January 8, 2026: Three powerhouse executives tackle healthcare's most complex sourcing decisions in this essential conversation. Lisa Davis, former CIO and Founder/CEO of Lisa Davis Advisory; Janet Malzone, Former CEO and Board Member; and Kristine Jarvis, Organizational Transformation Leader, reveal what leaders get wrong about offshore, nearshore, and automation strategies. From the pre-mortem technique that prevents million-dollar failures to the cultural metrics most organizations ignore, they expose why technical fluency without leadership maturity creates chaos. Discover how to rebuild trust after transformation missteps and why projects with the highest team disagreement deliver the strongest ROI.

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Key Points:

• 03:59 Challenges of Offshoring and Automation
• 09:41 Preparing for AI and Future Technologies
• 25:36 Leadership and Technical Capabilities
• 31:58 Holistic Transformation and Systems Thinking
• 43:06 Global Workforce and AI Myths

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Flourish: Leadership Here, Near, and Far with Lisa Davis, Janet Malzone, and Kristine Jarvis

Let's begin

Sarah Richardson: Welcome to Flourish, a podcast that explores the people pivots and principles shaping modern leadership. I'm Sarah Richardson, and today we are unpacking one of the most complex questions in business right now. How do we offshore nearshore or automate the right work without disengaging our core team or losing what patients and customers value most?

We are joined today by three industry subject matter experts, and I'm so grateful to have this opportunity to share the perspectives with you. Ladies, welcome to the show. Thank you for having us. Thank you. I'm so happy to have you here. I mean, literally, I always love to give a bit of context.

Lisa Davis: Thank you.

Happy to be here. I am a technology executive. I've been a Chief Information Officer for several decades in Department of Defense and academia. I am high tech at Intel and then spent my last five years at Blue Shield of California. I'm currently enjoying my portfolio career. Doing many different things including strategic consulting, some mentoring, and I'm writing a book about being the only woman in the room that's gonna come out at the top of the new year.

Sarah Richardson: Fantastic. We'll have to do a follow-up show and a book review for that. And for those of you listening, follow Lisa on LinkedIn. Her content is always phenomenal and very thought provoking. Janet.

Janet Malzone: Well, I'm also a fan of Lisa and her, her, her site, and I'm waiting for the book as well. It's got some great information.

The modeling I've experienced, the offshoring onshoring and the implementation of technology and the changing. How we change using our people and the models through change over time

Sarah Richardson: and always has a focus on the financial implications. So I'm so grateful to have you here. Thank you. And Christine, the idea master behind today's conversation.

My goodness. So thank

Sarah Richardson: I wanna jump in to really. Chatting about what suffers most when we move work offshore, nearshore, or outsource it and protecting what leaders need. I think about it in being like three different tiers of a framework. You've got, you know, the in-house component, which could be tier one, tier two, which is maybe nearshore, and then tier three, that offshore perspective and what it means for our teams when this happens.

So Lisa, I'm gonna start with you. What are the biggest misconceptions that leaders have about automation versus outsourcing?

Treating them the same causes leaders to make the wrong investments, and many times those investments are also not aligned to strategy. Or clarity in how the leaders are communicating to their organizations as to why we are outsourcing, or why we are automating and driving to those specific outcomes for each one of those separate instances.

automation can amplify your processes. What I have found in outsourcing and that it actually exposes the weakest ones that you have in your organization. So because those processes and that outsourcing is where your data, your workflows need to align, and both of them need to be aligned to the strategy that you're communicating to your organization.

Janet Malzone: And that's a great question because when you think about it, it at first on the surface seems really simple, right?

If I have an hour that I've done. In the US and I wanna send it somewhere else or automate it. It's a one for one, but, and then you have a labor arbitrage. Let's say you offshore it, so, oh, I took a dollar, a an hour in the US and put it somewhere else, so I'm just gonna work the same hour and I get that savings.

