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Today on Keynote

(Intro)

the sweet spot for automation is having those nuanced conversations to really know this is going to make a difference.

And we really know what we're after. And so it's not an implementation of a tool, but it's the pursuit of value.

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.

(Main) Welcome to Keynote and today I am honored to interview Mark Zirkelbach, CIO at Loma Linda University Medical Center.

Mark's a leader with extensive experience driving innovation and advancing healthcare IT. Under his leadership, he has led the way Loma Linda has achieved milestones that transform the way work is performed. Everything from a very successful implementation of an EHR to earning HIMSS Stage 7 and really demonstrating commitment to leveraging technology for improved patient care and operational excellence.

We will dive into all of these perspectives today. And Mark, welcome to the show.

Thank you, Sarah. Looking forward to the conversation. I am as well because you have such an amazing career journey. And I really think about that from the perspective of you've been at two locations for long periods of time, which means you can truly create influence and drive change and adoption.

the short version, and I think of my career in three segments. So I started, I'll say early, not quite sure that IT was what I wanted to do, but in the pursuit of a career and a job, it worked out, but it wasn't healthcare. It was, let's just call it more of a pure technology and infrastructure.

East Central, eventually one of the anchor points for Ascension Health. So I was able to do that and I was there for about 10 years and that's where I still leveraged I'll just say my technology roots, but pretty quickly took interest in, so how do we do the right thing, do good, provide value through automation, and so it became more about, so what are we doing here anyway, and more focused on that than just the technology.

So I'll say that lasted, 10 ish or so years. Then I left, and there's always things going on outsourcing organizational changes that impact your career regardless if you want it to happen that way or not. And there was an outsourcing event, and I decided to make a change.

And that was at a large multi specialty group. And that's where I really got excited about, okay, I can now start being a physician where I can. Work with folks that are really trying to do patient care and all, all the related or associated activities and focus on that and try to make it easier.

And so I was let's just say I did that for all three to five years and then decided time to move on another organizational change that I said maybe not for me. And that's where I ended up doing a little bit of consulting at Loma Linda, where I'm at now. And then the opportunity.

All along the way, there was always leadership lessons. Either I was trying to become a better leader or learning from other leaders. And I like to say we're all leaders. Leaders don't have to be managers. Managers are expected to be good leaders. And if you're lucky, that happens for you.

But I've always been focused on the leadership side and just encouraging myself and others. So what needs to happen here in this moment or in this situation and keep honing the leadership skills to be prepared and to try to make a good difference.

You bring up such an excellent point, and that's where you start may not be where you end up.

Probably makes it easier to have, meaningful conversations if you were more in the, I'll just call it the application space or that area that's a little more attached to what the business is trying to do.

But it's not where I started. If you're lucky enough to start there, then it's probably, if I can say better, like one's worse, it's probably better to get that exposure. But I'll say I've benefited quite a bit. Jokingly shared one of my stories I'll just say from my pure technology days that I've been able to take those lessons with me as well when it comes to infrastructure and storage and how to manage it.

It's still basically zeros and ones, as I'm reminded on a regular basis. They just move faster now than they used to. I don't think there's really a bad place to start. Just focus on why you're there. What's the organization trying to do? And the organization, most likely, at least in healthcare, isn't trying to do health IT.

It's a three part activity for me.

And you get to have such a diversification of learning continuously for yourself and for your teams, which isn't as common for some of our CIOs. When you think about your primary responsibilities and how you're aligning what you just shared with the organization's mission, where do you see the greatest opportunities in what you do today?

that's a hard question. I think a pretty easy answer though with the pressure that I'll just say. Our industry is under both education and healthcare. The pressure to, really transform the way things have been done from the traditional approach. Our opportunity is to help that happen with some speed to market, if you will.

And that's our opportunity. It's hat that we wear, I believe, in the automation spaces. Where that convergence of things have to happen, operationally, and if they can be automated in some way, we're trying to figure out where those two converge, and bring the, the greatest value we can to the organization by doing it well and effectively.

