forced Rapid Adaptation - Part One
With Karen Conway and Dave Brooks. Hosted by Ubaldo Ciminieri.
Intro: Welcome to A Hire Future in Healthcare, where we're exploring obstacles and solutions to healthcare's growing workforce demands. Tune in to hear from thought leaders as they share their perspectives on strategy, technology, AI and people who are paving the way for transformative change. Ubaldo: Hey everybody. This is Ubaldo Ciminieri and welcome to another episode of A Hire Future in Health Care. I am joined by two really just great people who've been advisors to us and friends of us who bring really interesting thought leadership perspective to the conversation of not only health care but workforce and health care and that sort of thing. And so today we wanted to just take that and showcase their thoughts on what's happening in health care today. And so I want to turn it over to Dave Brooks and Karen Conway who are joining me this morning. How are you two doing? And please do a quick intro about who you are and why you're here. Karen, you go first. Karen: Okay. It's a pleasure to be with you, Ubaldo, and with Dave. Really enjoying working with you and with the other advisors to interviewIA. So, Karen Conway, I am primarily a systems thinker, a lot of background in continual quality improvement. And really I focus on the supply chain. But supply chain really in terms of all of the resources that we need to deliver optimal health, to deliver health care and sick care when needed. And how do we optimize those resources in order to advance the objectives of value-based health care. And so I'm thinking very, very broadly about supply chain and about resource management, et cetera. Although I will admit that during the pandemic I did focus on those supplies and those boxes of PPE and other kinds of things that we needed. And there was one benefit personally to that. My children actually said to me, oh, mom, I actually understand what you do for a living. So that's just a little bit about me. Ubaldo: Isn't that amazing? It takes a pandemic for that to happen. But I mean, that's such a crucial aspect that a lot of people don't think about, particularly when you're sick, right? And you just want to be taken care of. The thought of supplies doesn't even come into my mind. If I'm walking into an urgent care, you just sort of assume that's a thing. But I mean, sometimes it's not. That can be a problem. Karen: Well, and is there an urgent care? Is there the right kind of personnel there to take care of you? So when I say supply chain is kind of not a great term, it really is about resources, all of the resources, human and stuff. Ubaldo: Yeah. Oh, I love that. All right. Dave Brooks. Hello. How are you? Dave: Hi there. Karen, I totally agree. You take it off for granted until it doesn't work properly. And then all of a sudden it becomes center focus, supply chain, resource management, all those types of things. So thank you for what you did to help keep people as safe as possible during the pandemic. So my background is more health administration, longtime health care executive in a number of large health systems, predominantly not for profit. Many of them faith-based health systems, kind of C-suite type player, including a number of years at the end of that kind of part of the career as CEO over a market for some large Catholic health care systems. And then a few years ago, after a very long run, I started early, young, I decided to, excuse me, retire early, if you will, or semi-retire early. I failed at retirement and left kind of the C-suite. And I actually spent a couple of years here in Metro Detroit, where I'm from and where I'm at right now, at Wayne County, which is the County of Detroit's part. So a large urban, one of the largest urban and unfortunately one of the poorest counties in the country as the director of health and human services. So that gave me a great perspective of public service, but also the challenges of public health, the challenges of community health, and the challenges of coordinating just a myriad of diverse providers and players in all of healthcare. And then I am now kind of doing a number of things, including honored to serve as one of the advisors, UB, with you and Karen to interviewIA, as well as a few other firms. But also I'm doing some teaching and I'm doing some consulting and just a nice diverse mix of things to do, which is great because it allows me to squeeze in going to sporting events or going as we were just talking about to rock and roll shows still. It was harder to do when I was working full time. Ubaldo: Dave, what keeps drawing you back in? You say you failed at retiring. What draws you back into this world of healthcare? Dave: It's probably a combination of personal and professional. You know, I'm still energetic and I still have an ego, so I want to feel like I'm adding value and I like to reinforce people to reinforce that to me. And I like challenge and so competitiveness, not competitiveness in a bad way, but competitiveness of the challenge of trying to get successful at something or help a team be successful at something, right? So that, and then on the professional side, I mean, I was blessed to have an amazing career, 35 years in the C-suite. So you know, there are, I had great earnings because of that. I've had great stature and again, back to my ego and all that, you know, Maslow, I got to self-actualize, remember the top of the pyramid. And I'm blessed with that. So I feel like I have to give back and I have a lot of experience now, whether it's good or bad or I have good ideas or not, it's a different question. You'll have to figure that out as one of your, since I'm one of your advisors. I have a lot of advice. I just can't guarantee any of it's good advice or you have to figure out what's good and what's not so good. So the fact that I can still kind of give back and help out and use that experience and not just kind of love it atrophy, um, you know, is important to me. That's kind of the professional driver that goes with the person. Karen: You know, I think that is so, um, you know, I think you find a lot of people who work in healthcare. I think we go into healthcare for that reason. Um, and then I think we can never quite leave because I've got a lot of friends who have asked me why, you know, when are you going to retire? And I'm like, I'm never going to retire. Um, I have this passion and if you're doing good work with good people for the right kind of outcome, you know, so personally, you know, as I've looked at, um, you know, I, I did a master's in the science of healthcare delivery a few years ago and it was really about where I got, I've always had this strong focus on the environment since I was in fourth grade. Um, but then really starting to understand the issues around health equity. And I think you'll hear this in some of our discussion. Um, sometimes I apologize if it's a little ad nauseum, but I have this real passion around chronic disease and because it's 90% of our healthcare expenditures in this country, it bankrupts individuals, it bankrupts families, it, it lowers the productivity of, of companies. Um, it impacts poverty levels in communities, which as Dave will know has to direct correlation to the clinical and the financial performance of hospitals. And quite frankly, if you look at what Fitch rating says, it is this increase in chronic disease that is a major drag on our national economy. So I'm always looking at root causes again, as a systems thinker and a quality person and how do we stem that that's causing this level of chronic disease that's having a negative impact on so many people. So I, you know, I'm going to do that until, um, until I can no longer contribute effectively. Um, and I'm like, Dave, it's like, I'll always have advice. We'll find out. Ubaldo: Well, there's always, there's always, we need that guidance, especially now. So it's kind of a great segue into the topic that we're covering today, which is, um, sort of how do we fast forward healthcare, right? What is, what does it look like to rapidly adapt to these market forces? COVID's a great example that, that you have to adapt to as, as anything, but particularly healthcare because if you don't, we've got problems. Like it's sort of, we're kind of at a crossroads. Uh, I feel like, and so, you know, what, let's start with those market forces. What is driving the need for this rapid adaptation that we're sort of seeing, um, you know, sort of like value-based care, that concept that's, that's, you know, kind of taking over, uh, what, what are those forces that are driving this? Karen: Okay. Well, you know, as I said, you're going to hear me talk about chronic disease. So if you really do think about the costs of healthcare. So again, I'm looking at this as a systems thinker, how do we design the system in a way that it operates in a way to deliver, um, what the system should do, which is deliver optimal health. Because when people are sick, you know, and people talk about who should pay for this, et cetera, the reality is if, if people don't have insurance or if people don't have access to what they need to take care of themselves, they're going to be sick. And ultimately everybody pays for that. If you just have to put it in purely financial terms, um, you know, certainly there's a human need and I believe that Americans, you know, are a very caring society. So we want to take care of people, but, but the reality is there is a fiscal impact on absolutely everybody. Now, one of the problems is, is that you still have a lot of markets that are still reimbursed based on fee for service. And so traditionally we have looked at that based on, we've got to have the volume of the services that deliver the kind of revenue that healthcare systems need to stay in the black to keep those doors open. Dave, you know, this better than anybody, but what I'm seeing is, um, even in markets that are heavily fee for service. Um, I'll give you an example. I had an opportunity to interview and work with, um, Kathy Jacobson, the CEO at freighter in Milwaukee. And she has a, she's a CPA. She has a financial background, but as a CEO, she's looking at it as a systems and she's saying we've got to slow the incoming coming in. We've got to help prevent those hospitalizations. Those people who would not need to be in the hospital if they had access, if they had a good job, safe and affordable housing, nutritious food, all of those social, economic and environmental determinants of health. So as a CEO, she's going, you know, and I'm looking at this at the impact, for example, on my workforce, they can't handle this over volume, um, of people who are needing their care because it's leading to burnout. We saw that in the pandemic, but it's still happening. And so how do we reduce that demand for services? So we're not risking that further burnout. And quite frankly, the loss of those critical employees that are keeping the doors open are there to take care of people and are quite frankly needed in order to have the sound fiscal operation of our healthcare system. Dave: Yeah. I mean, I totally agree with you. And I like the way you, you know, it's funny when you talk about cost, it turns so many people off, right? I mean, it's like the word is almost, uh, you know, this lightning rod of caregivers and clinicians think of it. Oh, you're just trying to manage a budget. You're bean counters. You're trying to find profits, you know, et cetera, et cetera. The community or others, public officials frankly think of it when they hear the word cost come out of healthcare people. Um, as you're just trying to, you know, maximize profits and income, you know, create big incomes for C-suite and other people and all of that type of thing, right? It's a turnoff. It's not inspirational. I think, you know, there's almost like a continuum where cost drives affordability and affordability drives access. If you think again about, you know, this uniqueness of American healthcare, it's all about access. We're in almost every other country and I'm not trying to do one of those, oh, we need to, you know, go into socialized healthcare, but in other countries there's a, there's already a min spec, a floor of access for everybody in the country. Now, certainly there are ways to go above and beyond for more of a service aspect of access, right? You know, the queue, as they refer to it in the British or the national health system, uh, you know, you can cut the queue or whatever it might be, the line, but everybody still has the right and access to those clinical services. It's just a matter of some service amenities that might change a little bit, except in America. In America, access is all about affordability because it's all about cost and coverage, right? And as we, if we can figure out how to manage costs to be something that's more reasonable for everybody, then it becomes accessible to everybody in a community, not necessarily equally accessible again in the sense of certain amenities, but, and that's what happened. That's why without access, people use the ER as their primary care center, right? Or whatever it might be, or issues become, go from being chronic to acute or life threatening, as you were mentioning, the chronic disease issue. And therefore an asthmatic ends up in an emergency room when they really, because they didn't have access to manage their asthma on an outpatient or a preventative basis, right? So they