It's not that simple because a lot of times that offshore work requires a little more coaching, a different level of review, a little different training, so it's not that one by one. And so it's reducing that headline savings everybody thinks they have. Then you go take a step a little deeper and maybe we have some communication differences and work styles.

And if you don't do it right here's the risk of not doing it right. You can lose your differentiation. And what does that mean? If you don't get all those components right, you can damage your brand because you're not delivering consistently. You're not having the same service level external to your customers, or even peer to peer, how you work together.

So that can cost the company culturally and you can do brand damage. So you gotta be very careful when you're looking at all the costs.

Sarah Richardson: Well, and the cost of how long it takes to reach that equilibrium of potentially what you had before. Like you don't, you're not just replacing one to one ratios in some cases.

Kristine Jarvis: Well, don't leave it to chance. Right? Or personality. Think about how you're gonna build that into how you choose your partners. Right? And emotional intelligence probably isn't a nice to have.

It has to be wired into the way we're making decisions. That means we have to look at our SLAs and say, what's it? I like to actually work with these people. What will it be like to when it gets messy? 'cause things will get messy. And so you want to have some practical, visible mechanics built into the questions that you ask when you're sourcing.

You wanna have some clear criteria and rating for the folks that you're bringing into the organization and how they handle situations, tension, pushback. We have all experienced some communication conflict in these types of situations. How do you work through those and how do you make sure that everybody walks away feeling confident in continuing that relationship?

Sarah Richardson: Now we have what I like to call the shock wave of AI because we're already, to a degree, having the conversation about people learning how to manage agents. So now you're gonna be managing computers and really struggling to deliver it in a way that's meaningful at this interval. And Lisa, when you. Speak with organizations, how are you helping them prepare for jobs that don't yet exist because of not only the AI implementation factor, but also the fact that we had a conversation with one of our partners recently who said, take every job description off of your website if you were a healthcare [00:09:00] system that is not clinically focused because there's probably a level of automation, ai, or otherwise, that can now be central to that staffing model.

Lisa Davis: Well, this is certainly a hot topic and one that I think many times we think of it from a tactical lens in terms of the use of ai, the use of automation no longer requiring people to do that. And I am actually trying to flip this conversation because we go through this. Training or new skills every time there's a new evolution of technology, whether it was cloud technologies that we've been talking about for 20 years, digital technologies, ai, now we're in agentic ai and through each one of those waves, was there a need to learn new skills?

Adapt and apply whatever technology is of that moment. Those are the folks that I wanna invest on the team. So instead of thinking of AI as. It's detracting from the workforce. I wanna think of AI as amplifying these critical skillset that are necessary no matter what the technology is. And if I have a team that has those skill sets, there's no doubt in my mind that they will be able to learn and adapt and apply the technology to improve mission outcomes, company outcomes, et cetera.

What needs to be true for people to be ready for a technology that's moving faster than anything that's ever happened to them before?

Kristine Jarvis: Yeah I think it's important for us to think about how do we shape and reframe the conversation, right? Instead of, this is going to take my job. We have to say, this helps me do my best work and really demonstrate how that happens and show them that they are respected, they're, they feel understood.

Make sure there is a lot of open communication about. How you leverage the systems that you're going to put in place, and more importantly, make sure that it's consistent. the same messaging is consistent across the board. I think emotional intelligence is critical in this. If leaders kind of ignore this fear that people have of AI taking their job or whatever it might be, job insecurity, concerns about their inabilities, to upskill, quicken up, all of those things, if we ignore that, folks can't get to where we need them to go to adopt new ways of working. And I think that's a critical path in adoption of AI and in organizations.

Sarah Richardson: What I find super fascinating is the aspect of value and investment, those returns. And Janet, what I am loving is all these companies showing up and saying, but we can help you do these things better and faster and cheaper.

Janet Malzone: The, well, there's a lot to think about and before I jump into that, I did wanna. Go back and kind of draw on what Lisa and Christine said. 'cause I really go back to like you said Sarah, that people are like, we've already been doing a great job. And you think about technology's been there, AI's been there for years.