You mentioned the desire to bring automation in to make a difference or to free up some of the tasks that humans are performing today. Is the propensity to want to move into some of those technologies something that is board level? Is it flowing through the C suite? Are you taking it to governance councils?

As an academic medical center, it comes at you from, I'll just say, a number of sources. It's not just top down or grassroots up. It's really coming at you from all angles, which I think is fine. That's part of the joy of being in the environment that I'm in is that, it's not all automation ideas have to come from within this team.

The hard part is getting folks aligned and being able to determine, so what matters the most here? And is there an opportunity to automate any of that? And the automation is. It shouldn't just be can we eliminate something, right? It should be more, can we make it so that it's easier to do?

And then, what really matters here. And in healthcare in particular, the human interaction is really top of mind. And I can't imagine learning and education is really that much different. It's all about, people and how they learn and how they progress.

And you've done some. Massive implementations. You've done the EHR rollout, you have done the move for ERP and HR for the enterprise, and then of course introducing all these other opportunities. When you think about the ability evaluate the workflow prior to making the technology switch or the implementation of the technology, what are some of those big lessons learned from either full system implementations, even down to some of these pilot projects?

What needs to be true for them to be successful?

So what is going on today that needs to be different? And we really started the last couple of years talking about value almost to a fault. I don't think people are tired of hearing about it, but what value are we after? That we're not getting today, and that's a very different conversation than I need this system or I want that system, because generally those kinds of statements can come from the place I used to work used that system and things were better there, or.

So how do you quantify value? And we've got two basic steps. We have direct value, which most people can relate to. It's hard dollar savings of some sort. Generally, I got rid of a tool or I eliminated, the need for some labor, and so we can count that as a hard dollar savings, the tougher.

And also, I believe the more relevant is indirect savings, indirect value. So that's got sort of two threads to it. One is I've been able to eliminate some steps or simplify the task. It's not necessarily, cut the time in half or reduce the total time, but I've been able to simplify the work.

Most people shy away from it. We've tried to lean in. We'll see how we do. And have more critical dialogue about, so what value are we after? And even if it's indirect value, how are we going to count it? Is it as simple as there was 10 steps going in and now there's five. And we eliminated half the steps are, Here's the outcomes that we're getting before the automation and after the automation and what's that worth, and it's really hard to put a value on it. But that's to me, the sweet spot for automation is having those nuanced conversations to really know this is going to make a difference.

And we really know what we're after. And so it's not an implementation of a tool, but it's the pursuit of value.

What value is it that you're after and try to get rid of the language around functionality and technology, even though it's really important and it's relevant, it's probably shouldn't be the driver of the discussion.

This

is what I'm counting on. I was reminded today, it was about two years ago I think we have to hit February before it's two full years, but we changed our way of working. We call it new way of working. we developed that with, I'll say, our operations colleagues. But one of the ways was simplifying governance.

So we don't have what I would say are the more traditional what's the list? What's the litany of things? Run them through a weighting process and based on the score, try to move them up or down a list. I'm not being critical of those things, but one, I had a hard time really keeping up with what the business wanted to do.

So let's just say we did something a year ,ago or some period of time ago, and it was generating the value initially, but it's not now. It just needs to be brought up hey, this it wasn't sustainable or something has changed and that solution isn't providing the value we need to provide.

It could be as simple as utilization of open slots and physician schedules or utilization of the or whatever it is. So if we do something and we think we've checked the box in terms of the value is there. We really rely on the business and us to identify it. Like we have a new opportunity here.

And I'm not being, I'm not criticizing my own craft, if you will, but it's probably not good way to do things in the future because we are trying to react to the market and not react to, did we do a a successful implementation? Were we on time on budget and, we stabilized after the go live?

Yes, but those are the table stakes. Now that's expected. What really has to happen is we have to generate the value that the organization needs, and that's usually a discussion. Yes. Sometimes there's metrics and KPIs and you can watch them and say, Oh, hey, it's not, we're not hitting those numbers anymore and we should be.