absolutely, if you can't breathe, you got to end up in an ER, no doubt about it. The question is, well, why can't they breathe? Well, they couldn't breathe because they couldn't get their meds or they didn't know how to use their meds properly, or they didn't get access to a primary care clinician or whatever it might be, or frankly, even someone online because of the $35 or the $65 or whatever was a barrier. So I do think that's a challenge for all of America and it permeates, but a lot of the challenges, a lot of the issues, but it's not as narrow as cost in the sense of, as a CFO might think of cost, only a CFO. I think leaders, right? And then the other thing, I'll just put a kind of a point of emphasis on what you were talking about. And I don't know if it relates as much to the cost or the economics. It's just the reality right now. Is this challenge with the workforce and burnout and talent and all of those types of things. If you talk to later generation doctors, either those about to retire or those at least ending their career or even at the peak of their career, but they've been for a while, have you ever talked to them and asked them about their kids? Are they encouraging their kids into going into medicine? And I don't know. I mean, I'll be honest with you, second, third generation doctors, I don't know if they want their next generation to go through what they feel like they've gone through. So not just physicians, but other care professionals, caregiving professionals. I worry about that. Nurses, I mean, the burnout factor right now amongst nurses, oh my goodness. And then with it, all the consequences that come from that in the sense of shifts not covered and therefore quality of care. And then that downward spiral of more and more burnout or frankly, the increase of unionization of nurses and other professionals because they feel like they need a collective voice because their individual voices aren't effective for them anymore in protecting their profession and protecting their relationship with a patient or each other and all that. I mean, it's a challenge right now and those are market forces, right? Not necessarily good forces, but those are market forces. Ubaldo: Well, that's the thing. I mean, it seems there are more negative forces at play than positive ones. And a big part of that is the human factor. I mean, that's such a good point. I'd never thought about sort of the passing on of generations of this work. There's a shortage clearly. And the most natural way to avoid that is to pass it on, but we don't because of the conditions. Man, that's a whole other show to think about. Wow. Dave: So let's do something about it. We can't sit by. So especially those of us with a little gray hair and going on here, we're going to need more and more of an effective health care system ourselves personally, right? As I get there, as I get older, those chronic conditions Karen's talking about and other things are going to personally affect me more and more. And I'm going to be relying on a really well-run, accessible, high quality health care system made up of caregivers who are thrilled to see me as a patient, right? To serve their profession. We have to do something about this. Ubaldo: Absolutely. Well, so what are some strategies? Let's talk about that. Let's talk about some strategies that health care organizations can adopt to be more agile, to be more adaptable in the face of these market shifts. To ensure not only their long-term success, but to ensure our long-term successes as the community at large, right, who need this care? What are some strategies? Karen: You know, one of the things I'm seeing, and Dave, I'd really like to, you know, from your position and perspective in health care, one of the strategies I'm seeing is more of this movement towards partnerships. You know, for a long time, we've seen a lot of the strategies in health care systems has been quite frankly around mergers and acquisitions. And one, it can support the continuum of care because people need things all along the way, whether they're coming in for a hip replacement or whether they're being treated for chronic disease. But what I, it was oftentimes mergers and acquisitions, quite frankly, for market power, because you need that negotiating power, quite frankly, with the payers. But what I'm seeing is more of a move towards trying out partnerships and thinking again about all of the different things that people need, because ultimately, yes, you do need that well-trained physician. And sometimes you need that specialist. But you know what? Sometimes you need a nurse practitioner. Sometimes you need a social worker. Sometimes you just need a peer who has the same chronic disease, who has been trained to be able to help with peer management. We're talking about what's the most effective, and I'm not just talking about cost, but the most effective kind of care. And then the other is really looking at kind of this shift from, frankly, we spend a lot of time about what does the hospital need? What does the doctor need? What kind of procedures deliver the most revenue? It's a fact of life, but we really do need to focus on cost. And what's interesting is we're seeing more and more studies, particularly among younger doctors who are saying, I also want to understand what is the cost of the care that I am prescribing? I want to be a partner. I want to be at the table. So it's a matter of starting to look at what do we need to do? How do we create partnerships? Maybe those partnerships sometimes do lead into an acquisition of a home health care agency or of an ambulatory surgery center. But a lot of times it's, can we partner with those non-acute and those social service agencies so that we can work together and share not only in financial success, but we're also sharing risk. So we're all in this together. And I think that comes down to leadership in terms of those kinds of leaders who can look at the ultimate goal and can look at value for everybody. Because if you don't change the system in a way that everybody can achieve value. That was one of the problems, I think, with the Affordable Care Act. I think we had to do something, but we tried to finance it by taking things away from the different sectors in health care. And we got to redesign the system in a way that everybody can achieve value that sustains it. And ultimately, we're all trying to focus on that value. And I think it is a lot about having also mutual respect for the expertise of all of the different players, whether it's different types of clinicians, whether it's the people who are managing the financial aspects of the house, and whether it's the people who are actually doing that stuff in the back, behind the scenes, who are making sure that the doors stay open, that the systems keep running, that the supplies are showing up, et cetera, and having that mutual respect for one another. That's what I'm seeing. Dave: Yeah, I like that. I think you're right. I mean, you mentioned it in the framework of partnerships. And I think that's right. And there's always been, I mean, again, the old guy here who's been around for 30-something years doing this. Partnerships and collaboration and all that was kind of the... As I entered the profession in the 80s, that was almost... it was less competitive of healthcare. Think about it. Almost every hospital was a single hospital, right? There were no multi-hospital systems and consolidation. So the nature of it led war partnerships and collaborations within communities. You literally even joint plan things. One hospital would say to a neighboring hospital, okay, so we'll do the birthing unit and you do the cardiac unit, right? That way we both aren't trying to do it and we're serving the community better. There were even organizations, planning organizations, governmental or quasi-governmental planning organizations that assured that and coordinated some of those things. And then it all went away when we said we wanted it to be much more market-based, not trying to say that's wrong, because remember what cost escalation was in those days and the cost-based reimbursement and so on. So partnerships took on a different mindset in a competitive world, right? And I think so much of it was built around and is still somewhat built around and you kind of got to it a little bit there, Karen. This illusion of control. Can you really have an effective partnership if you're not in control or if you have a need for control? And that's where acquisitions come into play or things like that, right? As opposed to we have common vision, we have common missions. How do we figure out how to do this? Again, you need the regulatory environment to allow that to happen. Antitrust, those anti-competitive behaviors get regulators coming down and looking at organizations and sometimes misinterpreting activities or being too narrow and everybody's afraid of that or at least we portray ourselves as afraid of that. Could also just be that control thing rising up in a convenient way. You never know. But I do think you're right. I'm sure every sector and every industry professional says it, but healthcare, I'd argue, is at least equal to, if not past, most other sectors in America as a team sport, right? It just can't happen without such a team. The different type of caregivers, the different type of roles from finance people to marketing people to supply chain resource planning people to hopefully some good general executive administrator types here or there, being self-serving, of course, but also all the others that make healthcare's ecosystem work, whether it be an organization or a series of organizations, it's got to be about a team and how you bring it together, which goes back to what you were saying, the partnership piece, right? And then what's the core strategies of all that, right? Which is trust in relationship. Extro: Stay tuned for part two of this conversation in our next episode. A Higher Future in Healthcare is a production of IIA Healthcare, a healthcare technology company and creators of interviewIA, an interview platform for healthcare organizations to streamline their interview processes to deliver unparalleled candidate experiences and to create a true competitive advantage for delivering quality care. Learn more at www.iiahealthcare.com.
Fast-Forwarding Healthcare: Market-Forced Rapid Adaptation - Part Two
With Karen Conway and Dave Brooks. Hosted by Ubaldo Ciminieri.
Intro: Welcome to A Hire Future in Healthcare, where we're exploring obstacles and solutions to healthcare's growing workforce demands. Tune in to hear from thought leaders as they share their perspectives on strategy, technology, AI and people who are paving the way for transformative change. Welcome back to part two of our conversation with Dave Brooks and Karen Conway. Ubaldo: The human component clearly is key. And so, but what's interesting when you think about adaptation and keeping up and those sorts of things, then you start to get into the idea of technology and AI and that conversation, right? Because more and more companies are leaning into the adoption of those sorts of things to move faster. And so how do you balance then what you're all talking about, this idea of partnerships driven by human relationships and trust and respect with the need to move fast and adapt fast, but always maintaining that human in the loop, right? That human core of caregiving, that taking care of patients in the community. How do we not lose that, but be able to move into the future in a much better state? Karen: You know, it's all about the right tool for the job. Again, this is how my brain works, but where I'm most excited, it's like AI can't do everything, but it can do some very cool things. The area I'm most excited about, and this has a quality and a cost component to it, is about predicting future healthcare needs. It's interesting. It's like Geisinger a number of years ago when David Feinberg was still the CEO, they adopted a program where basically you had to opt out of having certain data collected to start to understand, and they also did focus groups to get the human element of the patient, but to start to understand what are going to be future health needs. Now that's where, you know, is this somebody who's likely to have an injury? Is this somebody who's likely to have their hip or their knee wear out? Is this somebody likely to get a chronic disease? You know I had to say that. But it's like if we understand, if we can predict better, sooner, what the patient population will need. So individual patients, but then do it at scale. Then we can start planning ahead of time effectively to understand how we're going to meet those needs. And again, that might be how the acute care hospital is going to meet the needs, or it might be, hey, we need to have some kind of partnerships and make sure there's other kinds of resources that are available. That's very similar to kind of the example, Dave, that you were giving before. So that's about predicting, and that's about using data to make certain decisions. But health care will always require the human touch. Now that human touch might be, you know, literally, you know, sometimes, you know, my stepson is an orthopedic trauma surgeon. He needs to do his work hands on. But you know, sometimes that health care can also be delivered in a Zoom call, you know, at the end of a phone call, that visit by that peer manager. So again, then it's