And when I think back 35 years ago, which is now a long time ago, the things that I did when I first started are gone. They're gone. And then the people we hired. 10 years ago, the stuff they did when they started are gone. So it's always been an evolution. And now there's some fear in the system because of all this hype.

I need a high ROI. What does that mean? So before you can start calculating that ROI. You have to really understand where are you? I've, I might have a spend before I spend on this AI use case and project that I wanna do. So you need to first understand where am I with my data? Am I in a technical deficit already?

'cause I have to have value in the system. And this is not a simple model, just like we talk about outsourcing is not a simple model, nor is this, it's not a lift and shift. It's not a, if I take out this particular software, this particular head, I'm gonna have this return. So, and something that we've seen, I've seen over the years is when you're talking to your clients, let's say you're in a client service business.

Oh, if you replace people with technology, my cost is gonna go down. I'm gonna get a savings on my fee. And that's really not an accurate statement as you know. 'cause the tech has a cost, the subscriptions have a cost. The people to run, the tech has a cost and then that learning curve goes up. All of a sudden the people we're gonna have more talented people doing that.

And one of the things. I've seen, and there's some studies on this, that the highest return on investment on projects are the ones that the teams had the highest disagreement on, and they generally have the highest return versus those that your company has the most agreement. So you need to think about that, of I'm missing something, that we've got this violent agreement and maybe we need to explore where we're not in agreement.

And one way to. Mitigate that return on investment is to do something called a pre-mortem. And Gary Klein developed that particular pre-mortem method. So it's very interesting. You can do some reading and about that, but you get your team together before you start on this project. And you talk about that this project that we're gonna endeavor on is going to fail before you start.

What would've killed it? Now you're coming up with the real problem solving of what is knowable, what is controllable, what can we fix? Then you have a higher level of success. You can fail fast and it's not gonna cost you a lot of money or as much money because you're identifying these things quickly because these are big investments and you wanna do it right.

So some things to think about before you move forward. So as

Sarah Richardson: we've discussed a bit about moving teams to different offshore nearshore, even automated opportunities, when you start to break up the culture a little bit about the ability to do a pre-mortem where you're having healthy conflict and dialogue beforehand when your teams start to be dispersed and even if they're contracted to you, that actually work for you.

Lisa Davis: Yeah, communication. Communication is absolutely critical. And I've always said as a leader, I don't know and I think there's a data point on this, how many times do I need to say something or repeat something so folks really understand what is it we're trying to do? What is our strategy? What is the purpose?

And even more importantly, what are the outcomes that we're driving to? And when you're working with teams. Global dispersed teams. It's almost like the telephone game because there's a piece of information that seems to get lost. It even happens when you have the entire organization all in one place.

Kristine Jarvis: I love what you just said about that, Lisa, because I think that core question that really needs to be asked is what does this do to the trust? Yeah, to the belonging, to people's belief that. The organization that they work for is still a place that they actually want to continue working for. And this shows up in engagement in the way how people stay involved or how people kinda lay back and they don't engage or they don't leverage the offshoring [00:20:00] options that are available to them.

And so I think it's really important that communication that you talked about is just airtight at all times and really focuses on the cultural. Kind of integration of your organization. If you're offshoring in some of our locations in India or in the Philippines or in those in.

Those locations, you know, the way a person says yes is vastly different than how you and I and Janet will perceive a yes. Right? And so it's that culture education that has to happen in order for people to successfully work within this offshore nearshore model.

Lisa Davis: It's such a great point because I'm re reliving my intel days where I had teams in China and Malaysia and Costa Rica and Europe and Janet has called it out and you have called it out.

And I belong and I'm a member of that team, and I remember that required. I would go show up in Malaysia, in China. The leadership team? Mm-hmm. What do we need to do to make those teams feel like they are. A part of the organization and the work they do matter and impacts outcomes that we're driving together, you know, together.

So it's such an important point to call out

As we go through these types of decisions and processes, and so Lisa, how do you foster both the technical fluency and the leadership maturity at the same time?