And then the technology is the shortest leg, if you will, in terms of importance and difficulty to get that part of it, all three have to be lined up to generate value, but people in process are elusive to say the

Most of the time the technology's there. We usually have to double down and figure out some of those process components.

The hardest part can be that interdepartmental collaboration. How have you been successful in between IT and clinical departments? in enhancing patient care and bringing the right solutions forward?

So we revised our operating model so that for those clinical areas, we tend to refer to them as service lines, but it could be a department.

And we did a pilot to see, so does this make a difference? And. I wasn't too surprised that it made a difference. When you commit people to anything, odds of getting something done are going to go up, right? So we started committing people to service lines that were prioritized by the business.

Those people, now it's a team, with shared goals around a roadmap. And so we asked for a roadmap for that service line. And that roadmap identifies the value that they need to deliver. It's not a list of products or projects. Get me wrong. There are initiatives that are named, but it's really around the value that we are needing to realize.

It's just that function's roadmap and it takes a number of people, to make it an accurate reflection of what brings the most value. So we court, we do a we're up to eight, I believe service lines that have committed resources. And if there's interest, I can say how we did that. I didn't get to add people.

I had to move people around. To do different things than we did in the past, but that I'll just say to answer your question, we committed resources. to service lines that made a difference for the organization. And then the other thing we did as part of our new way of working is we proactively identified value with the business.

And so now we have resources, teams that work with the business to pilot more things. And We put structures in place where we're now scanning the market, trying to understand what's going on, networking more, spending more time looking at what our core vendors are doing and what's on their development roadmap and starting mapping it to value proposition.

So that became a proactive activity as opposed to a reactive activity, which is generally more the, the update comes out, the release notes are shared, and then everybody goes through and Oh, that would be good. And that would be good. And so it's a reactive process. We have found that this proactive pursuit of value really does make a difference.

When you think about how quickly things are moving, how are you fostering innovation, both within your teams, but also within the org? You say you're doing market scans and keeping a pulse on what your partners that are already embedded are doing. When there is that more unicorn type of solution or something that is much newer, especially in the automation space, how are you bringing that perspective into the organization thoughtfully?

I'll say this was supported, from an administrative strategic perspective, let's do this. As a methodology, which means we had to spend more time and the operations has to spend more time doing this sort of thing. Cause typically operations doesn't have a project team.

They have people that do operations. They do work and then in their spare time, they might be able to take on one or two things because they wanted them, right? Hey, we requested it and now it's time to do it. And we got to spend some time sort of making sure it happens.

Requests like, I need more people, I need more labor, I need more FTEs, whatever, however it comes out. Doesn't mean that it's a no or a hard no, but just a very different conversation than we need to restructure what our labor is doing so that we can do new, more value add work and so operations and us has had to figure out a way to carve out some of that time so we can do it because it takes time to do it well.

Otherwise you are reacting no matter how fast you think you're moving, you're reacting to something as opposed to. Pursuing opportunities that haven't been identified

It can take a long time to get the budget approved, then the contract signed, and then the queuing of the actual work to be done.

How long is that taking for you?

So we use a flywheel as our metaphor. We're trying to get the flywheel to turn faster and faster. And it's really getting at how many concurrent things can we do and then how quickly can we get them I didn't ask if I could do this, I don't even know if I could find it, but we have a bit of a tracker where we show the maturity of the idea.

So we have a tracker, and we have about eight roadmaps. We call them hyper automation roadmaps. And we try to show like, so how many are in each stage? And you can see pretty quickly Whoa, there's not much going on here. I won't call it out. But there's a whole lot going on here. I will call out the whole lot going on.

RevCycle. We have 18 or so initiatives going on in RevCycle because it's just, I'll just say it's a target rich opportunity where, the more we can automate it and essentially it's almost all administrative burden the more we can have an impact on that. The better is for the whole organization.

and put a pilot together and stand it up and see. We've got a, we've got a number of pilots. Now we talk about how can we do, be better at piloting. Sorry if I'm just rambling. Stop me if if isn't useful. But the old pilot model was, okay we looked at a bunch of things and we think we want that one.

