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The 229 Podcast: Strategy, Culture, and Innovation at Providence with Cherodeep Goswami

cherodeep: I say healthcare is unique because it's an industry that. None of your consumers want to come to you because they want to. They come to you because they need to.

Bill Russell: My name is Bill Russell. I'm a former health system, CIO, and creator of this Week Health, where our mission is to transform healthcare one connection at a time. Welcome to the 2 29 Podcast where we continue the conversations happening at our events with the leaders who are shaping healthcare.

Let's jump into today's conversation.

Bill Russell: all right. It's 2 29 podcast. And today I'm excited to be joined by Cherodeep Goswami, the chief Information Officer at Providence of Renton, Washington. Huge system c Charo. Welcome back to the show. Are, is it CIO or CIDO or CDIO or what other consonants or vows have they given you?

cherodeep: Well, it's Tuesday. So today it's uh, chief Information and digital officer, CIDO.

cherodeep: I will say I thoroughly enjoyed it, which you and I have talked over the years that one way to learn technology's best users is to understand operations in running supply chain, running culinary service. Buses were good. A lot of others taught me my place in the universe, let's put it that way.

Bill Russell: Well, we, we go back a ways now. We was the first time we met at BJC

cherodeep: No, actually, you and I crossed paths when we were at Harvard for a session, but then you came and saved my life at BJC through a very important divestiture. And since then, we've become good friends.

Bill Russell: We, we sat through the John Halamka, John Glasser sessions up at Harvard together. We

cherodeep: Yeah.

because you know, you really I'm not sure there's any other industry where the context matters as much as healthcare

cherodeep: I, well, I even, I came from outside healthcare and to this day I say healthcare is unique because it's an industry that. None of your consumers want to come to you because they want to. They come to you because they need to. And two, it's probably the only industry where volumes doesn't equal margins.

Most people don't understand that. They think more patients means more money in the hospital's pockets, and it's anything but true. So those two things that people learn when they're coming from outside healthcare would be a good first lessons, which both of us took a while to get to that point.

But the first thing that struck me about you is you always had a smile on your face and it was infectious. And I think the second thing is. you were I put you in the category of philosopher. You had deep thinking around a lot of the stuff that you were doing. It wasn't just, you know, it just nothing with you was just a technology conversation or a workflow conversation.

It's like there was. You know, bill, we have to do this in healthcare. We have to move these things forward. We have to do a better job for I, and it was, I mean, you you always caused me to think one level below where I'm at. now you're at Providence, seven states, 52 hospitals. You have a relationship first philosophy. How do you scale that to 120,000 caregivers without losing that personal touch that I know is so important to you.

And to all our viewers who are listening to this also know that Bill had this role in many different ways as a CIO at St. Joseph's in California years ago, which you and I have joked quite a bit about our similarities

Bill Russell: You're still cleaning up my mess. I got it. I understand.

You start showing people the direction and back to that point you made. Why do we do what we do? We can make a better living, in many other industries, but when you come back to the industry of healthcare and everybody has to go to a hospital at some point in their lives, when you tie that back to the mission, you tie that back to rounding on the front lines.

So that doesn't change.

Bill Russell: alright, so you've been there since since May. Is that

cherodeep: That's right. Yeah.

Bill Russell: All right. So, you know, every organization has. Let's just call it cultural distinctions that maybe don't show up on the brochure. What surprised you most about the Providence culture as you've gotten a chance to be there for these first eight months?

cherodeep: So I'll tell you, it's my first faith-based system that I'm working for. And while both of you, both you and me, have spent enough time in St. Louis that is headquartered to many of the faith-based systems living, living in a faith-based system. Is very different. Every one of our meetings starts with a reflection.

That is very in humbling, I would say, and reflection is sometimes it takes 10 minutes, but it sets the tone for the rest of the day, rest of the meeting. And then when you walk the front lines and you see it in practice it's actually, is, it's rewarding. At the end of the day I'll say it that way.

I've worked in academic medical centers, I've worked in other places. This one's different for that purpose out there.

Bill Russell: You know, it's it's terminology means so much as well, by the way I left St. Joe's and started my company, that is the one practice that I brought with me. We do a reflection before every meeting

cherodeep: Very.

cherodeep: Mm-hmm.