Lisa Davis: This is such an interesting question to me when I was thinking about this, because you can't. You can't have one without the other. 'cause I thought initially.

Okay. And I've been in these situations where you have tech fluency. the tip of innovation. You're driving innovation and modernization, but you have a lack of leadership or leadership maturity. And what does that create? Usually chaos is usually what we get, right?

Integrate it and working together is ultimately what is going to create success for the organization. So understanding that and focusing on that to make sure that you are creating both within the organization I think is key to how we leverage and show how the technology can really drive meaningful outcomes.

And so, Janet, I'm curious from your perspective. What is an example of a time your organization you've worked with has turned a sourcing shift into a leadership opportunity? Like how do we help people actually get there?

Janet Malzone: really. Being strategic about these opportunities is part of it.

Let's bring up that group to say, I want you to project manage. I want you to be engaged in this because it's gonna bring them to the next level. It's gonna get them into the details. It's going to get that next level of your team. Supporting it, understanding it, getting the buy-in. 'cause that buy-in from the middle is so key.

So what you do is you bring them in to several stages. There's plenty of stages to bring in other people for leadership, be it the project management, be it in the pilot stage to give the feedback, to be in a group that are going to do the rollout and implementation and be that leadership voice. And once they get that buy-in.

We've already talked about. It brings in trust, it helps with our culture, preserving that culture for that rollout. Now they've got new tools in their belt. They want it to be successful 'cause they were part of the process. So to me, you can't just throw something out there, just trust us. We'll, we're gonna, we're gonna get to 20% integration.

It doesn't work. Trust is earned from leadership. One comment at a time. One different conversation, one-on-one through transparency, listening and showing that feedback actually influenced decision making. So the, these are actually perfect times to bring in people to develop their leadership.

But if you put those culture metrics up against, you know, the business metrics, I might imagine that you're gonna see some clear and define the thresholds that the organization is actually willing to cross. From a culture perspective, what are you willing to do with your people, with your leaders to get them to buy in?

I think you'll have far more. Clear decision making and you'll have a higher retention of said staff. Mm-hmm. And willingness and engagement to grow in the organization and really work together as an organization. So it's a great point you

Janet Malzone: bring up there and that cross section, what we're saying is how do you get people from all over the world?

Kristine Jarvis: Yeah. But the positive gossip, right? Mm-hmm. You talk about positive gossip in previous conversations and making that an integration opportunity for all leaders, and that's just a great terminology. I love that.

Sarah Richardson: Christine, what's the best way to keep your pulse on the cost of that cultural transformation?

We have metrics for just about everything that we're implementing and doing, and I've rarely seen a business case or an ongoing model that says, culturally, this has been the impact on our organization. What are some of the things we should be looking for?

Janet Malzone: So, such a great question. It goes back to you can't really put this on a, a.

Balance sheet. Right. You've gotta think about some poll surveys you have to think about during and after the move. What kind of surveys can you take regarding trust in the leadership, the clarity, the communication, sense of fairness. Right, that really does matter. And confidence in the future of where the organization is leading.

And so those are the areas that I would focus on if I were measuring a global transformation.

Sarah Richardson: I can't help but think about. The fact that global tech and financial giants continue to shape our digital future. And then there's this whole space of leadership accountability that has a beginning and an end.

Janet Malzone: I'll jump in on that one. And I love how you say that some female leaders, I think a lot of this starts with inherent empathy and also creativity and how we problem solve. And it has to all start with landing on your values. You have to be always aligned with your values. Yes, we need governance.

We need to focus on what are organizational values and our culture, and understand as a leadership team, bringing in the voice from that leadership team that is your guiding star, that is your non-negotiable. So always having that lens, if I'm gonna make decisions, I've got my strategy, I've got my values, and I've got also my non-negotiables is it qualities my people because it's easy to fall into the hype.

You might as well say, let's just put this up for sale and call it a day. Sticking with your guiding stars, your non-negotiables have to be in the conversation and having that room, having a diverse room that's actually standing up and pointing those things out and having those commitments that we're gonna keep all of these as part of our foundation as we move forward, and it can be done.