about determining if you understand the needs, then you start understanding what kind of human touch is needed. Is it a doctor, a nurse, a social worker, et cetera? And again, it's about managing to the needs of those patients that we care about. Dave: Yeah, I don't know if it's generational, or, you know, my generation or how much it permeates younger people. But I think you're right, Karen. I mean, the reality is we trust other clinical professionals with our health care. Now if they are choosing to use technology and AI and other things to support them in the right way, I'm okay with that, right? But I, Dave Brooks, I'm not looking to not have a clinical professional of some sort helping me navigate, coordinate, think through my health care, right? I'm not looking to turn that over. I don't trust it. Maybe someday, again, maybe that's generational, both age generational, but even first generation AI in health care or whatever, you know, and two or three generations of AI in health care, whether that's two years from now or five years from now or whenever that ends up being, maybe that will be different. The same way right now, I do now trust my Chase app on my phone to do all of my banking, where frankly, five years ago, I still actually, although I don't know how last time I've been physically into a bank, but at least I went to an ATM at a bank, you know, and that seems okay. Now I don't even go to the ATM other than when I actually need a physical bill. Other than that, cash, I don't even deal with an ATM. I just do it. So that, you know, now we're in the second and third generation banking technology and AI. I've adopted, I've accepted it and I trust it to a different degree. We're in first generation health care AI. So we've got to just recognize, we've got to go through some certain cycles. And again, the intimacy of one's health care needs and expectations also probably affect how rapid, you know, you used the term rapid adaptation earlier, UB, will probably influence our acceptability of what is rapid or not rapid, right? If you think about it. So I think where technology and AI are there to serve and support care professionals, it's going to generally add value and be adopted and kind of move along. Whether it's there to replace professionals or it's there to create efficiencies or it's there to, you know, make up, you don't need a person to do this. Let's use a machine to do it. I'm not saying that won't always make, won't always, these dollars and cents wise make sense. I don't know how quickly we'll adapt that, allow that to happen both as the health care systems or providers, but also even then the consumer, the patient, the family, the community. I think we're not there yet. Karen: Now, you bring up a really good point though, Dave, is, and there's kind of two sides to this. Everything in my life I've always looked at is both and not either or. So one, you know, what's our responsibility as patients? You know, we have historically and those of us who have been around longer, you know, it was much more about you just let the doctor decide. You know what? We need to take more responsibility for our own health. At the same time, just solely relying on, and I'll use a current example, you know, how many people have gone, well, I'm going on WebMD and I'm going to put my, you know, my symptoms and it's going to spit out the answer. Well, you know what? We are not trained in medicine. So we don't know how different parts of the body interact, et cetera. And the other fact is it's not just about the physical. It's about what's happening in your mind. It's also about preferences. Some people are very risk averse. Some people are not. Some people have, you know, have the financial capabilities. Some do not. It's about treating the whole person. And I want to go to those professionals who have expertise in a variety of areas. The one thing is I would like the health care professionals across that entire continuum to work a little bit more closely together and share, you know, you know, I've got a friend who's got she's got Parkinson's. She's about 15 years into the disease. She has she has nine different specialists that are working together and she's making sure they all talk to one another. So let's look at technology shouldn't run things. We should determine how technology can help us optimize what we do. Dave: It's funny. Within the last day or two, you know, one of these many emails we all get with, you know, updated news and health care facts and figures, you know, modern health care, whatever it might be. There was something I remember seeing within the last day or two that talked about the accuracy of AI in in clinical care. And it was like 70 something percent. I forgot exactly what it was. And it you know, it's 70 something percent accurate. Now I don't know what that I didn't read the whole thing and read the study was almost more the headline. And then I thought to myself, I wonder what the human performance is. You know, it's not 100 percent. I mean, caregivers don't get it right. And I don't mean malpractice. I just mean, you know, complicated issues that they it doesn't always work perfectly or is understood perfectly. So it's not 100 percent either. And then I thought to myself, OK, so let's let's give humans the benefit of the doubt. Let's say they're 85 percent and AI is only 75 or 72 or whatever percent it was. So obviously it's outperforming it. But what about what happens when you put it together? So does all of a sudden it become as a combined model? Is it like 90 percent also when you take the human at 85 percent or whatever? And I'm making that up and AI at 72 percent. And I'm making that up separately. But when you combine the two together, I would assume it's got to raise above that maximum currently at 85 to something better. What is it and how do we start thinking of it that way as an enabler, as an enhancer versus a replacement? I think that's the part that's scaring people right now, both caregivers, but also patients and communities, you know, why the regulators are going to get involved and all this type of thing is it's it's seen like you were saying, Karen, as kind of an either or not an am right. Not a combined between the two. How do we figure out how to do that? I mean, it's part of what our… go ahead UB. Ubaldo: Well, I was just going to say it's such a good because one of the things we're going to do after this is follow up with an article that will kind of. And I think this this actually is a good conversation to have in that article in terms of because for me, I feel like the biggest issue is how we introduce these concepts to people and how we define these things. Right. So if we're coming out of the gate saying that AI is going to solve all our problems, well, then we've now set that expectation unrealistically high. And so, of course, everybody is going to either be scared of it or think it's going to solve all our problems. And neither happens. But and we end up at 70 percent. And so it's like we're not setting the right expectations. And I believe part of that is the responsibility of leadership to come in and write, define these things and introduce these things to their workforce and really say, look, this is why we want to do this. And this is how it's going to help all of us be better at delivering care. And so I want to I want to leave that that dive in conversation for the article. But I think it's I see this just in general across the board. You know, marketing sometimes is not a good thing. It doesn't do the right thing that we need it to do to spread the right message. And it just confuses things and it causes fear. You know, I think we see a lot of that just in general. And so how do we avoid that? And then, you know, I think that's where leadership can play a big part. But so let's leave that for that. How about one last kind of like thought provoking, you know, leave behind each of you to close us out just, you know, around around what we've been talking about. Dave, I'm going to let you go first. Dave: All right, I'll do it that way. Karen, you get to be the closer you get to wrap it up there, which is probably good. Smarter. You know, but I am going to launch a little bit on what you said. Let's leave for the article because I do think it relates to it all. It's again, from whether it's technology or AI, and I'm still struggling with kind of there's a I think there's a difference between the two. But I don't know if I can explain it as a non-technical person. But I'll lump it all together kind of as, you know, using machines to enhance or be involved in processes versus humans only. And I do think that connecting that with what you were saying about leadership, it's going to be a lot of this is going to be about being willing to trust our teams. If the C-suite says we're going to be bringing this technology or this AI in to help make, you know, you know, I'm from administration. I'm here to help or whatever the cliche is, or orders from headquarters or whatever it might whatever the bad cliches were about us suits when I was a suit. You know, if we're bringing things and telling people here's how to improve your work or you need to do this or whatever, you know, it basically says to people we don't trust you. And I think if we start saying we trust our teams, we as and we as a collective team need to figure this out with whether we are automating processes or we're bringing AI in if there's a difference between the two or whatever. Let's trust our teams to help us figure that out. And I don't mean let's have a nurse who's now the chief nurse information officer figure it out. No, let's have the nurses, the staff nurses be involved with that. Now a good leader, a CNIO leader will know how to do that and bring that in versus be directive. But I think we're going to have to figure out in a in a different way than we've done it in the past how we trust our teams to help organize and solve this. It can't happen out of the C suite or out of management alone. Karen: Yeah. Yeah, I think, you know, absolutely. And I look forward to exploring all of those concepts because I think you're spot on, Dave. I think I'll just end with just a thought in terms of perspective. I thought it was interesting your point you made earlier about kind of when we went from we went from a situation where you had kind of a cottage industry at different hospitals and health care systems saying, hey, I'll do this and you do that because that's what's going to benefit and we're not going to duplicate. Then for a variety of reasons, right and wrong, you know, moving much more to this market based. But I think we've created this sometimes this assumption in health care that it has to be highly, highly competitive and that we can't be successful unless we are. And that I disagree with that. And I think we've got plenty of examples. I had the opportunity about 10 years ago, wrote a co-wrote a book on global leadership. And in that had a chance to interview about 10 different global leaders, one of whom was Jim Whitehurst, CEO of Red Hat. And he talked about how this open source approach, this very collaborative approach, they basically gave away, you know, the IP to some of their competitors. But because of other things, their service approach, et cetera, they actually continue to do better than their competitors. You see this now with Tesla, you know, and people starting to partnership and using some of their technology, whether it's for, you know, the batteries or whether it's for the refueling. And I've had a personal example, worked for over two decades with a technology company that was started by five competing health care suppliers, Johnson & Johnson, Baxter, Abbott, GE and Medtronic. And they came together and they said, you know what, we all have a shared problem and we can either spend a bunch of money duplicating our solutions or we can come together and even better yet, they said, you know what, we've got to create a solution that is supporting the needs of our customers. So a solution that solves, you know, solves the problem for everybody. It's the idea of where is it best to collaborate and where is it best to compete? And you can do both. And so I look forward to being able to look at that at multiple levels in the follow up blog we'll work on. Ubaldo: Yeah, I love it. Well, I can't thank you both enough. This has been an amazing conversation. I mean, clearly we could go on for so long to talk about these things because it needs to that these conversations need to happen. Right. And so thank you both very much for your time. Thank you listeners for tuning in and, you know, continue to look to check out our series here at A Hire Future in Health Care because we're going to keep having these conversations and these follow up articles and those sorts of things. So thank you all again. Thank you, Karen and Dave. It's been great. And we'll check you all next time. Take care. Extro: A Hire Future in Healthcare is a production of IIA Healthcare, a healthcare technology company and creators of interviewIA, an interview platform for healthcare organizations to streamline their interview processes to deliver unparalleled candidate experiences and to create a true competitive advantage for delivering quality care. Learn more at www.iiahealthcare.com.
Reskilling and Cross-Training Healthcare Workers to Fill Critical Roles
With Michael Isaacs and Dave Brooks. Hosted by Ubaldo Ciminieri.