Bill Russell: matter if it's uw, BJC, it, the pace at healthcare is hectic. And I founded that grounding and also the fact that it's not just the leader who does the reflection. had it's anybody

cherodeep: Everybody. Anybody? Yeah.

Bill Russell: Who's sort of assigned that thing. You know, they will come in and I remember that reflections could be anywhere from, you know, just a famous quote and people dive into it. Something that's motivated you, a story you know, some people share a video and it just, it slows you down and reminds you, oh yeah, there's people coming through our front doors today who. They're bringing a loved one in, this is a really big day for them. So I took that with me, but I think we hear it in the language.

I mean, you said ministries. I started by saying this many hospitals and you didn't correct me. But you essentially said ministries and I remember now that, yeah, they, we did refer to them as ministries. because when they started, they were ministries.

cherodeep: were ministries. Yeah.

Bill Russell: the sisters keep reminding us. It's, there's still ministries, there's people

cherodeep: Right?

cherodeep: Yeah. Yep.

Bill Russell: I think that's one of the ways that faith-based healthcare has impacted the rest of the industry. because I know other organizations now refer to their staff and their employees as caregivers, not just those people who are in the hospital. You know, what are, what's some of the other language that you've heard as you've been there that sort of sets the tone for what you guys about and what you do.

cherodeep: size and complexity is a, brings its own languages. When you're talking 129,000 caregivers, 52 ministries, you just start. Understanding that there are a few more zeros than other places in healthcare that we have talked about. Uh, and, And so that, that's one piece that we, I have learned to appreciate.

So, no pun intended, but we do actually speak more than one language when we are at work in across areas. And so I had the privilege of visiting India and it's a whole different world, a whole different language, but serving the same mission. So those are some of the other unique things that I've been experiencing and enjoying in my tenure.

Bill Russell: You know, you started at UW during c. And in one of those interviews you talked about how you like to really interact with the staff and do meet and greet and you did other things to that effect. How does scale impact that? I mean, you, there, there could be a case to be made that you may never meet all of your staff members.

But we don't have to meet in person all the time. So I'm back to doing my coffee sessions later this month where 10, 15 people just show up open hours and it's sometimes the most energizing conversations. It's, I call them the no agenda meetings in. We can talk about anything as long as we do it with respect.

But once you open your doors, it takes a while. But people walk in as a leader. You've heard me say this before, meet people where they are, not where you are. And so, you know, sometimes Saturday morning, sometimes with a night shift make yourself available and people will show up. So.

Bill Russell: so I've had you on the show. A couple times I've had people from Providence on the show as well. Plus as you pointed out, and I was gonna try to keep secret I was at St. Joe's, which is I think, a number of the, California ministries, the Texas Ministries of of the Providence ministry now.

cherodeep: Oh, okay.

Bill Russell: for the last decade or so at Providence.

Had BJ Moore on the show a couple times. I've had Kevin Manon on the show and, and others. And so I, I went back just to refresh my memory of some of the things. And it's interesting because I want to talk about. Continuity, right? So, BJ Moore, one of the things, he drove home, he was on the show twice and he drove home.

He had a mantra and it was simplify, modernize, innovate. And I don't know if you know this, but you had a mantra when you were on my show and it was three Ws. Do you remember talking about the three Ws,

cherodeep: Yes, sir.

Bill Russell: Workforce, workflow, and wellbeing? I think were the three Ws,

cherodeep: Yeah. Yeah.

Bill Russell: looked at that.

If people have listened to those shows we really focused on cloud computing and and standardization and all those things. That was a lot of the conversation a lot of the conversation with you and I was. The pragmatic application of technology to the problems that's that face healthcare. I'm curious, you know, as I sort of lay that out of, I had the benefit of looking at all those transcripts and pulling that stuff up. how do you communicate sort of continuity of some of the things that BJ was saying, and then maybe even a divergence into doing some different things.

cherodeep: First of all, bj put a very strong foundation in place, very strong foundation in place in having a solid infrastructure. Always allows you to aspire for bigger and better things because you have the privilege of having a strong foundation. So, taking on, building on that I have my threes.

