Keynote: Insights on Healthcare Digitization and Value-based Care with Jason Joseph
Episode 14013th October 2023 • This Week Health: Conference • This Week Health
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  This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Today on This Week Health.

That's not the gap. It's not knowing what to do necessarily. It's being able to do it.

And the way we came about this is exactly like you said, right? We need to create a foundation which will be necessary but insufficient for our future. 

 Thanks for joining us on this keynote episode, a this week health conference show. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health, A set of channels dedicated to keeping health IT staff current and engaged. For five years, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our keynote show. CDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders. Now onto our show.

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  All right, here we are for another keynote episode. I'm excited to have Jason Joseph, the chief digital and information officer at Corwell Health. The last time we talked to Jason, you guys didn't have a name. You were sort of in between names and now it's Corwell Health. So glad to to welcome you back to the show.

Thanks, Bill. Glad to be here. We did have a name. It was just a terrible name. I think it was BHSH System at the time which we were looking

for. That is right. I do remember that. I was having trouble

saying it. It was just like... Yeah, it rolls off the tongue real easily. No, we're glad to have a name and have an identity that unites us as a system here.

I like the name. Tell us about Corwell Health.

Let's start there. Yeah, Corwell Health is the product of two reasonably large health systems, Beaumont Health in kind of southeast Michigan and Spectrum Health in western in northern Michigan which consists of now three care divisions.

So the Care Delivery Divisions are our Corwell Health South Division, which really was the... Centralized around what used to be Lakeland Health down in St. Joe, St. Joseph, Michigan. Then we have Spectrum Health, which is really centered around Grand Rapids and kind of the north and south of Grand Rapids, west side of the state of Michigan, if you will.

And then Beaumont Health, which is on the east side of the state. So those three care delivery divisions, and then Priority Health, which is our integrated health plan serving just over 1. 2 million members and growing. So, certainly fairly large system. I think our total revenue is between 14 and 15 billion on an annualized

basis.

Is there any area of Michigan that you

do not cover? We don't really have care delivery services in the upper peninsula. Our health plan really covers the entire state and there's pockets, where we are a little bit lighter in terms of our care delivery assets, but for the most part, we consider ourselves a statewide organization.

, the interview sort of writes itself when you're bringing together two fairly large organizations. Talk about that process. Talk about how that has unfolded over the last I guess it's been almost

st of:

But, as we came together with this work we got off really quickly in planning on what we were going to do. A big part of our strategy is to bring integrated care together. Having a health plan that's integrated and thinking about the future where we believe care is going to be much more value based, we're going to be looking at the total cost of care, the total value that we can provide to our communities, and that future is going to be increasingly digital, right?

So we may not know exactly which parts of this are going to be more or less successful, but we can agree on some general directional things, which is healthcare needs to get more affordable, healthcare needs to get simpler, we need to bring it together more, we need to create kind of an alignment between the incentives of care and coverage in order to drive some of that, and we know that it's going to be increasingly digital and increasingly automated just to survive in a world where everybody really wants to get more care and more value out of the system as a whole.

And healthcare is one of those industries where we've been very fragmented, we've got a lot of duplication, and we know there's huge opportunities on the table if we can just harness those. So our goal is to make sure that we can go after those in as efficient and effective way as possible. So that kind of launched us on a very aggressive integration plan.

And we started that with board approval. Less than six months from our go moment, from the day one of our integration. We had been planning really even prior to that, but really kicked that off. And we just went live with a single ERP. So that's finance, HR and supply chain, as well as warehouse management, all those related services.

In July, and that is on workday. So we've now got all of our system corporate services, our health plan services, and all of our care delivery divisions on workday. We did prior to that. Bring everybody together on communications platforms or Microsoft Shop or on the 365 platform, which includes Teams and all the things you would imagine there are.

Intranet here is going live here this month which will really unite us on a common platform for that level of communication. And then kind of the icing on the cake, I mean, there's about a go live every week around here. It's just been absolutely... a very intense period. And it's, I liken it to being about mile 14 of a marathon, right?

And we're still going, but it is a very fast pace. And we're going to, culminate that with a single epic and all of, not all, but boy, the vast majority, 150 or so third party applications. that surround our epic, including PACS and nutrition systems. You can imagine all the other things are going to be consolidated.