Intro: Welcome to A Hire Future in Healthcare, where we're exploring obstacles and solutions to healthcare's growing workforce demands. Tune in to hear from thought leaders as they share their perspectives on strategy, technology, AI and people who are paving the way for transformative change. Ubaldo: This would be an interesting conversation to have because Dave, former admin across many organizations, Michael with what you're doing with the rural clinics and things, I imagine maybe this probably comes up quite a bit as you guys grow. Dave: My view was, Michael, your background, HR and so on, will be, this will kind of be you kind of being the thought technical expert on all the challenges, not just in rural. I mean, this is as big of an issue in an academic center in downtown, any downtown urban area, as it is in rural. And I can just kind of add some color commentary from a general executive viewpoint, whatever, but this is much more in your sweet spot, recruitment, all the challenges there right now. Michael: Yeah. I mean, I think some of the things, when we're talking about growing employees and how to do that and how that is just essential to the workforce, I actually think about not as much what I'm doing right now, although it will end up translating there. We're just at a little bit earlier stage, but actually my last organization, Physicians Immediate Care and how COVID affected us so much because when COVID first hit, it was all hands on deck. And then eventually there was a big wave of labor that just sort of left the market for various reasons. And so it was really interesting to see how that affected us because if you look at it, and we were right at the tip of the spear, we're urgent care. So we're seeing more patients than you can imagine. And for us, the position that we were really losing was our rad techs, those who were shooting x-rays and extremely important to see what was going on doing all these chest x-rays and everything. But they had an opportunity to go back and go into the hospitals and become CT techs and MR techs and the like. And I didn't have that growth opportunity for them. So interestingly, what I did is I pushed my team and I had a really large training team to dig in more and to be able to create learning opportunities to train medical assistants and create them into actually rad techs, limited rad techs. We turned that into actually a DE and I program without labeling it as one, but to turn someone who was making $20 an hour, $18 an hour into someone who was making $85,000 an hour. So that was really how we did a lot of our training internally, solving our own problems and the community's problems at the same time. Dave: Yeah, you think about, we've all overheard the last 6-12 months, this whole issue of full work and no one's returning to the workplace in general industry, right, in the general community and that maybe COVID accelerated what was going to happen anyway or maybe it didn't, but it recalibrated the world as we know it. No one's going to ever go back to a five-day work week in a cubicle in an office anymore. So what's the healthcare caregiver analogy for that? Did COVID, like what you're getting at, Michael, did COVID accelerate what was possibly going to happen for caregivers in a traditional model that they were already burning out anyway, they were already dissatisfied, things were going to change, but it just all accelerated and now we have to figure out how do we adjust the caregiver work life model, nurses, radiology techs like you're saying, or anybody, what's their new world, what's the world going to be, how do we figure that out, and so on, right? Because that's what the bankers are figuring out or all these other industries right now where people don't want to return to a nine-to-five cubicle Monday through Friday anymore, right? Michael: And I think the first wave that we saw was how much can we move to telehealth? How much do I not actually need to see a patient in the office at all and I can just do it through Zoom or whatever? And I think pretty quickly we learned that that doesn't work. It doesn't work for a lot of things. It's fine for some and for some it's, you know, that just isn't, you know, it's too impersonal and, you know, the physical touch is just necessary within healthcare. Dave: But how do we find then, how do we retain and how do we recruit workers, staff who are of the mindset they don't want to go into a clinic for a 10-hour shift and have this grind of, you know, patients in the waiting room waiting to be roomed, waiting then to be seen, waiting to be discharged and do that for a 30-year career? And they watched how taxing and burdensome that is to other peers or the older generation, whatever it might be, and they're coming into this saying, I don't want to do that. Boy, you know, so how do we start finding those workers? How do we match them up with our opportunities and how do we change our jobs as well? Michael: I was going to say, I think there's two focuses there and I think that's exactly it. One is you clearly have to find someone who's mission driven, who isn't going to see taking care of patients as a grind day in and day out. And the second part is you have to make taking care of patients not a grind day in and day out. And part of that, you know, if you're on the primary care side is, you know, a patient visit is not a 10-minute patient visit. Because as soon as you're doing that, then that is what turns it into a grind and that is what, you know, degrades care for patients. And so we have to look at this much more holistically, not just from, you know, one side of the coin and say what's going to be driving a fee for service value, but that's also going to be, you know, burning out your staff. It's not good for your patients and it's just not long-term sustainable. So how do, like you're asking, Dave, how do we create a different model? You know, spend more time with our patients. You get to know your patients. Dave: Yeah. Yeah. Although at some point or another, I mean, I think about myself, you know, walking around the hospital floors and watching the work world of nurses and patient care techs, particularly on a nursing unit and how physical that job is, how taxing it is clinically and emotionally for them, along with obviously that physical piece. And I, and you know, and nurses who may start their career in their early twenties, you know, by the time they're 40 or 50, after doing it 20 or 30 years, just their own aging, let alone, you know, the burnout factor or the repetitive burnout factor. I mean, can you expect a 50 year old nurse who's been in career 20 or 30 years to be willing to work on a nursing floor anymore? And now the shifts have gone from eight hours a day to 10 or 12 hours, 12 hours a day, right? No, it's a, it's a great question. And we haven't radically, you know, yeah, we've created, you know, more breaks. We've tried to, we've created, we used to call it, of course I lived in Seattle at the time. So it's only kind of a, it's, it's a typical West coast thing, but we created, as we rebuilt our hospital, we created dedicated rooms in each unit called the Zen Den for the nurses and the staff to go decompress for a little bit of time to recharge, right? When needed and so on. I mean, yeah, we've created those things, but we hadn't, you know, we danced around the edges of the job. The job is still very physical, very taxing, very challenging. How do we, how do we work on that? Like you're saying, Michael, how do we change that? Michael: It's a great question. I wish I had the answers to that one. Ubaldo: So what I was going to ask around that then, so, because Dave, that seems like a bandaid, right? Like, oh, well, we're physically, we're going to come up with bandaid solutions to this. But to your point, like, and to address that piece of it, it sounds like what you both are saying is, you know, how do we address that in the recruitment process? How do we, and is any of this happening now? Where we're thinking, you know, let's say someone's coming in as a nurse and they're 25 years old and yeah, they're going to be here till they're 50 plus. Is that even, do we even think about that in the recruitment process? That, that, that fact, or is that something now that's becoming part of the thought process because of COVID? Michael: I think Dave was saying that's not, that's not even sustainable. Ubaldo: Well, but I mean, what I'm asking is like to think ahead and to say, because yeah, totally… Michael: It's a, it's a, it's a young kid's job. Ubaldo: Yeah. Are we thinking about that from the beginning is what I'm asking, you know, like, like, okay, they're coming in as a young kid, but now for this person, are we even thinking ahead to when they're 50 and they can't do this young kid's job anymore? Right. What's next for them? How do we build in a journey? Dave: That's, that's where I would go. Yeah, I think the macro viewpoint is how do you build a career track so that when someone joins as a young clinician, nurses, PCT, whatever the role, my patient care tech, whatever the role is that there there's a recognition that, you know, not only are their interests going to change over time, uh, due to the repetitiveness nature of it, but also even the physicality of their work and how do you build a career track so that if you can recruit a nurse at 25 years old out of, you know, whatever training program and you, and they want to retire with you at 60 years old, that it's not all going to be four 12 hour shifts a week on a nursing floor. So the beginning of it may be like that. And at some point it's going to evolve to have other types of intellectual challenges other than just the physical nature of nursing. And then maybe there's care management or utilization review or clinical quality or all the different other roles. And I'm just picking on nurses here as an example of a track that can evolve and you, but you build that in upfront and then how do you recruit knowing that that's the fit, right? Michael: That, but, but I, but, but, you know, to, to pick on nurses and I will to go back even further. And I remember this 15 years ago, there was an article like, why can't we hire good nurse managers? And it's that they're not trained to be nurse managers in, in school. This is not, they're, they're trained to be nurses, not managers. So this, this becomes the, you know, the challenge of administration and HR to put leadership training in place to grow your, your young nurses into nurse leaders and exactly what Dave was talking about into other, other clinical areas, because it's not sustainable to work a 12 hour shift into move patients around when you're in your fifties. This is, you know, I'm in my fifties and, and, you know, I get out of bed and go, and I'm not getting someone else out of that. I'm just getting myself out of bed. Dave: So by the way, Michael, wait till you turn 60. Michael: So right. So these are the things that, that I think we're talking about, or what are these, you know, clinical paths or, you know, when someone got into nursing, it sounded like I can do this forever, but what does forever mean? You have to be able to move into something, whether that's leadership for some, a different clinical path, rather as moving into an outpatient setting or, you know, as Dave was even talking about, if you're looking at a PCT job, you know, does that mean you move into now you get additional skills and now you're a medical assistant on the outside, something along those lines, right? Dave: Yeah, it's, it's kind of a, I mean, the, the comprehensive holistic view is as we recruit young talent into our organization, we want to find a match for them wanting to stay with us their entire career. But our commitment back is we will let your career evolve with us so that it's not 35 years of exactly the same job as you started with us. It's going to evolve over time, partly based on your interests and your capabilities, along with the organization's needs, along with where healthcare is going to go. Because 35, I couldn't predict what 35 years from now is going to look like in healthcare from a workforce viewpoint, right? And then how do we match that with people who want to do that? Michael: And I was just about to say for some people, that sounds great. mAnd for other people, it's not because the conversation is going to be, show me exactly what my career path is going to look like. And my answer is I can't because it's going to be dependent upon you and whatever you want to do. And certain people are going to be like, oh, that's great. Or no, I want to know what my next step is and when, when that's going to happen and exactly where I'm going to go. But I think we're talking about a little bit more flexibility in putting it in the hands of the employees to say, I'll go wherever, just give me the time and I'll go there. And I think that's a really exciting way to look at it. Ubaldo: That could also be, I would say if the pandemic taught us anything, it's that it's not necessarily just reliant on the person though. It's also reliant on the market forces, the situation that's occurring at the time, right? Because to your point, Michael, when you were talking about re-skilling assistants to be techs now, that was almost out of necessity because of the shortage. And so what was that conversation like? So when you all talked to assistants and said, hey, we have an opportunity. It's… what did that conversation look like? Michael: Yeah. And, and I think it's, again, it sort of goes back before because we had already created an environment in which we were a learning organization where we had already trained medical receptionists to become medical assistants. So this was part of the organizational DNA that you could come into this, this company and grow. And so those people who were willing to raise their hand, we were like, great. So this was just that, but more they're like, oh my gosh, a, a licensed position and it was somewhat dormant. And so we were also working with the state to get educational positions alive again from the state and the licensing going again. So it was, it was pretty big. And so people were really excited about it. But because they already had faith that we were going to do it for them. And so I think that that was part of it is that it wasn't just like this high in the sky kind of thing that we were doing, even though it sort of was for us, because it grew out of like a problem that we had and we're like, okay, well, what do we do to solve this problem? Well, grow it ourselves. I don't know. But, but they were on board with it because of that. And that's, that's how it happened. Dave: But Michael, where does the, you know, again, as, as more of a general administrative type me, you know, I always look to how do you organize and orchestrate the teams to work on things. And I, so the challenge is to you, is this an HR function or is it the clinical manager's function of the area? And how do you, who, who takes lead, who drives it? How do you do it as an organization? Because you need to do it in scale, not in any one particular area. Michael: And I think that was what was great about our last organization was how in alignment we were because there were really three entities that were driving this. And it was the clinical, clinical operations training was sort of that mediator and then HR. So training reported to me and we were all sort of, you know, sitting in the room and saying, how do we do this? They had the problem. And I see my role as, as HR is to say, how