We should leave this industry. So that empathy is very important to tying the infrastructure and the back end to the frontline innovation. It's in our blood at Providence. Providence is known in the industry for its innovation. Innovation should not be confused with invention and creation of shiny objects.

Innovation drives change. Innovation is very deliberate, and in the spirit of continuity, I've kept that innovation. DNA from the past leaders out there. And at the end of the day, it does matter about impact. It does matter about outcomes. Sometimes in the spirit of us being data people we can call out statistics, 92.7% out here and 48.3% out there.

We need to have business outcomes, not just technical outcomes. So those were my three words. Respected, tradition kept the continuity, and then set new horizons for 2026 and beyond.

Bill Russell: Let's talk about innovation. You are absolutely correct. I mean, in the industry, Providence is known for innovation. Sarah. Recently left, but, you know, has a strong legacy there of innovation as well as, you know, it's countless other people, clinicians, and others. One of, one of the quotes I have from you is that, that struck me as I read it again, was innovation without a purpose.

It's just another hobby. that sound like something sound like something you would say?

Bill Russell: and I assume you'll have this ability as the CIDO, how do you focus that innovation on what is truly gonna matter to that point of care? To the patient experience, to the patient outcome, to the clinician. I mean, you started this by saying something and I sort of glossed over it.

I wanna come back to it. Reducing access by seven days is. Across a scale of providence is amazing. That's a significant innovation and it may not be like we introduced a new tool and now all of a sudden it's seven days. I'm curious what did drive the seven days?

Is it process? Is it technology? What is it?

cherodeep: It's always all of the above. And to be fair, a lot of the hard work started well before I got here. I just get to be the face among many to take pride in saying we have reduced that by seven days and we look to reduce that to under 25 days by the end of this calendar year. But what it really comes down to, if you think.

The other side of innovation is disruption. The technology side of innovation and the big scheme of things is easy. It's easy, but think of amount of stuff that we na introduce in the name of technology that goes out and disrupts. Sometimes adding to the workflow and sometimes unfortunately taking tasks and jobs away out there.

And you have to manage that change management. Very well. because without that innovation becomes the lipstick on a pig. And it becomes successful for 60 days and then as soon as the support system goes away, it crashes and burns. So access was a big deal and across the industry, right? One way to reduce access is to get more providers, but we know that's not happening anytime soon.

The technology piece assists, but rarely does it become the sort of, the catalyst for the change in these cases.

Bill Russell: The the five why's is interesting to me. I used to do that all the time and it's hard to do it and not annoy people, but, you know, you just get why, you know, it's almost like that little kid, like, why, like why? And then you start backing it up for 'em and saying, the reason I'm asking why is, because you just said we do this.

Why do we do this anymore? like, oh, well this is why we did it. It's like, d do those, does that situation still exist? And a lot of times we're just, we're stream of consciousness. Things just keep going. because there's an inertia to them.

cherodeep: Yep.

It's like, I don't know why we do that. And you get to that point of going, all right, the, what's the best way to do these things? It's pretty interesting.

cherodeep: And to your point as we keep you know, harping on this one. We don't treat diseases the same way we did 30 years ago. We don't get paid for the diseases the same way as we did 30 years ago. The way we practice medicine in the ED and the OR and other care settings have changed significantly, but the way we deploy technology in healthcare sometimes doesn't change.

Bill Russell: Yeah. And you know, one of the things I've found interesting and I talked to, I, I don't know if I captured this on the interview, but I talked to Rod Hockman after he did a presentation and I found that anytime you asked him a question, he answered it identically. Like, he had his three points memorized and he answered 'em the same.

I, and I said to Rod, I'm like, rod, you know, you said that last week and you said the exact same words, like, why don't you know, change it up a little bit. And he said, bill, this is one of the, this is one of the things you have to remember about scale. I'm gonna get asked that question at every staff meeting, at every hospital. And if I say it differently. each hospital. They're not, I, you have to create, is there, are there things about scale as a leader that you're either learning or have to figure out how to do a little different than maybe at uw? I.

We don't treat as I said,

Bill Russell: have to tell me. I flew from Southern California to West Texas. They

cherodeep: so, yeah. Yep.