And we're going to have that one platform for all of our care delivery organizations by July of next year with a go live in April as well for our South division. So it's going to be intense. And to say that's been our major focus would be an understatement. Yeah.

That is, that's incredibly aggressive.

I just interviewed Moore last week, and we were talking about their plan to integrate everything. Now, granted they, they cover from Alaska to all over the place. But he was just saying to me, Hey, we just finally finished getting to one epic. After, I think it was five years, we just got to the ERP after four years, and part of their challenge was they just kept acquiring while they were trying to consolidate.

So it just kept compounding itself. But so the timeline that You've sort of laid out there. That's an incredible accomplishment from your team. And I, it's not over

yet, I guess. Well, the way you do that is you basically have to have a good foundation you're starting with.

And you have to agree that foundation is largely going to serve most of the needs. And, if you get into every debate on every little thing, it's like, well, we go left here and we go right here, let's, have a council to figure out whether we go left or right because it's very.

Difficult. So we really have looked at it to say, look, we're going to take lot of the practices that are just in place, knowing that we have really strong quality measures, strong financial, strong experiential things. And then let's look for those areas where we do have measurable benefits and make those changes versus trying to take every place and almost re implement it.

And that's one way that you go fast. The other way you go fast is you just decide to go and you move and you set an aggressive timeline. And so many of these things, Get lost in kind of organizational attention span, right? You have a window here to do this. And so we knew that in order to get our attentions.

on this. We needed to move quickly. We've done this in the past at smaller scales, and I'll tell you that wanes pretty quickly, right? There's a lot of excitement up front about what you can do together. By year two, by year three, by year four, everyone's like, are we done with this yet? Can we focus on some other things?

And the challenge I think is that if your strategy is what I described to really bring healthcare delivery in this integrated package and drive value If you don't do these foundational things, you're going to be fighting with one hand tied behind your back for the foreseeable future. And so we knew that was so imperative.

We needed to go quickly. We got our board on involved, our executive team, our leadership, and we just said, we're going to go. And for the most part, I'll tell you what our teams have been. Rising to the occasion, just absolutely incredible pace of work, but with such precision and excellence, I just can't say enough about the caliber of our

teams.

One of the things I heard you say there was your organization has a very clear vision for what the future of healthcare is going to look like in the state of Michigan. It is going to be value based care. It is going to be delivered digitally. We are going to have to really address the cost of care.

Talk about the alignment from board to the executive team and how it came about and how it permeates the

organization. Yeah, I heard a really wise board consultant that was just on many boards and I look up to. Say, there's a difference between clarity and certainty.

And I think we absolutely have clarity, which is, if you squint, you look, we can all probably coalesce and agree. And we got that agreement with our board. We had a retreat post integration with a brand new board, like a month into the integration and spend a lot of time crystallizing and getting clear about what we believe that future look like with amazing unified.

around what people really agree to, regardless of what kind of legacy organization people came to, regardless of their position in our executive team, spent a lot of time really doing that. I think that was huge because it really set us on a path to say, okay, if that's where we agree, we're going to go.

Then let's work backwards as to how do we get there. And that, that got a lot easier because we said, well, if we're going to go there, then we need to have one ecosystem for our clinical and revenue systems. We need to have one platform that we can share information, run our back office very efficiently, need to be able to communicate across the board.

We need to get to a single brand, which is where the Corwell Health came from. And we needed to move forward into a future where we were aligned in one team and not in this, well, West versus East or Spectrum versus Beaumont or whatever those things. That's a process that takes time, but I definitely see us moving in that direction.

And for the most part, with any change, you get those speed bumps when you make it and everybody goes, Oh, geez, it's now becoming normal and expected. And there's far less of that. And that'll just happen over time. It's just part of the process.

Not having that would have been a totally different answer.

It's interesting because it's almost not rocket science, because you rewind about a year and a half ago to February and you're looking at UnitedHealthcare's profits and whatnot. And you're looking at health system profits and you're going, Hey, one of these is going to have the capacity and the wherewithal to deliver health to the community.