We've seen it done time and time, but we've also seen it go the other way. And when you just let go of that foundation, it gets, you're on a very slippery slope for your whole organization.

'cause frankly, this is our superpower. We're system thinkers and when you're driving, whether it's a digital transformation, an AI transformation. It's never about the technology. The technology is just one swim lane and the broad transformation you're driving in just like Janet called out. It's always about the people.

And if you neglect, let's just say one of those swim lanes, you likely, it'll wind up costing you more money. It'll take you longer amount of time to do it and. You may not succeed at all. So viewing it holistically and using that systems' thinking of this will affect the entire organization. And I'm a huge fan of Kotter.

I always have been from a change management. And as you're building out that transformation. Building in that stakeholder alignment, finding the folks of the, the naysayers in the organization, getting them to buy in. Building change. Catalyst. Catalyst, getting quick wins, small wins that build that momentum.

Sarah Richardson: I love TER as well, and I always tell people there are eight steps and you should pay attention to all of them. That's right. Maybe some in different like levels of uh, leading into them, but they all matter throughout and that's why I always tell people, if you don't have a good change management framework about 70 to 80% a year initiatives or they're gonna fail or be significantly delayed or cost more.

Kristine Jarvis: A writer and author by the name of David White who says, transformation is to hit present reality at high velocity and watch it break apart at impact. Right? We go into transformations thinking we're just going to do.

One or two little things in an organization. It's never one or two little things. It work has to flow successfully through an organization. And so you have to recognize just what Lisa was talking about and what Janet was referring to as well. If your work flows through an organization, you are touching everyone and therefore you're touching the culture and the foundation of your organization.

And when leaders stand up and say, we have failed, your organization is likely to turn around and start rallying behind and say, okay, how do we help? Because somebody took accountability. Accountability is critical in resetting a culture if you don't have a leadership change subsequently to a failed transformation.

So you bring me to the question, but I'd like to hear what the others have to say about that. 'cause that's a great question. Well, for

Sarah Richardson: sure. 'cause I'm curious, like what are the principles from a leadership perspective that Yeah. You, that keep you grounded in all of this change?

Kristine Jarvis: Yeah. Certainly for me, for as a transformation leader, communication, consistency, and transparency at all times.

Lisa Davis: I love those.

And in addition to those three words, I think I'd add one more quality. Mm-hmm. Because what we're doing, and people have to see it and they'll know it whether we're driving actually quality and impact and the work that we're doing day in and day out.

Kristine Jarvis: Mm-hmm. Mm-hmm.

Janet Malzone: I, and I couldn't add another word to that list of four.

Sarah Richardson: I feel like I have to throw a trust in there just 'cause we've talked about it so much as well. Right. But I'll tell you, for all of us that have done these in our careers, that whole sense of urgency, which is part of that whole change management model, it could be important to you. And if it's not important to anybody else, it just like being, you're not going anywhere.

Janet Malzone: part of my communication to get to trust with that consistency and transparency is what is in it for me. I'm not just doing it because you said so.

It's because that goes back to tell me why it matters to me, how it doesn't harm me, how it helps me, right? Mm-hmm. And a little bit of how did we get here? What is and mm-hmm. Some of why are we doing this? It's like, okay, I, I can see how you got there.

Lisa Davis: And you know, there, there are cracks that begin to form while doing this.

Kristine Jarvis: I had this experience with Lisa, and Lisa probably will never remember this, but, or you might, but I was working with her on a transformation in one of the, our shared organizations. And we had a wonderful professional services firm helping us at the time, except they weren't getting to where I wanted to go.

And so I paused the whole meeting and asked the question, so how are we gonna do that? And Lisa stops, I'll never forget this, and said, can anybody answer that? And because that's one of the best questions that have been asked at this. In this meeting today, and I, it was a pivotal moment for what hap what subsequently happened, but also for the organization to be able to understand that we are building this together.