Probably going to go with that one, but let's say we're going to pilot it because in case it doesn't work out, we can say, oh, it's just a pilot, we're going to cancel it. Now it's really, what's the mindset around this pilot? Are we going to do more than one? Are we thinking this is the one, as long as it works, then we would scale it?

Or, no, it's one of x, and we're going to try all of them, and then we're going to learn from those pilots, and then decide, hey, will any of them scale the way we need them, or not? So it's a whole different mindset. We recognized, so we learned from this one, we put a contract in place with a vendor, assuming the pilot would be successful.

So you, we have have to get your head around. So what is this situation anyway? Do we have a pretty good idea that this is the one and we can negotiate a little more firmly with a vendor or, we're not really sure. Let's just see if we can get a, get the vendor to go along with a pilot, not charge as much, we'll put our sweat equity into it and we'll do a few of them and then we'll learn and then we'll decide.

So it's all about due diligence, right? Like how much do you have to do to know what you think, to reduce the risk or to know what you think the right thing So we're trying to get smarter at how do we shorten that cycle? Should we, what was my question the other day to the team?

Okay, so what are the two or three things that have to happen in this pilot? And could we do it in a week? Could we just confirm in a week that those two or three things are going to work the way we need them to? Or no, usually a pilot's a month, two months, three months, they're in months not days.

So we have to move faster on those

And to your point, Mark, if you put in a pilot and two things aren't true from the get go, and that's negotiating the contract so it's favorable to whether or not it's successful, There's also that conversation with whomever is most affected by the pilot that, Hey, this may not work, or we may not choose to pursue it.

And now there's this really expensive product that you're paying for three people instead of a more scalable solution because you didn't tell The group that we're trying this out, they just basically assumed we get to keep it, especially in a pilot that is multi months. And some people latch onto this technology pretty quickly.

Those early adopters can be as beneficial as they can hamstring you in some of these implementations.

\ My brother was a used car salesman. He would just let people drive the cars. Home on the weekend and bring it back if you don't want it.

Sorry, we got to take it away. Pilot's over. What do you mean you're taking it away? So you do, we just have to get smart. The main point is not all pilots are the same. You're not trying to prove the same thing or learn the same thing. And so a little more sophistication is necessary. We would rarely do pilots I was at least my thinking was if you don't know for sure what you want to do. And spend some more time until you know for sure what you want to do. But that doesn't work anymore. The world's moving too fast. And these things are all commodities. Or at least turning into commodities almost overnight.

It's amazing and frightening at the same time. We have to up our game around knowing what it is that we want to do so we can go get the value. Because it is. end of the day are we providing value or not? And if we're not, then we need to be. And so we have to do something to provide value.

The ambient technology or is it what the vendor is wrapped around the technology to make it more integrated with the workflow? The ambient part of it, it should be, maybe a commodity cost. And if you've as a vendor have figured out how to make it really easy for people to use it and adopt it, and you've wrapped that around what's called workflow or functionality or user interface or whatever, then that would be really good to understand.

But what tends to happen is it's just a blob, right? Yes, there's ambient in there and there's Functionality and technology. And it's all one thing. And the reality is no, now we have to be good enough to talk about them separately. This is the same as it is in all the other products.

What do they want to charge us for that? This is actually unique. It's a differentiator. How long are they going to have that advantage over what you might consider your core vendor or whatever? And then you've got to try to make decisions about we're going to wait for our core vendor to get there or no, we're going to go.

you

staying in front of the security element with things moving as fast as they do, the rapid pilot perspectives in your organization? How do you keep your organization safe?

It's tough.

We try to embed that discipline and everything that we do. We obviously have a dedicated team around information security, but our infrastructure and our application folks have to carry some of the burden for security and, be able to be mindful and watchful. So it's not just InfoSick reviewed it and signed off.

And so therefore, we It's good. The reality is, and especially when you start getting into large language models where what you vetted and installed learns after you, this is the way I describe it, like IIS is really good about change management. I'm not talking about people change. Now I'm talking about technology change.