And one of them's not going to, unless they change their model. And you guys have adopted, I think it again, squinting out. What looks like a winning

model? there's bets on both sides, you look at some of the larger for profit organizations, they're betting on a fee for service model just being really low cost and how they deliver it, right?

In that, in the payment models aren't yet all aligned, so this isn't a transition we can make overnight, but the principles that exist between driving efficient operations and then managing the utilization and the lower cost of venues of care. Like all that wins regardless. We just have to figure out how to make the transition with our payment models and survive that transition.

I think we're as positioned as well as probably anyone in the country to be able to do that. Well,

let's talk technology. what does the consumer experience look like? I mean, you guys cover anyone who's driven through Michigan knows you got a handful of cities and you got. Kansas in between, you have rural in between.

So, what does the digital experience look like or what are you trying to create?

We, we've got virtual care presence really throughout the state. And, especially with specialty care, subspecialty care, tertiary and quaternary services that we serve, even beyond the state of Michigan, in some cases, we're doing transplants.

We have a, world class. Children's Hospital that we bring from all over really the country. So, those digital and virtual capabilities are foundational to that. When everybody started with this, it was almost like a replacement for an in person visit, right? And it's like, oh, hey, you could drive here and we could see you, or we could do it virtually and digitally.

And that still exists, especially when distance is a thing. But increasingly, this is more of a way of rethinking the model of care to say, wait a second, if we've got the ability to monitor in home, we've got the ability to have those multiple caregivers weigh in on a situation. There's certain things you always have to be in a physical proximity in healthcare to do.

We're not going to be doing surgeries in your living room anytime soon, but we certainly can do a lot of the care processes in a very different way, monitor people differently, make sure that we have interventions differently. That's what we're really working towards, right, is that care model of understanding, say, does this thing have to be done this way?

That's the fundamental question we have to ask. Does the value we're producing for this patient, for this member, have to be done this way? Or is there a better, safer, More better outcome and lower cost way to do this, and increasingly with digital capabilities and stuff, the answer to those questions becomes, yes, there actually is.

We just need to be able to make that change. The hard part of a lot of this is, hey, we've found a better, cheaper way to do this. Sorry, there's no payment code via Medicare or whatever to do that yet. But when you have the value based capabilities, you can say, well, That's okay. We can find a way to do that and still make us full as a system.

And then it's the right thing for everybody. It just makes sense.

I'm going to steer this conversation into what I think would be an interesting topic for people. I remember when I became CIO at St. Joe's and I had to literally go to the executive team and say, look, you got to give me a one year reprieve. I've got to build the foundation. And what you just described is a lot of go lives, a lot of things.

There's also a lot going on in the digital space, but there's only so much capacity within your team and within the organization. It's not only within the IT team, just capacity within the clinical team to start thinking about how we're going to do this, how we're going to do that. How are you managing through that?

What is it? look to have the organization aligned around. These are the priorities. We will get to the really cool things that you're reading about today, but we just don't have the capacity right now.

Well, the short answer is you have to do a little of both. Right?

We're not standing still with digital, we've got a virtual nursing program that's we're standing up. We've got a virtual ICU that's expanding in the light of all of these things. But what we've done is we've done it strategically and said, where are we going to stand these programs up? Where are we going to build the foundation even of these new innovative programs?

But as we build onto a common platform, so much of the complexity of healthcare isn't figuring out whether you should do virtual nursing or whether you can apply. A different model of remote monitoring. The complexity is how do I translate that model that worked over here to all the complexity of the infrastructure we have to run it over there.

And, the models are different. The algorithms are different. The alert systems are different. The builds are different. The formularies are different. I mean, go down the list, it's all different. And what you get is stuck in the muck of non standardization. We're saying like, look, if you can pick up a program and say all the foundational elements from how you get your images, to how you read them, to the algorithms that are applied to the formularies, everything that we've got is the same. I can now deploy those models when we innovate in any part of our system to the rest of our system at, a hugely faster pace than if I had to just recreate it because recreating it's what we all do already. And, we all share, we all say what's going on. Our CEOs are out there, our CIOs are out there. We're all talking. That's not the gap. It's not knowing what to do necessarily. It's being able to do it.