can I, how can I drive outcomes from my seat being HR? And part of that is I have this big training department and I can leverage those resources to make this happen. And so it was like, we're all just, we're all just going to be, you know, pushing to the same goal here. Very, very simple. But yes, they were, I mean, ultimately this is not an HR initiative at all. This is an operational initiative that HR was a hundred percent behind because we understood what it took from training. Dave: Yeah. That's, that's, I mean, that's where my mind was going to that ultimately you need the manager, whatever the right title is, but the person who is the leader over and operating unit, the X-ray department, the, you know, eighth floor ortho nursing department, the ER, the, you know, pick your favorite department and I'm leaning on clinical ones. You need that, the leader of that area to recognize their ecosystem is changing and evolving and they've got to adjust, but you don't want them to invent the way they do it themselves. They won't necessarily know how to, and I don't mean in a disparaging way, but that's not what they're, right? And they need someone to provide them technical kind of a horizontal and a vertical, right? They run the vertical, but who's running the horizontal of that function to equip them with the tools, technology and otherwise, so intellectual and otherwise frankly, so that they can be better at running their vertical and not have to invent it themselves. Right? How do you think that is that HR's job and training's job, you know, but then they deploy it? It'd be interesting to understand that. Ubaldo: And secondarily to that, to add to that a part B, what are specifically some of the tools and technology that you've seen, heard about or used that made that successful? Michael: Yeah, I think honestly from a technology standpoint, we were not, this was not really a technology push as much as it, you know, as much as anything else, because this was, there was a lot of classroom learning, like just because you had to sit for an exam. It wasn't something that you could just roll out a technology and do a lot of online learning. You had to be sitting, you know, in front of an x-ray machine and, you know. Taking x-rays. So, but I think what really made it work was sort of what I was talking about before. And that is that alignment, you know, a lot of project planning, but making sure everyone was on the same page. Our training team, our training team grew out of the clinic operations itself. And so because they understood what it was like to work in the clinics, they had the street cred right away. And so they could actually, in addition to Dave, what you were talking about of sort of the manager drafting the people and getting them on board, the training team itself was able to do that as well and sort of tap someone and say, hey, I think you'd be great for this. And so it was very much of a cohesive approach to it. And so I think that also allowed people who may have been a little tentative to take the leap and say, you know, I feel like there's a lot of safety around me to do this because my manager is saying it, my trainer is saying to do this. You know, HR came up and said, hey, we got you. I think this would be something great for you. And that allowed people to go ahead and do it. And that was amazing for us. Dave: Yeah, just think if you had in addition, how do you again do that in scale? What type of information do you need to know about your workforce so that you know who to tap and who likely is going to be successful at it or not successful at it or interested to begin with or not? You know, that type of thing. Michael: So interestingly, we were doing this at scale. We were doing this across 60 clinics. And ironically, the one thing I didn't have, I wish I did, was a better pulse on my employee population. I, you know, I use some great tools on the hiring side and on the management side. I am a big fan of Predictive Index. So we use that for hiring and for management. I didn't have a tool on the sort of HRS side that would give me predictive analytics on my employee population. But this is where I would default because I had a great HR team in the field. So that would balance that out. But I didn't have a great HR dashboard, electronic dashboard that I could pull up that would say like, oh, you know, clinic 102 is on fire or something like that. Ubaldo: So how did, I used to put a fine point on that conversation around recruiting. How did what you all were doing impact your recruiting efforts? What did it do to inform? And maybe, Dave, this is more of what you're getting at, but how did it inform that recruiting process specifically? And did it change anything for you and your HR team? Michael: Yeah, definitely. So I think with our recruiting, particularly with Predictive Index, you know, we identified job specific profiles and our retention was double what the industry standard was when we really honed our recruiting. And so I was there for about five years. And so, you know, I had a really good run of being able to see that change over that time period. And so being able to identify and this bringing it really sort of full circle to where we started those people who are mission driven and say, this is where I want to work. This is the industry in which I want to work and being able to create that environment in which it doesn't feel like you're just being beaten up day in and day out where you can throw other kinds of activities into their job. And that's what we tried to do. But hiring better at that front end was clearly key. You know, again, the retention and turnover double, you know, double the retention, half the turnover of what our industry was, was the key there. Dave: Yeah, it just seems like the more you know about your team and the earlier on, you know it the more comprehensive you can be about fitting your analytics side, Michael, what you were getting at, right? How do you then start matching with people, what their needs and development is going to be, their careers are going to evolve to where they want to take risk, where they don't want to take risk mutually back to the organization, the same thing, right? Michael: Exactly. Ubaldo: Well I think this is, we almost laid out a playbook almost for how to approach this. And I think it's a great spot to sort of maybe end this conversation, but I want to continue it in a follow-up blog talking about sort of the future of healthcare workforce development. You know, how can we look ahead 25 years into somebody's future and pair that with opportunities, cross-training, re-skilling, you know, but aligning not only to their passions and mission, but then aligning that to the organization's mission to your point, Michael. It sounds like that's sort of the differentiator is that you got to have someone who aligns to the organization in more ways than one, not just that they meet the skills necessary for the role. It's got to be much more than that if this is going to work, which is probably why we haven't seen many instances of this working across the industry, because I feel like most hiring is just reactive, right? Like we need help and we're just going to hire temp people or whatever it is because we need it, as opposed to looking at the long-term. So I say we continue that conversation in a follow-up blog. Any last thoughts on this conversation, Dave? Dave: You know, I think what you just said, but I wouldn't necessarily label it only reactive. I think it's short-term, right, versus long-term. We hire to fill an immediate need. Healthcare unfortunately does not think three years out, five years out, 10 years out, whatever. We've never had that ability because it recalibrates and changes so quickly and there's this pressure constantly there. And you know, at some point or another, that's such a disadvantage compared to thinking more longer term and matching individuals with organizations where they can have your whole, you know, have our billboard on the freeway shouldn't be, you know, come work for us as a nurse and you'll make, you know, you'll, we'll give you an extra day off a month. It should be, come work for, spend your whole career with us. We will look out, we will help you navigate your whole career. We will find, we want you to be a fit for our organization forever. So to speak. How do you think that way? Longitudinally, not just transactionally? Ubaldo: Yeah, absolutely. Dave: I don't know, Michael. Now that's again, a non-HR guy who always gets to tamper in the HR world. What do you really think about it? Michael: Yeah, no, I think it's funny because in, I made a decision to leave health systems a while ago and the last two companies that I've worked at, ironically, one of them being PE backed, this one being VC backed. But you'd think that the focus may even be more on build the positions, get the numbers, let's see the results. In those two organizations, the focus has been more on quality of hire, fit with mission than in any of the hospitals that I've ever worked in. So I don't know if that's ironic or if that's just a true shift. And I think even more so in the organization I'm with now because we're value based care. And so it is very much so. I don't really do much recruitment unless we're talking about our physicians and physician leaders. And there the conversations are, if you're not a fit, you could be the best provider in the world. But if you're looking for a fee for service kind of environment, this is not going to be the role for you. So I'm hoping that that is a bellwether that that's where we're moving. And that it's not just that it's those two organizations, but it's that those are more recent. Ubaldo: Well, gentlemen, thank you very much for the conversation. This was awesome. I look for more conversations like this with our team and as always, thank you all for listening. Check you later. Take care. Extro: A Hire Future in Healthcare is a production of IIA Healthcare, a healthcare technology company and creators of interviewIA, an interview platform for healthcare organizations to streamline their interview processes to deliver unparalleled candidate experiences and to create a true competitive advantage for delivering quality care. Learn more at www.iiahealthcare.com.
Equitable Healthcare Access: Balancing Business and Social Responsibility
With Michael Isaacs and Karen Conway. Hosted by Ubaldo Ciminieri.
Intro: Welcome to A Hire Future in Healthcare, where we're exploring obstacles and solutions to healthcare's growing workforce demands. Tune in to hear from thought leaders as they share their perspectives on strategy, technology, AI and people who are paving the way for transformative change. Ubaldo: Hey, everybody. Welcome back to A Hire Future in Health Care. I'm Ubaldo Ciminieri, and I'm joined by Karen Conway and Michael Isaacs. You've heard them before. They're back. This time, Karen and Michael are paired up, and we're talking about equitable health care access. When you think about that and how you might balance business with the social responsibility that comes with a lot of health care, quality of care, value-based care, community care, just taking care of each other, right? First of all, welcome. How are you two doing? Karen: Doing well. Glad to be back. Michael: Doing great. Thanks to see you again. Ubaldo: Let's dive in, because I think first and foremost, I'd love to hear from both of you how you define equitable health care access. I think it's something that because of the pandemic, there was a big spotlight on access to health care and who has it, who didn't have it, et cetera. I'd love to hear from both of you. Karen, if you want to go first, how do you define that? What does that mean? Karen: Absolutely. I think it's obviously that ability of anybody to be able to access the kind of care and resources they need to be healthy. I think a lot of the discussion, particularly with the Affordable Care Act, was about insurance. That is certainly whether or not you have insurance or whether you have the ability to have insurance or to pay for that insurance or to pay for the care that insurance doesn't cover. That's one kind of access. Certainly another is if patients are on Medicare or more importantly on Medicaid, sometimes it's just being able to find a doctor, a nurse, a provider that will take that kind of insurance, et cetera. But the other is, I mean, it can be as simple as do you have transportation to even get to the doctor? I know I did some work with Kaiser Permanente and they were noticing that people were not showing up for their appointments. What had happened is they had moved the bus stop and the bus stop was just now too far away. They literally had to go down to city council and say, you know, you got to change this. Sometimes it's does that individual have time off? I mean, there is a myriad of things. And the other is quite frankly, and we've seen this since the National Academies of Medicine did their landmark report back in 2005, that the reality is that even when insurance status, income, age, severity of conditions are exactly the same, the fact is that people of color get lower quality care on average and that equates to worse outcomes. So we'll start there and we can talk a little bit more about how do we address that going forward. Ubaldo: Yeah, that's fascinating. What about you, Michael? Because I think you have in the work that you do at Hopscotch Health, I don't know, is it similarities, differences? How do you define that? Michael: Yeah. So, you know, at Hopscotch, we focus on the rural and primarily the Medicare patient population. So we focus a lot on access and everything that Karen was just talking about is spot on. I think additionally to that, it's even when you have all of those services, assuming that you have the coverage and you have the access to care and you have the transportation to get to where you need, it's still navigating the system itself. Because now, okay, my doctor wrote me a prescription, but they don't have it at my local pharmacy. So how do I get this prescription that I need to be healthy? How do I maintain a good diet when there's not healthy options in my community? So I think access to healthcare happens to be a lot more than just going to see your doctor. It becomes a whole community involvement that becomes, it's very complex. Ubaldo: Well, and Karen, you brought up the black population and I think not only the black population, but many underrepresented groups, even just the talent that's reflected in their local healthcare system isn't reflective of them oftentimes, right? And that's, I think that's where that equitable access, that doesn't feel achievable to them because, well, this doctor or this mental health provider, or even this nurse, they don't understand me and my culture and my health. So why, it's like, I don't feel comfortable enough to go to them. I don't see myself reflected. Karen: It's a critical issue. Absolutely. In terms of trust. So one is, one of the other measures of access is whether or not you have access to a regular provider, that family doctor, that person that's been treating your family and you trust them. And certainly in the black population, many, many wrongdoings in terms of like the Tuskegee Airmen, et cetera, that have created some deep seated mistrust as well. The other issue, or we've seen in rural America, and Michael could probably address this as well, particularly when a hospital might close, somebody might not be comfortable going to the other hospital. Just, you