Bill Russell: don't belong here.

cherodeep: So, so those things have to be respected. And keep in mind, we also have a team in India, so you have to respect the culture and the regulations. Regulations are different by state and county too. So standard gets overused that term. So, but at the end of the day, it is what are the non-negotiables?

Bill Russell: I wanna talk about some things with you that'll help maybe other CIOs mean I, I love the conversations we have. I, I wish I could just drop a recorder. the table when we sit around with even with some of the other people that we have conversations with. So here's what I'd love to do. I'd love to throw out some of the things that people are struggling with and just start talking through 'em with you. So, for example everybody's talking about. You know, last year it, it reached a fever pitch, but I think people are gonna realize that was not a fever pitch. This year's gonna be a fever pitch.

So. Ambient. We have computer vision starting to take hold, and obviously we have some we have some generative AI models that are starting to get used as well as the countless other ai models that we've had, we've implemented over the decades. You know, there are systems that are still struggling with setting up AI governance and AI strategy, and then there's others that are playing around with it and moving forward. How do you think about that, that, that continuum, if you will. You know, is it how do you make sure that you don't get out over your skis in this process? And then how do you make sure that you don't fall behind as well? I.

cherodeep: I don't know if I have a magic answer because I think we as an industry still have, don't have a common definition for the word ai or the two words, ai, right? Everything under the sun was being called AI at some point, including spell check. So we've gotta.

Bill Russell: magical as they fixed my spelling. What are you talking about?

So in that journey, I would say, again, tied back to those purposeful outcomes out there. So in my world, whether it was at Wisconsin or out here. I always go back to where are we doing ai? What are we doing for, so if I'm doing it in an acute care area, how am I doing that? What predictive analyst analytics am I taking to reduce length of state?

I'm just giving you specific examples. You know, what can I do to reduce length of state? What can I do to reduce preventable harms in an ambulatory setting? What can I do for a message driven triage? You said ambient was a win. I really think another huge win. Was in basket fatigue for providers across the country.

Another area we don't talk about a lot is aI in the imaging space. We did some fascinating work in early detections for pulmonary embolism and other forms of ICH, which led to not just length of stay, but and prevention of a adverse outcome for the patient. Those are very purposeful when you start going through things.

And then, of course let's not forget the nonclinical side of it. The world of billing, the world of rev cycle. I mean, if someone is not doing AI in those areas, the question is why not? What kind of governance are you waiting for to come and tell you to do it? So whether it's claims, denial, prior auth, you name it, we should be doing that.

Stay the course, deliver them, scale them, and then move on to the next three or four. So those are the centralized big ones that we push. And in the meantime we do incent individual departments to say, do all the AI in your world and come back with efficiency in your own space and return the resources to the organization.

It needs to pay for itself out there. So you have the big AI and the small ai, and that's how we try to cover so.

Bill Russell: I think one of the things I'm gonna tell people this year is nothing's changed. Everything's changed and nothing's changed. We still start with what are we trying to accomplish? What's the problem we're trying to solve? We still start with those things. We still have to have discipline around prioritization, right?

cherodeep: Yeah.

Bill Russell: people along and all that stuff. So while the tool sets have changed. None of the disciplines have changed, really. I mean, we still need governance, we still need prioritization and all those things.

Diffusion of ambient across the book.

Bill Russell: Very few. I. But wouldn't you argue, because I think I'd argue this too, if a, if a physician is more effective without it, I'm not sure I'm gonna force 'em to use it. I really want, I mean, this is one of those tools where I'm sort of sitting there going, yeah, you know what, if you've customized the EHR to your whatever, and it's boom in you're, you know, it's slowing you down, by all means, keep doing what you're doing.

cherodeep: A hundred percent. I mean, at the end of the day, it comes down to the capability. Some people still prefer typing. Some people prefer a scribe. Some people uh, prefer a transcription and some people prefer ambient. Where I'm going is if you look as an industry or saturation beyond primary care family medicine, it's still less than 60% in most cases.

If you start thinking of specialty care, it's still not getting there to that point.

Bill Russell: Right.

And the ambient of 2026, I believe, is very different than the ambient of 2023 or 2024, because now we are getting into coding in other forms of revenue generation beyond. The provider fatigue aspect, which was version 1.0. So these journeys never end, but we have to keep improving on those to reduce what we call the administrative burden on the health systems.