And the way we came about this is exactly like you said, right? We need to create a foundation which will be necessary but insufficient for our future. And we're going to get through that as fast as we can. We're going to start planting these seeds of where we want to be in the future and we're doing those things.

But boy, we're going to hit turbo boost once we get through this bolus of work that really gets us on the same platforms and watch out because now we're going to be highly connected. And it, and one of the unique things we're also putting in Epic Pair Platform in our health plan, we're connecting that up.

So we've got Data feeds now flowing between our care delivery organization and our health plan. So a lot of the friction that's there is starting to go away. And we're starting to see the benefits of that level of integration unfold as well. It's just, it's a really exciting time, I think, to think about this, but I'll tell you, you gotta have that clarity of where you're going.

And even if you don't get it exactly right, you've got to be pointed in that direction. Otherwise, you're going to wind up chasing the... The trends and it won't really get you where you want to be.

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You brought up virtual nursing. I want to talk about nursing a little bit. How is the nursing experience changing with regard to the implementation of technology and.

You could talk, specifically about virtual nursing. What does that look like? How is that being implemented? Nurse sitter, those kind of things. How are you thinking through those things?

Yeah, I mean, we've probably been doing sitting, those kind of things for years and years. We were one of the early adopters of that technology and we've been partnered with some tech vendors in that space to continue to expand our virtual programs.

Cause, when you look at those types of things, there's, it's an easy It's an easy math, right? It's easy to do it. And so you need to expand it. I feel for our clinicians in today's day and age, man, it is a tough world to live in right now. We've given them so much more to do, so much more responsibility.

The documentation burden is very difficult. And then we've layered on all the complexities of just our society right now of what we're trying to do in the midst of saying, Hey, let's get more efficient. And, we've run out of runway of just saying, Hey nurse we'd like you to do this You just can't do that anymore.

We're no longer talking about, how do you save on nursing? You're talking about how do you get enough nurses to even fill the pipeline? That's not going to change in the near future. So we have to find ways of saying what burden can we take off of your shoulders, whether that's documentation, whether that's just coaching and mentoring.

We have a higher contingent of younger nurses now and the older nurses, the more experienced. Nurses are leaving the workforce, right? So how do you bridge that gap? And some of that we believe might be putting your some of your experienced nurses in a virtual console, allowing them to be mentors and coaching on those difficult cases, or looking at some of that burden that you don't need to be in the room with.

You do a Medication reconciliation are some of those things that in allowing the folks that are on the floor to really have really have a solution there. So I think when it comes to nursing and clinical frontline staff, we have to really be driving towards solutions that help take some of that burden off, but not just add a different type of burden, actually look at it and say, Hey, this isn't just about doing the same thing and putting a digital bed down.

I think we've been digitizing things for a while. The digital transformation, not to use that overused term, it's really about rethinking the whole thing to say, now, if I've got this other way of doing it, how do we change our model? And so we've got teams that are focused on that right now, which is. a bit harder, right?

Because now you've got to think outside of the box you're comfortable with into a whole new model of where you're going to do it. The only way you're going to do that is to have that platform, have the foundation, do some of those tests and say, this works. But then you've got to say, when this works, I want to put it everywhere.

And I don't want it to take another five years to scale that sucker out. I want to be able to do that in a really rapid pace, which is why all of this kind of builds upon itself.

So, UGM is right around the corner. And I assume with your implementation that some of your team members will be up there.

What kind of things will you be looking for from a partner like Epic you move forward? I mean, they're so foundational to so many of the clinical workflows and everything that goes on in the health system. What will you be looking for from them?

It's interesting when you talk about Epic, they've been so focused on hyperdrive for the last few years, when we talk about these things, it was like, watch out, because when hyperdrive is done, we're going to really, do a lot of these things.

I think we're already starting to see them shift gears away from what I call their foundational rebuild to, this next level of capability. But, we have really been pushing the envelope with what we'll call population health and analytics, right? Understanding aging. And segmenting patients and members across our system to say, Hey, how do we deploy our resources most effectively?

And that's been a, I think, a concept for a long time, probably a decade or so in care delivery organizations, but we're putting it into practice because we've got actual value based technology. arrangements on the hook for some of these things and some very pragmatic things like pulling those scores and alerts right into the console of Epic.