know, and particularly if they're not seeing people that understand them. I had done in grad school some work on how we could treat pediatric asthma in children of low socioeconomic status. And it was really important that we develop different strategies. Like with the black population, we worked with the churches. And so we would have church, people from the church were trained by a medical professional on how to go into the home or work with the kids after service about how to use their spacers. With the Hispanic population, it was more a matter of one, to speak the language. Another was, what about the fear of those folks who think that they may be undocumented and so they don't want to talk? And working with the Native American population, a completely different approach. So it's, you know, the end goal is the same, but the care has to be very customized. Ubaldo: Yeah. I mean, Michael, I imagine is that in the rural communities that you all operate in, is that exacerbated? Michael: Yeah. I mean, we see obviously the incidence of disease that we see in the rural communities is much more than disease that we see outside of those rural communities and the urban communities. And the ability for us to be able to connect with minority patients in those rural communities is extremely important. So that just goes back to basic. What I see is basic good healthcare hiring practices is that you need to have providers and the rest of the staff that is reflective of the community. Often we think that a rural community is monolithic. It's always a white community. That's not the case. Not the case at all. So we need to have a diverse staff who again can reach our patient population where they are. You know, if you look at the studies and they don't have the numbers in front of me, but I know that when you bring in a Black physician into a community that does not have one, it increases the overall health of the community drastically. And that's not just of the Black community, it's of the overall community. So these are really important things for us to look at providing care in rural communities. So this is, I look at each clinic that I have and look at the breakdown of the patient population, the overall population, the patient population, and then my staff to make sure that I'm not alienating patients who I'm trying to actually serve. Karen: One of the things that I think we forget about when we've had this workforce shortage as well is think about one of the best things you can do when we were talking about access. Sorry, I'm going to back up for a minute. I get myself confused here. You know, when we talk about access, you know, sometimes it's not access to health care. It's access to that which improves your health. And for some people, it's having a job that makes a livable wage is the best thing you can do. So as we start thinking about more disadvantaged communities, and I have done more work, so I really enjoy getting Michael's perspective from more rural, I have done more of my work in the more urban environments. And you think about like on the west side of Chicago, where, you know, the life expectancy is dramatically lower than it is just, you know, five, six miles away in more downtown Chicago. And, I mean, there's a number of really great programs being done, led by hospitals and health care systems to increase economic development, create job opportunities for people. And, you know, that's the best one of the best things that you can do. One, they get insurance, one they have the money to afford because just because you have insurance, etc. But you still have to have that trust. But you think about think about a resilient workforce. People who have lived through adversity, you know, they're the kind of people who can really make a difference in the lives of people in the operations of our health care system. Ubaldo: It's interesting because so my wife works in health care and she's working on sort of this benefit program. And we were having this conversation and she had asked me who I thought, whose response what I thought, whose responsibility is it for somebody's health? You know, it's kind of an interesting question. And it's I'm sure there's many different answers and perspectives on that. But to that point about, you know, having a job, right, or having a place to live, having food on the table, like it's all connected, but yet, it doesn't seem to be in practice, everything's very separate, right. And I get my initial answer in that case was, well, maybe it's the insurance company, because they don't want to pay out for, you know, major sickness or anything like that. So what can they do to help somebody stay healthier? But now you've got me thinking like it's it's way more connected, and there's way more involved there. Karen: It is all of us. It is, you know, a lot of times it does fall to the hospital or the health care system. And as an anchor institution, you know, one of those institutions, much like a university that, you know, they're anchored to the community, they're not apt to pick up and move and go someplace else. They are potentially apt to close if you know, they can't continue to operate. But but they can't do it alone. You know, particularly hospitals and health care systems dealing with some of the most financially challenging times ever. But, you know, it's also up to the community, the local businesses, the government, and it's up to all of us, you know, we all have a responsibility to keep ourselves as healthy as possible. So, you know, we need to work together. It's a system. Michael: So really interesting. I was talking to a physician earlier today, not not one of mine, not a you know, a member of my group yet. And I asked him what you know, if you could design your ideal role as a physician, what would that look like? And he started to describe what his clinic would look like. And his clinic had a gym with personal trainers, not for him, but for his patients. And his gym had a kitchen with chefs to teach his patients how to how to cook and it had a grocery store with only healthy food. And it was a very holistic approach to health. And he said, you know, I spend all my time not doing anything with health care. This is all sick care. Yeah, I could just actually teach people how to be healthy. That'd be nice. Karen: You know, I've got a I've got a good story that plays off of that, that I think, you know, is a little bit of his vision. One of my favorite success stories is what's called the Geisinger Fresh Food Pharmacy. Geisinger is a health care system that is in Pennsylvania, dealing with, you know, a fairly large Medicare and Medicaid population. And what they discovered is that they had a much higher rate of type two diabetes than the whole country. And type two diabetes is really an epidemic proportions in this country and a lot of other developed countries. And so they figured out, you know, they looked at who these patients were. And they discovered, you know, that they were getting a lot of their food from the food bank. And the food from the food bank was the worst food ever. Or people with type two diabetes. So what they did is they they worked with the clinicians, the dietitians and the supply chain to source better food for these folks. But they also recognized that in many cases, they didn't know what was good food for them for their particular condition. Some of them didn't have a hot plate, didn't have a refrigerator, didn't know how to shop or cook. So they surrounded them and provided all of these different kinds of services. And I'm very, very proud of some of the work that the supply chain did. But what's amazing is their the data, the patients were showing up less in the ED, they were being admitted less. Their labs were better. They were happier. The clinicians were happier. It was it was not just one thing. Ubaldo: Yeah. So how does that? Okay, so this is a perfect segue then into the business conversation, right? Business versus social responsibility. How do you do that? But also approach this as a business, you know, many for profit systems and things like that. How do you balance the two? Can you why is there not more of that happening? Like you both described that more holistic approach to health versus sick care? Michael: Yeah, and I've been on both sides of this equation. And I don't see the I don't actually see the the disagreement as much as there needs to be. I see it as a if you approach it from a value based care perspective. And our whole conversation has really been a really from a value based care perspective. You know, how do you drive true health outcomes as opposed to, you know, treating episodic illness? If you approach it from that way, whether you're nonprofit or for profit, you're driving the good in health care. And where I am now is is for profit. But we're driving the good for communities. And that's really what matters. I've been with nonprofits who that are very, you know, fee for service based and lose sight of the fact that there's a community involvement. And it's all about how many patients can we get in, I'm going to buy the practice and how many surgeries do we get and let's keep our our beds filled and the mission of health care can get lost even though they are a nonprofit. So I think it really comes down to, you know, not not what your tax status is, but what your core what you're really doing with it. Karen: Yeah, what's your mission? You know, this isn't about that I spend a lot of time thinking about and I have the opportunity to work with a lot of hospital CEOs and or health system CEOs and and CFOs. And so I really look at and again, I kind of I have to look at everything as a system and how things are connected. And, you know, so I'll talk I'll talk to them and you think about it, as I mentioned before, some of them worst financial year ever last year. Their patients are sicker, many of them put care off. They're staying in longer, they're more expensive to care for. In the meantime, inflation, everything's get costing more, you still have labor shortages, supply shortages, and the staff is burned out. And so you come, hey, we want you to address health equity, and access to care and also things like climate change, which are which is also a critical need because the sad fact is, is that healthcare operations are a major contributor to greenhouse gas emissions. But that's a whole nother. But anyway, you go, now you want me to deal with these things, I can't do it. Yeah, my argument to them is actually if you look at the intersection of health equity, environmental sustainability, and the economics of healthcare delivery, particularly around chronic disease, we spend 90% of our national healthcare expenditures on chronic disease. So you go, how do we lower chronic disease, because in a volume based healthcare system, we have tended to focus on those high dollar procedures, you know, and so what's going to bring money in the door. And it's just a matter of doing business. It's not that people are bad because they're doing that. But in a value based business, we need to have good financial business practices based on keeping people healthy. And so it is about focusing on, you know, so you got to get to the root cause. What's causing the rise in healthcare and you know, folks like Fitch would say, it's chronic disease, and the growth in the number of chronic diseases that people have, that is a major, you know, a real drag on our national economy. So and the fact is, as people say, well, I don't make as much money on somebody with chronic disease. Well, you know what, you're losing money, because that person might come in for that high dollar procedure, like a knee replacement, a hip replacement, etc. And if they're obese, if they have diabetes, if they have any of these other things, they are a much higher cost patient to take care of. And they are very likely, much more likely to come back, be readmitted. And that's care that that hospital is no longer. Don't get reimbursed for that. They don't get reimbursed for that, right. Ubaldo: Wow. So, man, my mind's racing. I mean, there's, it's the well, and then I mean, if you think it's also a quantity number two, because you know, the population of people who are aging and getting older, does that is that equal to that chronic disease rate, right? Like that growth in chronic disease rate or, or is that more spread out? Karen: Well, you would think and yes, you get older, you get more chronic diseases, you know, you get arthritis, you know, you know, chronic disease. But the fact is, is that children who live at or below the poverty level have a 33% higher risk of getting a chronic disease and they're getting it 10 to 15 years younger than their white peers. As an example, it really is an issue of poverty. The fact is, is that people of color tend to be disproportionately more in the lower income areas. But the other fact is, is that you get one chronic disease, they're generally inflammatory, you are much more likely to get another chronic disease and another chronic disease. Michael: And, and to add onto this with, with many of these chronic diseases, they're often, they're mismanaged. I'm not saying that the physicians are mismanaged, but they, the people who have them are falling through the cracks. And so this is where we can do so much better because it's, it's not like, you know, a cancer where you're, you're diagnosed with it and then, oh my gosh, there's all these other things that may come. This is like, if you get in front of it, you're, it's very easy to manage these things. And so it's, you know, it's like a ground ball that you just like go through your legs kind of thing. And the other question you were asking. And we can just get in front of them. Karen: And who's responsible, you know, we always think it needs to be the doctor. You know, there's some very successful programs where it's called chronic disease peer management, where, you know, I have asthma and I could work with somebody else who has asthma and I could be a support system. So it's not always the doctor or the nurse that we need to help with this. Ubaldo: Well, so then, so final topic, and this goes right into the workforce, like how, what are some good approaches maybe to building your workforce with people who think more along the lines of social responsibility, right. And understand all of these ideas and strategies that you all have been talking about and can help play a role. It's almost like a Trojan horse to fixing this, right? Like if we hire, you know, more nurses and more techs who align with this part of the mission, you know, then maybe we can really solve for this at the ground level, right? Like they're the front lines. They can sort of help with this. Is that, like, how do we do that? Is that a good strategy? How do we get to balancing this better and taking care of the community better? Michael: Yeah, well, you know, as we were sort of talking about how COVID really created that bifurcation, if you will, of the workforce, where you had people who had the opportunity to go work in other industries and make more money or stay within healthcare because they were mission driven. And then as an organization, you had the opportunity to make the decision to, am I going to create a hiring plan that is mission driven? Doesn't mean I'm not going to increase wage rates, but am I going to create a mission driven retention plan or am I just going to throw money after money after money to try to keep people? And so I think that was sort of the first decision about that. And