Bill Russell: I'm trying to remember if you were in the room I think we were talking with with Alistair and some others, and he was talking about using AI for outbound calls.

cherodeep: Mm-hmm.

Empathetic, still achieved the objective even with objections and whatnot at the end of that 25 minutes. And I think he made the point. That if if a call center agent had spent that much time with a person, they would've missed their metrics and they would be like, put on probation. He goes, but AI does it and who cares? because it's doing 50 other calls at the same time. but I think the thing that amazed me about that was there are use cases I'm not even considering right now that I didn't think AI was ready for. And as you hear that, you start to go, wow, that. You know, that opens up some possibilities.

I'm curious in the call center and whatnot are you thinking about how ai, how are you thinking about maybe how AI gets applied to the call center?

cherodeep: Course.

Bill Russell: like, still have 20 call centers. because I was trying to get rid of the 12 call centers we had at St. Joe's at the time.

It's hard to do

Taking it to Wisconsin and talking out here with the vendor how to put that. Because that is the perfect the perfect blend of the human in the loop that we often talk about where, because the technology started driving the individual that was, that called in for an oncology appointment, but ended up being more towards a.

Psychological help piece, but it brought in the human in the loop to validate it wasn't going south or things like that, versus sometimes just reading off a script. It was a fascinating use case, which has appealed to me time and again from the time I heard it. Out here we are taking on initiatives like our contact centers and bringing in more automation in the form of ai and with my operational partners who are, I'm really blessed to have them.

Worlds out here, so.

Bill Russell: there's a fear here that's sort of underneath this AI conversation you know, how is this going to impact our work or, you know, our jobs specifically.

cherodeep: And I worry about that and we may be going down a completely different path over here because when it comes to re-skilling, I do often wonder where does this remote work environment. Going to take us Monday because gone are the times where you can just walk, you know, down the hallway to another person, a colleague, and talk about it and learn a tip or trick, you know, out there.

Bill Russell: That was Ja. Jamie Diamond's. Jamie Diamond's. Main point for bringing people back into the office in New York was, he goes, I can't train the next generation unless they're at the elbow and I've gotta have them at the elbow. And I was like,

cherodeep: 100% on that. Yeah.

Bill Russell: wonder if we're gonna get back there in healthcare. I don't know.

cherodeep: I'm doing my part to make sure we get there. Uh, Time will tell whether I'm successful or not. It's important. It's important to build culture out there. You know, something, some things you can't do remote. We are just coming off a holiday season. Well, why do families get around a dinner table for Christmas or Thanksgiving?

You can do it remote. Why do people travel and go through airports to make it all the way It is hard. But that's where tradition, culture, habits, you know, change and um, and prosper. So.

Of course they're, and then Google came out and they're like, Hey, they're going to Google to find, you know, healthcare information and now chats. PT comes out and they're like, Hey, they're going to AI to find healthcare information. Well, the reason is, because I don't have access to my doctor. 7 24 365 and the three things I just mentioned, I have access to 7 24, 365.

cherodeep: Well, I would say as I settled in Providence, I've also realized that having California Washington, Oregon is three states. I'm also dealing with a community that is extremely tech savvy. Silicon Valley is in my backyard you know, out there. So I would say the more, if you make it harder for the patient to access ai.

They will find workarounds through create Access ai, and then it becomes a bigger problem for you. So there is a day coming, if not already here, where our providers and care teams need to be trained to help having the right conversations with the patients in when to use ai. Versus when to refer to AI and when to call the doctor first.

I think embracing AI with the right guardrails is the approach to go, and at the same time on our provider side, and I say providers, I'm including all clinicians out here. We have to make it easy to embed AI into their workflow rather than having it as one extra step outside. Because when patients see their providers using ai, they feel comfortable that they can trust the technology out there.

So.

Bill Russell: you know, what are you bullish on at this point as you look across the landscape and its ability to impact any of the quadruple aim.

cherodeep: This is the best time to be in healthcare technology, you know, because we are coming out of the COVID era, so to speak. It still feels odd to refer to it in the past sense. We have technology that has become more affordable. AI has been around forever is the cost of GPUs that have gone down, that has made AI affordable to everyone.