This is so fun. Anyway.

Sarah Richardson: Well, and that's why we're here because, I mean, we've covered some pretty heavy space, but when you have rapport with people and you've done hard things before, it's fun to look back and say, oh yeah, we did that, or we did this. Knowing that, I mean, my goodness, if y'all ever got that band back together, what you could do next.

But that importance, you have those people, they're your lifelines that are out there. It's time for us to have a little bit of fun though, with all this heavy conversation. And so Christine, this one is for you. What is one thing you would never offshore?

Kristine Jarvis: Do not ever offshore, your change management communications training, or anything that touches the human element that needs to stay on shore and work with the people so that you can reach everyone holistically.

Sarah Richardson: Okay. And for you, Janet, what's a function that's better near shore than in-house?

Sarah Richardson: What about finance? For the people listening that are sitting there in your business office, like doing prior auth and doing referrals and doing all of this management, what does that mean for them?

Janet Malzone: So for me that, you know, it, this goes back to, you know, we are looking for those efficiencies. Some of the people we're gonna have, we've got that upskill opportunity and also. What I have seen over the years, and it is amazing, we are all overwhelmed. The finance teams are overwhelmed, so it's not this, oh, I'm gonna take all the jobs we have today and we're gonna move 'em out.

It's a constricted base. So there's, there is this huge need and so it's how do we boost up our existing teams?

Sarah Richardson: It's that piece. I wanna walk into a rev cycle team and say, we're gonna take all the things you hate off your plate. I mean, yes, it'd be like this huge up like roar of like, what are you gonna take?

And, our boss asks that, ask us that all the time. What do you not like doing? Exactly. And how do you find a way to automate it? And it's such a way It's changed. Mm-hmm. The way our organization thinks about automation and they, like, you can take the stuff I don't like off my plate. Yeah. I'm in. What does that, what does it mean that I have to do?

Lisa Davis: It's a great approach. It's a great approach. We actually had those conversations with the finance team and Rev cycle management was one of them, but it was always, they weren't able to find the dollars. To focus because we were always so capital constrained, and that's one of the things with automation and AI requires.

Kristine Jarvis: And so, Lisa, so Lisa, is that location agnostic? I'm just curious. Yeah.

Lisa Davis: it may be location agnostic. You know, when I think of location, I always think in terms of differentiation of IP and skillsets and where does that IP need to be protected in. If you're asking me in terms of what skills would I be move near nearshore or offshore or keep in-house from a technology lens, I'm thinking.

Sarah Richardson: No, well it's, I mean, it's important because there's certain things you just you know, it makes sense to diversify your workforce in whatever way possible. I mean, ever since COVID, people are so much more open to that conversation. Mm-hmm. And yet you can't be careless with the ability that just 'cause we can be anywhere doesn't mean we should be anywhere.

Mm-hmm. So, Lisa, I have to ask you, what's the AI myth that five years from now, which feels like an eternity in the world we live in today? A couple years from now, what are we gonna look back and say, that was baloney. That did not happen.

Lisa Davis: I am counting on to spilling this, that AI will shrink the workforce and in fact, it will actually raise the skill bar and we'll create jobs that we haven't even yet imagined yet.

Janet Malzone: So for me, it's my global workforce is delivering on the same level of quality. So I'm always gonna start with quality. That is my non-negotiable and that's what I would expect from a global workforce.

Lisa Davis: Love that answer. Janet. I'm gonna go with authentic leadership and clarity in the messaging across that global workforce.

Kristine Jarvis: And I will wrap it up with consistency in that workforce and process and people and the way they're treated and in the technology services that are available to them.

Sarah Richardson: I love all of those and how important they are for the ability for a organization to keep thriving even when there's unknown change coming.

GMT20250714-172930_Recording: Thanks for joining Flourish. Remember that every healthcare leader needs a community to learn from and to lean on. Find your people at this week, health.com/subscribe. Share this episode with someone who needs encouragement today. Keep flourishing. That's all for now.