so now the organizations have made that mission driven organization, you know, decision that we're going to go after people who want to help people. That's the key decision right away, right? So now how do I retain these people? How do I continue to grow them and do all of that? It's a huge one, a huge lift, but it is necessary within an environment in which wages are going up and everything else. But that is really the key in an environment where all of that is moving right under your feet. Karen: I think the mission, you know, that's certainly one of the keys in particularly. I think, you know, I don't like to generalize about, you know, different generations, but I think we are seeing more of that. You know, people want to work for companies that are taking care of the people who work there as well as, you know, taking care of people in their community. There's lots and lots of data. I want to make one point related to kind of our value-based and our volume-based because a lot of times people, you know, we were saying, really, if you're moving to a value-based healthcare system, you're going to see a lot more of these drivers. But I'm seeing even in markets that are still very fee for servicencompensation, like the CEO of Freight Art in Milwaukee, still very much fee for service market. And she said, we must work on the economic development in the communities. And that includes looking to people in those communities to hire because the reality is we can't with the workforce that we have, we can't handle this demand. So one of the things that they're actually doing is investing about $100,000 a year in each, in different individuals, training them while they're on the job to become, for example, surgical techs. Filling a need. But they're making this investment. And, you know, what kind of loyalty do you have in an organization? You know, and then I, you know, I think I've mentioned before possibly but a program that I learned about in Chicago called Jump Higher, where they were, this was a supply chain program, where they, they had identified that they had, you know, they had shortages in supply chain. And so they worked with some different institutions and had a cohort of people who got stipends if needed, transportation if needed, childcare if needed. And they were, they were given opportunities to learn like life skills and soft skills or power skills, as some people call them, like communications, customer service. But they also were able to do job shadowing. And a job shadowed with the supply chain. This was at Rush University Medical Center and also with their distributor concordance. Every single person who graduated from that first cohort got a job paying at least $65,000 a year. Wow, that's great. And that's a career. People don't think about, you know, supply chain is not until the pandemic. But that's it. There's a career pathway. Yeah. So that, you know, it's those kinds of things. And again, looking at all the different kinds of workers and talent and skills that we need in our organizations to keep the wheels of healthcare moving. Ubaldo: That's incredible. Well, and I love, you know, when you were talking about going into the community and sort of teaching people at the churches how to go and take care of, you know, their neighbors. You know, you see a lot of that. I was part of an organization called CU Peru that would do that in the Amazon, right? They would teach community health workers to go back to their villages in the very remote parts of the Amazon to take care of their village. And it's sort of a fascinating and what an interesting strategy to consider as we fight this workforce problem that we're facing of finding enough people to help take care. Like, and what a maybe what a great way to solve that, that, hey, nobody looks like me in this healthcare system. Well, community healthcare workers could be an interesting solution and like programs like you just talked about, Karen, like, how do why don't we go out and create something within the community where now I look like someone who's trying to help me stay healthy. And it's true healthcare. I just think that could be really interesting and really fascinating to think about. I love that. I love that. Karen: I think it's a matter of to use a really bad healthcare analogy. It's different between putting a bandaid on the problem. Yeah. And I don't remember, somebody told me this story once and it was about doctors were standing at the side of a river and babies were floating down the river. And so they were pulling these babies out of the river as fast as they possibly could. And suddenly one of the doctors just walked away. People are going, where are you going? We need you. And he goes, I'm going upstream. I want to know why the babies are ending up in the river to begin with. So, you know, understand root cause and then find out, you know, what's customized the solution and find out who the partners are and, and create more of a systemic solution to the problem. Ubaldo: I love that. That's, I love that as a great final thought, Karen, for you and Michael, what any, any final thoughts on this conversation? Michael: Yeah. I just, hard to follow that one to be honest. Ubaldo: I was already asking cause I'm like, that was like, wow, that's a great place to end. Well then let's leave it at that. That's a great, great conversation. Thank you both as always. You know, we got to keep having these conversations. This is, this is our lives we're talking about. And so thank you both. Thank you audience for continuing to tune in and listen. Stay tuned cause we'll have more episodes just like this coming, coming your way. All right, everybody take care. Extro: A Hire Future in Healthcare is a production of IIA Healthcare, a healthcare technology company and creators of interviewIA, an interview platform for healthcare organizations to streamline their interview processes to deliver unparalleled candidate experiences and to create a true competitive advantage for delivering quality care. Learn more at www.iiahealthcare.com.
Cultivating Culture: How Healthcare Organizations Build and Shape Team Values that Build Great Teams and Attract More Talent
With Ben Wiederholt and Dave Brooks. Hosted by Joe Thurman.
Intro: Welcome to A Hire Future in Healthcare, where we're exploring obstacles and solutions to healthcare's growing workforce demands. Tune in to hear from thought leaders as they share their perspectives on strategy, technology, AI and people who are paving the way for transformative change. Joe: Hey everybody, welcome to another episode of A Hire Future in Healthcare. I'm Joe Thurman, co-founder of IIA Healthcare and your host for today. I'm joined by two of my favorite advisors, Ben and Dave, and they are amazing leaders in the health care space. You've heard them on some of our other podcast content. And today we're here to talk about culture and cultivating culture and building amazing health care organizations and how important that is to continuing to attract great talent, build great teams, and all of those fun topics. But before we jump in, how's everybody feeling today? How are you guys? Ben: Fantastic. Great to be with you guys. Dave: I'm doing well as awesome. Joe: Good, good. Well, as many of our listeners know, or maybe they don't know, both of you guys have been in the highest levels of leadership in thinking about health care, being both advisors and president CEOs of different health care organizations. And so let's just kick off with just your thoughts as someone at the top when you're thinking about culture, just the broad topic in health care. What does that mean? What does that give us some context for the word and for the way that you think about it as leaders in health care to kick us off? Ben: Yeah, I'll start. I love that question just to get us going, Joe, because I think about culture as the way we do things. I think culture as ethos, our reputation. What is the underlining experience of what it's like? What is our collective why and sense of purpose and the extent to which the individual staff and employees feel like they are connected? I think that really provides really important inputs into that sense of community, shared purpose, and ultimately the culture of the organization. Dave: I was going to add, or I would have started with exactly what Ben said about it's kind of the how we do things. There's the what, the why, the where, all the other cliche-ish things there. But the how part is really made up of the culture. Even myself as a leader, I was probably less aware of it or sensitized to it earlier in my career than I was later in my career where I started to recognize just how we do it, how we're wired, how we're put together both individually and as teams and then as teams within the organization, the whole organization just became more and more important to me of being recognizing what I'm supposed to do as a leader to help that along. Right? I mean, the dumb 20-year-ago Dave as a leader was dumb, which just did not really get it compared to now later in my life. There's something about that experience. Ben: Yeah. And Dave, just picking up on that. I mean, I've made so many mistakes and resonate so much with what you're saying in terms of how clueless I was in terms of the importance, but I've come to appreciate just how fragile the culture is and how there are so many opportunities to reinforce and not to take those opportunities to reinforce that desired culture for granted because it doesn't take many of those. And the complexities, especially in the industry of healthcare, the complexities can just get out of control and can steer that culture in a direction faster than I realized earlier in my career as well. Joe: Yeah. No, I was going to say really quick, that's, I mean, we're diving into, first I'm going to say the answer is different than I thought it was going to be. Because the whole world of the Simon Sinek's and starts with why and all the things that we've heard for the last decade plus. But to your point, like healthcare, the why is pretty clear. We're there to save lives and to take care of communities. And it's just interesting as both of you have leaned into how we do what we do as healthcare organizations and the fragility of it that you're talking about. And that's so complex when you think about that as what it means to build culture within the context of healthcare. And so how do you get, I mean, obviously I should inherently be excited about the why if I'm working in healthcare, but I don't think that's always true. Sometimes it's a career path. So as leaders, how do you really build that into a culture of compassion, of caring, of impact? Explain that, unpack that a little bit for people who are thinking about this. Ben: Yeah, well, I'll start. One of the things that I would always try to emphasize to, for example, one of the parts I like best about the job of being a CEO is welcoming new employees during new employee orientation, really setting the stage for them and setting the tone. And I think to create a sense of momentum and pride, it's part of it is how do you differentiate from other healthcare organizations? And one of the things that I was known for saying is, you know, there are lots of points of access when it comes to healthcare organizations through the full spectrum of outpatient to home-based care to emergency to inpatient. So there's lots of healthcare organizations out there that will care for patients. And what I always try to stress was the distinctive separation between the organization I wanted to be part of and what I invited the organization I was inviting people to be part of is it's not just about caring for, it's about caring about. And so how can we create that experience and that connection with that patient, that individual that we're interacting with and really helping them think about it's not just, again, caring for but caring about them knowing that they are the most important person in our world at that very moment. You know, we don't have much influence over what happened to a person before they came to us or what's going to happen when they leave, but we can influence and impact the experience that they have while they're in our presence. Dave: Yeah, you're right. You know, Ben, we used to talk about that and, you know, with the reality that at least on the hospital side, it was not uncommon that the patient or the family that we're working with is possibly at one of the worst moments of their life, right? Certainly one of their most vulnerable moments of their life, but possibly one of the worst moments of their life. And we, if you kind of always remind yourself of that, right, every encounter in the elevator, in the stairwell, down the hallway, obviously at any type of care setting side, in the waiting room, in the cafeteria line, wherever it may be, you know, the healthcare worker, hey, it's just another shift, it's just another, you know, whatever, even the healthcare leader gets, falls into that trap too easily, right? How busy we are. Oh, I got to run and grab a quick bite before I go back for my six hours of conference calls this afternoon. No one understands how tired and busy I am. Oh my God, the pressure, the pressure. And I get in, you know, I get into that cafeteria line and standing in front of me is a family again who might have just lost a loved one or might about to lose a loved one or the, maybe the most joyous moment, the birth of a baby just occurred. Who knows what it is. These moments that are occurring and the irrelevance of my problems when that's going on, right? Just, it just regrounds you if you don't forget those types of things. And then that, how does that then let you permeate culture, you know, as a leader, as a staff member of a healthcare organization, right? Ben: Awesome. Yeah. Dave: And that's kind of what you're saying, Joe, I mean, there is an advantage, the higher purpose shows up in healthcare, at least on the provider side of healthcare pretty easily because you're, you're, you're always, you know, one degree of separation at most from caregiving, either you're a caregiver or you're witnessing caregiving or you're directly supporting caregivers generally when you're on the provider side, right? So that helps you on that higher purpose part. But then the question is how do you make sure that, back to that culture issue of how I do it or how I interact with others or how we do the work comes into play, right? And I think the burnout factor that we're all worried about and we're seeing more and more of, or at least it's become much more relevant, it seems to people, it has to do less with the higher purpose. Again, I'm, I'm prejudiced about the provider side of healthcare because that's where I spent most of my career and again, I think there's a great advantages of it in the sense again of that connection. I think the burnout comes about less about the higher purpose, but more about the culture getting in the way of however that you as an individual feel about being able to connect to that higher purpose. People, I don't think healthcare professionals burn out working hard for 12 or even 14, 15 hours straight. They burn out when you're not connecting with that higher purpose that you know should be there or had been there or was there, right? Joe: How much? I mean, totally. I agree with all of that. And, and, you know, I used to always say that culture is like a vine, right? It's going to grow and it's going to go different directions. It's either going to be guided or it's going to just