So you have to keep an eye on it in a different way and periodically vet things again that you've already vetted. Even though you didn't change it outright, it changed itself because the model that it learned on has changed. therefore, we can't introduce security risks or bias or things that you thought you had guarded against.

That one's a tough one. That's a really tough

it's ongoing as much as the evaluation of the processes that you're using. So if that philosophy has already taken root in your organization, adding the security element may not be as much of a stretch as it could be for others. With the portfolio in front of you, what are you most excited about?

So that would be amazing if we can make a difference for our care providers, etc. Spend a lot of time making sure the notes are right. And then the other, really big opportunity is in our ref cycle space where, we spend a lot of time trying to get paid and a lot of money and not throwing any any negative comments towards payers.

then, the turnover number, the cost to replace somebody It's pretty significant, hard, again, hard to add it all up, but we've tried. And so we think if we can make this a really good place to work, it's easier to work here, easier to do the right thing, less needless, overhead to, to have satisfaction at the end of the day that you could do your job.

We think that's also a really big Clinical burden reduction, rev capture, and process efficiencies and easy to work That's a perfect triangle of aspects for what you're looking to do. And what is the safe way to be able to share it for professionals who are looking to move up in their career?

They want to be a CIO. They want to hit that VP role. You have a storied and successful career. What advice do you have for them?

it's what's the other little saying that I've thrown out there a few times. It's hard to teach leadership, but you can learn leadership. And what that means is it usually comes down to the individual and how important it is to them. To sharpen that skill, it's hard for, Hey, I'm going to make you a really good leader.

How did the triangle of things you're looking to solve come forward? So thank you for sharing all of those with our listeners and our audience, because it's not often that leaders are at one location for longer periods of time and have a chance to really create that foundational. Experience and sense of ownership inside of an organization.

Sure, yeah. All right. What's the one piece of technology you use every day that you could not live without?

So the love hate is my phone, I suppose would be really hard if I couldn't be mobile and I'll say mostly productive. I won't say that I'm always productive when I'm mobile, but mostly productive Or at least have the option to be productive.

So I think that's the one. And I know phones have a lot of yeah, but what's the one thing on the phone? Don't make me do that. But if you do, I would just say it's collaboration and communication. If the only way I can collaborate and work with others is to be standing right here at my desk or in a room physically with somebody, I'm not, those aren't bad ways to collaborate, but if that was, you The only way, then that'd be pretty tough.

And we've been able to be, more efficient around, I'll call it just in time collaboration. I'm not saying that works for everything. Sometimes you just got to be in the same room, have those crucial conversations and, read the body language and all that, but not everything falls in that category.

So I think that would be my technology device and the purpose is, I can collaborate better with that device than without it.

And then armed with your phone, if you could work remotely from anywhere in the world.

I don't know what those places are, but if you do, let me know.

I'm a scuba diver, Mark, until 8G, I think, the underwater columns comes in. I don't know that it's that feasible. And that'll defeat the entire purpose of going underwater to have a, serene personal experience. But it's probably going to happen before too long.

All right, last question, especially since you touched on the importance of the leadership aspect. What's a book or movie about leadership that's inspired you?

So I'm fortunate. I get to teach a leadership course to healthcare informatics, master's students here, school of allied And so my mentor introduced me to this book that's called the leadership moment. And I use that book to teach the course. Like I said, it's hard to teach leadership.

They're extreme situations, makes it a little easier to point out. Where the leadership was lacking or where it was stellar.

Thank

you. Because I feel like our conversation today was like a mini master class because you bring so many perspectives and points of view that people need to hear.

So I appreciate you taking the time to be on Keynote. Thank you for attending our summits, our dinners, being a part of this community. We truly couldn't, when we would not want to do it without I appreciate the invitation, Sarah. Always happy to share. And like others I'm still on that learning journey myself.

Likewise. For all of our listeners, thanks for tuning into Keynote. That's all for now.