We have some capabilities now when we have patients who are in a risk contract, we flag that for our clinicians and it's like, why would you want to do that? Well, sometimes it matters in their decision making to say, is this somebody that we're actually looking at and understanding, okay, Well, maybe I want to spend a little bit more time with this individual that I wouldn't have necessarily spent to figure out if there's a way to avoid that extra test or whatever that might be.

And ideally, you're going to apply this all the time, but there are cases where we look at this and start to think about, applying the analytics differently. I think the other area where EPIC really... Needs to keep pushing forward is on that idea of care outside the walls, right, that's where we're going to be moving into and they've certainly got good foundational stuff there, but bringing those into programs that you can implement and not have as many holes in the process to go through, I think, is going to be really critical.

So that's the areas we're going to be really challenging. Looking at and shadowing with EPIC quite closely.

Let's talk a little bit about data and analytics. There's been a lot of talk about data,

information, insights are going to change how we deliver care. And then we always get into the conversation of how do we deliver those insights at the point of care so that they can actually have an impact.

Talk about that work and what you guys are doing to really enable the data to deliver outcomes.

Yeah, so, we've actually brought together our data and analytics teams into a program in a new, really, department we've called Integrated Data Analytics, and that team is now responsible not only for the analytics and the dashboarding and the predictive modeling, we actually have a Advanced analytics group focused on AI right now.

So we've got some of those capabilities all the way to the basic blocking and tackling, reporting, dashboard, consolidation, and that type of work. We're kind of on the data strategy side, looking at simplifying the data foundation. So we're actually using some cloud technology around a platform called Snowflake for a lot of those kind of integrated.

Areas where, Cogito isn't necessarily where we would want to go with it especially when you've got multiple instances of Epic currently and we're trying to solve for that gap as well. Over time, we'll have to figure out where you put things and where, but we're finding a lot of value there.

I think the big thing on the data and analytics, I think, getting that simplified is always going to be a challenge in healthcare, right? I mean, everybody has thousands of reports and dashboards. You always are in a battle of producing those and getting them standardized and rolled out. And our team is like making huge progress in doing that right now, even through our integration.

I think as you look to the future, I think it's going

to be a bit more about how do you leverage that platform? How do you bring your data together? And then how do you put it on a set of capabilities where you can develop those predictive and prescriptive algorithms? And train and feed your AI, whatever that's going to look like.

And that's a different set of problems, right? It's not quite as structured. It may not be quite as organized. It may not be quite as list grid oriented data. It's a different world. So, bringing in the talent to do that and then, and looking at those use cases and being able to drive it is going to be really important for us.

So we have structured that. And, If you take that Squinty model I was talking about, the two things that we pretty much agree on in the future is going to be... Look, it's going to be very digital, but in order to be very digital, it's not just taking what we do today and making it, digital, it's actually applying a level of intelligence and automation to it, which is where all of that comes in.

There's so much that we do that, quite frankly, based on whether it's AI or just really good predictive intelligence and knowledge, You could automate. You don't need all the steps in between everything else for it to be done. You can actually get to a 93 percent certainty on what should be done and let your patient or your member take that step with some digital guidance and not necessarily need physicians and all that stuff involved.

It's just, we're not there yet as a society, but I think we got to start heading in that direction. And that's where that technology is going to really come of age.

A fair amount of your role of the tech lead technology person's role is looking at the future? What kind of questions are you hearing?

What kind of things are your clinicians bringing up as you're rounding and talking to people? I assume you're hearing AI all the time and they're asking you, How should we think about this? Where's it going? What are your thoughts? Is that the primary one you're

hearing right now? Well, AI is, having a moment, right?

So, certainly, with chat, GPT, everybody can see it and they're like, oh my gosh, I could ask this thing anything and it gives me a coherent response,

right? by the way, I saw a video yesterday. Where a doctor asked ChatGPT how to deliver a baby, and then it came out. And the doctor was just looking at it going, Man, I hope no one like, reads this and says, Okay, I think I can do this.

I think I can deliver the baby.

yeah. Incredibly powerful and scary. The challenges, I heard somebody describe it this way. They said it's like a pathological liar intern. You can ask it to do whatever you want, but know that it may blatantly lie to your face.