grow wild, right? But either way, you will have a culture. And how do you feel or what if you were to have a magic wand and running an organization facing all the struggles that healthcare provider organizations are facing right now, what are the two things that you would focus on, right? Around the culture conversation when we're thinking about to your point, yeah, burnout is a real thing and people are getting burned out and how the organization is doing the things that they're doing or what's expected of them or maybe it's the communication. But what are the one or two things that you would focus on that you would just put all of your energy into if you had that luxury from a culture perspective? Because it is so essential. It's so important and inevitable, whether it's going to be a good culture or bad culture, it's going to be there. Yeah, just what would you unpack that a little bit? What are the one or two things you would focus on? Ben: Well, it's interesting. I think the key is really modeling exactly that and what you would focus on and what you highlight, what you want to reinforce. And I think it's those examples of care team members that are going above and beyond connecting with a patient, with a family member and finding those examples throughout, going back to what Dave said, it's from the time they arrive on the campus to the time they leave from the helping them in terms of from parking, from an environmental services standpoint, through the cafeteria and certainly in the patient room and everything in between. But highlighting and thinking about are we focusing on as we have communications out to staff or we have our in-person meetings, are we focusing just on the volume, the financial results or are we focused on the value, the quality of care, how the health of the population is changing, how this particular staff member went above and beyond for that patient or for that family member and really making that a point of emphasis and reinforcing those behaviors that are reflecting the culture that you want to see integrated in your organization. Dave: Yeah, I like that, Ben. Probably about 15, 20 years ago, more on the clinical quality focus area, there was this concept and I'm being generous to myself to say 15, 20 years ago, it's probably 30 years ago, but since I'd like to not think of myself that old, I always underestimate it. There was a concept called microsystems thinking. I know it's a recording but I'm still showing on the video here for the rest of us. Joe: Dave's putting a circle up with his hands. Dave: Microsystems, you can annotate it, you can do the play by play. Microsystems and macrosystems. Think of two concentric circles. The quality thinking was, because I think it's very applicable to what Ben just said, the quality theory was that at the microsystem, healthcare is about more than likely caregiver and care receiver, patient, family. The rest of it is all macrosystems there to support that microsystem. That was the clinical quality improvement theories around it. If you take that same overall concept, or at least that's where my mind went, Ben, with your examples, and you take it into culture management, if that's part of a leadership or a leader's role, and I go back to that, what do I do individually as a leader? That's the microsystem. The people I'm impacting, either one-on-one, some direct people that I support, or teams that I'm leading or I'm involved with, or again, that hallway conversation I have with a staff member or a family or a visitor or a patient, whatever it might be. If that's the microsystem and I have an ability to impact and demonstrate my culture and the organization's culture there, I should do it, I think the challenge for leaders are, but we also have to figure out how do we make sure that happens at scale. That's the leadership challenge even more so, because I'm a good guy, and I'm in healthcare for the right reasons. I do believe that. Other than those moments where I forget because I'm having a bad day or a pressure-filled moment or something bad has just occurred, more than likely my microsystem's cultural impact is going to be pretty solid because I want to do that. I'm going to smile at people, I'm going to connect, I'm going to say, how are you? I'm going to engage. God help you if you ever sit next to me on a plane or next to me in an elevator, I'm going to talk to you. But my job is I moved into more senior leadership, especially at larger organizations. I realize, but how do I make sure that happens at scale? That's also the senior leader's job. So how do you put systems and structures and policies in place that reflect the organization's culture or help it flourish? That's a lot more the role of senior management, senior leaders, than it is necessarily my individual personal one-on-one actions. I'm paid too much to only deliver the one-on-one. Right? Joe: Well, and I love that. I think, obviously our world is talent selection. How are you thinking about building good teams? How are you streamlining process? And to piggyback on what you were just sharing, when prepping for this conversation, I found an interesting quote from a company called HubSpot, a technology company, and it's in their culture code. And it says, culture is to recruiting as product is to marketing. And so to me, as a product guy, as a tech guy, when I unpack that and think about that, you have nothing to market if you don't have a product. If we didn't have a software product, we would have nothing to market or sell or put out into the market. And so as leaders, and now looking at healthcare providers, health systems, leadership that not only has to design and build and scale, they also have to understand that everyone is facing this people problem. It's not even table stakes. It's below table stakes. It's inevitable that you're going to have patients and people you have to take care of. So that's not something you offer that why. You're going to have patients. So if you don't have a product that your talent team can market, if you don't have a culture that your talent team can market, then you're going to fall short. And that starts to impact you on the quality of care you can provide, on the financials, on everything, and starts to break the fabric of your organization. I don't know, does that culture as to recruiting as product is to marketing, does that resonate with either of you similarly? And I mean, what does it bring to mind? Ben: Yeah, no, I think it does, given what you were saying, Joe, with how competitive recruiting is, and to the points earlier about differentiation. I think prospective employees are going to be pretty skeptical. So I think it's just being able to convey with words and images and examples the culture that you want to have. I think that's a good start. And given the skepticism that those prospective employees are going to have, they're going to want to experience it sooner rather than later. And I think one way to do that is to think about the systems and the recruitment process and the onboarding process that is going to give them that opportunity to interact with the team members. So team-based interviewing and creating those mechanisms where they're able to interact with more people. And then at the same time, the challenge then is to maintain the efficiency of that process. So how do you involve multiple people, give the candidate an understanding and experience of other people already in the organization? Because that's going to be pretty telling in terms of what their experience is like as an employee, how they talk about the culture. So to be able to give them that exposure through the interview process and the systems by which to still do that in an efficient way, I think is a really important component. So that people can, that's what you're selling to your point around trying to communicate that culture and the recruitment process. Dave: Yeah. I mean, I agree. I think you're both right. You nailed it. What makes where my mind goes, it's a little bit pessimistic, unfortunately. That is with healthcare organizations, all organizations right now, but healthcare organizations particularly being so pressed for talent, you will worry about how much then is being compromised just to the warm body syndrome, right? And you worry about that because if you're recruiting for fit, there's skills and there's experiences and a little bit of that's more black and white in the sense of evaluating either they got it or they don't. But at some point it's more of an art than a science, right? And you're recruiting for fit as well. And if that ends up based on this cultural conversation being such a key factor, maybe more than we ever thought, then you worry about how much we compromise at sometimes or are willing to because right now we're so desperate for more people in roles. How many shifts aren't being filled by nurses or pharmacists or therapists or whatever the clinical area is, obviously outside of clinical as well in healthcare or any field, but healthcare particularly. And it makes me worry a little bit right now that we're moving for speed, we're not moving for long-term quality of fit. Joe: Yeah, which is so important. Like you say, whether it's the mirror test, can they fog up a mirror or warm body or any of those things that we've all heard, those analogies. It's definitely, I think, concerning to leadership, concerning to team members when they feel like the organization maybe doesn't have a strong plan around how to improve culture, improve the ability to attract people. And I think it's such an important topic, so much to dive into on that. And as we wrap up, I'm not going to press and push you guys each for your magic bullet answer of how someone can solve this if they're listening to this, but rather I think we should end on a high note. Both of you have been in healthcare for some time and maybe just share a story of either you being on the giving or the receiving side of something that just left an imprint on you from a cultural perspective, something you are a part of that just stands out to you in your career. And maybe out of that, someone can get an idea or can think of something that they could implement at their organization, or maybe they can just fill a little bit better. But yeah, just share something that either you were on the giving side or receiving side of from a cultural perspective that just impacted you. And leave us with that. Ben: I'll start and just build on something I alluded to earlier. And I would really prioritize meeting new employees during new employee orientation to set the tone in terms of culture. And that was so impactful and I would make notes around and ask them about their background and ask them the question of why are you here? And open up to very practical responses to very deep and profound responses and to be able to then connect with them and ask them connecting back to something that they shared during the introduction and the orientation. And just being willing to do something nonconventional. I started with a Pump Up Music song, One People from Henry PFR. And I don't know if many people know that song, but I was introduced to it during a spin class. And it was near the end of the class, I was just toast. And that music came on and it just really got me going. So I would start new employee orientation with that. And I would ask people to be mindful of what was happening inside of them. Hearing just the beat and the rhythm of that music and contrasting that to moments before it started. And if something like music can do that, just think about what else in the realm of human experience we can bring to bear in our interactions when we're not just hearing something but actually seeing and experiencing that exchange and how different that can be. So I remember I was just feeling a little bit creative one day and tried it and I repeated it for the rest of time because it works. Being willing to do something a little bit different to connect to that experience and taking it beyond. Joe: Love that. Love it. Dave: Do you guys want me to sing right now? Is that? Joe: Yeah, do you know it? Can we get a little background track? Dave: Yeah, that wouldn't be pretty. Speaking of bad culture. Yeah. You know, for me, there's so many places I could go, Joe, with your comment and launching off of what Ben said there too. But you know, I guess I just found myself when I needed to get recharged culturally, kind of back to your, kind of what's the one example, not that there weren't thousands of them. But for me, I learned for some reason, I'm sure through just trial and error, I learned early on that being able to, most of my day was spent in conference rooms or meeting rooms or maybe an office here or there, you know, the life of a general administrator. And when I needed to recharge, I walked around the hospital or the health care organization. Sometimes it was a clinic, sometimes it was a hospital, maybe even a corporate office, but I hated when my office was there. And I'd force myself to go out to the field and walk around and just watching caregivers in action, you know, just the light bulb would always rekindle for me and I'd be recharged in some way or another. And I just forced myself to do that. I remember at one place I went, we moved the admin offices down the hall, et cetera, you know, and after a period of time, it was kind of like, finally, we can put in a little coffee station. And I was at that point the CEO and I remember not allowing it because I said, when we need a cup of coffee, this will force us all to get up and walk down the long hallway. And it was just one long hallway to the cafeteria to buy one. I said, and I'll give everybody money back. It's not about buying the coffee. If you need it, I'll give you each a $20 bill every Monday. You know, you overpaid executives and I'll pay out, but I'm the highest paid. So I'll give you each a 20 and I'll pick up your coffee for the week. That's not the point. The point is it will force you to get out of our offices and both be exposed, leadership presence, but also observe. And that was for me how I recharged and how I pushed team members to do it too. And that always helped me from that kind of that culture example, Joe, you asked for. Joe: Yeah. I mean, so many nuggets of wisdom and thought, you know, around culture and even, you know, I spent almost 20 years of my career in talent and talking about culture. And I just love some of the nuanced details that the two of you shared today. I just think that it's such an important thing, but it is it's something that leaders and talent teams have to start to master and truly challenge themselves on when we're thinking about building great systems, building great teams. And so now this was great. I'm sure everyone will love it. And we're not just here to care for people. We're here to care about people and in health care. I love that. I love that saying. And so thank you again for spending the time. Again, this is Joe Thurman with IIA Healthcare. You are listening to A Hire Future in Healthcare. We had great Ben and Dave, two amazing people here today and tune in next time. Until then, have a good one. Extro: A Hire Future in Healthcare is a production of IIA Healthcare, a healthcare technology company and creators of interviewIA, an interview platform for healthcare organizations to streamline their interview processes to deliver unparalleled candidate experiences and to create a true competitive advantage for delivering quality care. Learn more at www.iiahealthcare.com.