But we do. But we do, we keep up with regulatory changes. We keep up with cyber issue changes, and we have shown year after year that we have actually reduced preventable harms. We've actually reduced length of stay. We have actually made patient care better, and not just the quantity of years that a person lives, but the quality of life that a person has in their last 20% is much better right now.

Our biggest win in this coming year.

Bill Russell: I'm going to do lightning round here and then we'll close it out. Person you'd most like to have an hour conversation with. We'll start with dead and then you can give me a live as well.

cherodeep: That's an interesting one. My answers have changed over the years, I would say. I would definitely dead. I would definitely, it's a very interesting name. I'll throw Oppenheimer as a student of physics and I, no pun just a coincidence that you have had with Einstein behind you. There. But as as a physicist, that was my first degree of physics.

I'm a big sportsperson and I would definitely like to meet Louis Hamilton, who is a very well known formula One driver.

Bill Russell: one.

cherodeep: And not because of his seven years of being the champion, but with the grace with which he accepted defeat, which I still think the other team cheated for the record, but with the grace with which he accepted defeat.

Still came back the next year. Not just to compete, but be a role model for others to follow. That speaks to me. Volumes of a leader that I'd love to meet in, understand how he operates.

Bill Russell: Have you seen the F1 movie?

cherodeep: I did, I did.

cherodeep: Yes. And.

Bill Russell: It, it was, they, at one point they said he was listening and he goes, they're in third gear.

They wouldn't be in third gear in that turn. You need to, and they, and they were trying to be so authentic with the movie, they're like, yes, absolutely. We will adjust that. There was, yep.

cherodeep: I actually have a picture with the actual car that was used in the movie. Thanks to a a friend of mine with connections, let's put it that way. But since we been talking F1 I always say, you know, if you watch a, a surgical case, it is like a Formula One race. There are hundred thousand things that can go wrong, but it takes the sheer grid of individual.

Teamwork, you know, for that hour and 40 minute race, there's a team of thousand people, you know, from the factory to the pit that make the driver looks good. And a surgical case is very much the same it is. It is like an orchestra, but it's actually chaotic when you think of all the things that can go wrong, should go wrong.

And we come out saving lives.

cherodeep: Yeah.

Bill Russell: of the complexity that you're talking about and those kinds of things.

cherodeep: and millimeters my friend. That's what healthcare is about. You know, it's between paralysis and a normal life. Milliseconds and millimeters. So,

Bill Russell: movie you saw in a theater.

Slum dog millionaire,

Bill Russell: the that's the direction that we're going, I believe.

cherodeep: slum dog millionaire. So you tell me whatever year that movie came out,

Bill Russell: gosh. Wow.

cherodeep: that's it. I have not been to a theater.

cherodeep: Go. I'm not a big movie guy, you know, now, so.

Bill Russell: That's that's interesting. Books. Do you get a chance to read books?

cherodeep: Oh, all the time. All the time. Finished, a very interesting novel. It's called Friends Like Us or Someone like Us now. I can't remember the name. It's about a driver from Somalia in New York City and what he has to go through. Fascinating story. Uh, I got,

cherodeep: New York Times list.

Bill Russell: How you

cherodeep: a pretty active group of friends that's in books and references from time to time, a bunch of our share art lists.

But any given time, I'll have three or four books lying around and I won't read all of them at the same time, but but Nick,

Bill Russell: great philosopher would, reads lots of books

cherodeep: here we go. Here we go.

Bill Russell: we've come full circle on the interview. Well, hey I, I appreciate you coming on the show. And sharing your journey so far. And I look forward to many more, conversations over the next couple years. I can't think of anyone.

I'm more excited to have the opportunity to impact communities at the scale that you're impacting at that than you. I'm really I'm excited for you in that role, and I'm excited for the team that you get to work with. And I'm glad that you're one of the people that, the legacy of the small legacy of what I did at St. Joe's is getting passed off to. So

cherodeep: Wow.

Bill Russell: it.

Bill Russell: Absolutely. Well, take care my friend.

cherodeep: take care. See ya. Bye.

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