And it's, you always need to check its work. Right. And I think that's a good way of thinking about where it is today. And so, the generalized is probably, use Gartner's It's probably up at the peak and starting to come down as people are starting to use it. But, things like, okay, we've got a thousand knowledge articles in our help desk.

Can I train an AI of all that thousand articles and can I go from a 30 percent self service rate to a 70 percent self service rate? Well, I certainly hope that at some point we could start to think about that and I can use my agents to solve the more complex problems and not the things that are really readily available to us.

other people. So I think we're going to start to see those kind of things come up. I don't know yet whether the co pilots and the, dedicated assistants are going to get us where we want to be. I'm sure they're going to improve some things. I just don't know how fast it'll go. People are betting on, two to five years and they're probably right, but I think it's warranted.

There's a lot of technologies you look at and you're going, I don't know. This one feels like they're, we'll figure this stuff out and we're going to figure out how to apply it. I think, back to your question about what are the technologies people are looking for.

If you ask the clinician, it's almost like back to the Henry Ford example, if you ask them, Customers what they want. They want a faster horse. I think a lot of times when you're confronting clinicians about what do they want, they're gonna say, I want a better E M R, or, I want less intrusive way of doing this documentation, which is probably true.

So there's an element of that with, the DAX is of the world and the AI that's gonna help with documentation and automation and that we have to. But I think that the bigger question is, how do you not even need to do this work anymore? Like when you're in a value based arrangement, how much of this is just documentation burden that we've put on you so that we could get paid?

And if that is no longer the main driver, if we can relax some of those things, rethinking the way the model doesn't always work. So you have to have some teams that are working on improving the way it is and there's a technological path there. But then there's got to be some people thinking about blowing it up and really removing things, right?

Adding more technology on top of processing is going to make it better. We have to start stripping things away and getting to the core, and that's, I think, when you get to those aha moments, the iPhone moments, if you will, where all of a sudden, all this other stuff became irrelevant, because you said this is what we need.

I don't know what that exactly looks like right now, but I can tell you, it's highly automated, it definitely leverages data, it leverages digital capabilities, it's going to be highly connected to monitoring, right, you're going to be having data feeds, and you're going to have, Moving a lot of the brains of the health system away from the unit or the floor or the clinic exam room and starting to think about the brains as a collective group of people that may sit in a different facility or virtually and are really providing input to those touch points that look differently.

And I don't know if that's 5 or 10 or 15 years from now, but I would bet pretty highly that's what we're going to see for healthcare at some point in

a, we've been stuck in this. Incremental innovation cycle in healthcare for so long that I think we think, oh, what's the next thing? What's the next thing?

Instead of what's a new thing? What's a different way as you describe it? I'm curious not to go back to the AI conversation, but I'm going to pull you back there a little bit. And do you think there's capabilities that you will have internally? Like, specifically to AI, either training models, building out models, and those kinds of things.

I'm curious if people are thinking, hey, this is enough of a game changer that we probably need some in house capability.

Yeah, we're asking that question right now. We do have some data scientists. in our employment right now and we're, we are doing some build of predictive models and we've decided that those are areas where we do need to be invested.

We don't yet have our own large language model. We are not yet training it ourselves. I think the, we're a large enough system that we're, I'm probably on the fence on that. I think we're more than likely going to wind up having some capability, but it'll likely come through partnership, more than it will come through, me just trying to hire and build up and staff for these things.

And, I think we're still a little bit in the Wild West, so it's going to take some time to do it anyhow. But that would be my bet. I could be wrong on that. I mean, honestly I just don't know. I think the challenge for it is the complexity of the data, the complexity of the workflows in healthcare are going to be very hard for anyone to do on their own, unless you're absolutely massive, right.

And I think that this is an area where you're going to wind up with partners that are working with multiple organizations and doing the plumbing and some of that core for you. And then we will probably have some people there together. Trainers and, prompt engineers and those kind of things that we'll need to have so that we can deploy those things.

And it might just be the new way, we employ software developers today. Maybe some of those skill sets get retrained and start to look more like, prompt engineers or some of those things. So I don't know if I had a crystal ball, I'd tell you, Bill, but maybe, it's a tough question.

Well, I'll tell you what here's the here's the exit question. We'll go back to where we started. You. As an organization are implementing a lot of things, there's a very fast pace. I want to talk about your team. I want to talk about building a dynamic culture. You brought two teams together under, under one banner.

Talk a little bit about I mean, obviously you're moving so fast. Sometimes you don't have to do that because everybody's focused on goals. But I'm curious, I guess, the intentionality of bringing the teams together and building out a team and a culture. Talk a little bit about that as the closing question.

It's a great question. It's, I think, one that, I wrestled with quite a bit, and I have had the blessing of doing this right and doing this wrong in the past. And, the one thing I would say I've learned a lot of things, but one big thing I've learned is teams don't get created by telling them that they're a team and teams don't get created because you put one leader in charge.

Like that isn't creation of a team. Teams get created when you have them walk through fire together and you give them a project and they have to rely on each other and go do it. And so, there's one school. Thought that says, hey, as you're doing these integrations, you have one team supporting the old tech and this old tech and this old tech.

They have one team doing the new implementation. And then at the end of that, you'll bring them all together and they're going to be a one big happy family. In my experience, that doesn't actually work. Because what you wind up doing is Fragmenting and splintering your team even more. You got a team that has a goal of maintaining a system and a team that has a goal of putting a new one in.

They're not aligned. And so what we decided very deliberately in the first six months, we reorganized, we restructured, we put everybody on one team. We said, you are now one team and here's this boatload of work you got to go figure out how to do together. And what that wound up doing is taking away the Me, them, us, they, and started to say, wait a second, we got a lot of work to do.

How do we best get it done? And what people started to see is there's plenty of work to go. There is more than enough work to go around. And they started to rely on each other. And there's some intentional tactics you use, like bringing people together. like it matters to see each other and to trust your team and to just talk about your families and how you got here in your career.

And, over time, people realize, like, regardless of where you came from, we're all the same, right? We have the same goals. And that has been, I think, incredibly positive. We just got through one of our employee engagement surveys, and we had a lot of Things to work on for sure, but a lot of positivity that 100 percent would never have happened if we didn't have teams kind of aligned right up front, just kind of bit that bullet, decided to get the hard work over right up front, get that realignment done, and then move forward.

And I think that allows people to Calm down a little and not think like when's that other shoe going to drop. So that would be my recommendation. If you're faced with that big change, do that hard structural, anything you do structurally and foundationally quick and up front, just do it. Because, the one question I, I often will say guides me is what does the person in my seat Or me, if it's, if I'm, have the opportunity to be here in five or 10 years, what are they going to wish I would have done differently?

Like, what are they going to be cursing me for not doing? And like, those are the things I want to be doing. I want to be sitting there and say, thank goodness Jason had the cojones to go do X, Y, and Z back in the day. Because if not, we would have been in a worse position. I think those are, it's how you can get your strategy right.

And that's how you can know that you're. Headed in the right

direction. Yeah, and make sure that you address the difficult challenges. Sometimes in leadership, there's so many difficult challenges that we're just like, I can only handle five of them. Now, you, I mean, as the leader, you got to space them out, however you have to do them.

But you, I mean, the big problems end

up on your desk. It could be hard either way. You just want to have less debt when you're done with it, right? And so do the hard work up front the best you can. Get people going and do it for the right reason. I mean, be transparent and let people know that we're all in this together.

And, what I found is that humans are generally very responsive to other humans trying to do the right thing, even if they disagree with some of the tactics. And I think that's a big part of it is getting your team aligned to say, we're on the same journey. We're going here, right? We're going to do it with integrity.

We're going to do it together. When you start to get those things in line, all the other stuff starts to work itself out. You still have bumps. You still have the challenges, but more often than not, I'd bet on that team getting to where you want to go than a team that isn't unified, that is divisive, that is not quite formed.

You're just going to have a whole different set of problems to work through.

Yep. Hey, Jason, I want to thank you for taking time out of your schedule to to share with the community. It's greatly appreciated.

Bill, I always appreciate our conversations, some of the best ones that I have, so I appreciate it as well.

Thank you.

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