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Welcome to this week in Health It, where we amplify great thinking to Propel Healthcare Forward. My name is Bill Russell, former healthcare CIO coach, consultant, and creator of this week in health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

I want to thank Sirius Healthcare for supporting the mission of our show to develop the next generation of health leaders. Their weekly support of this show this year has allowed us to expand our offerings and develop new services for the community. Special thanks again to Sirius Healthcare. All right, I'm excited.

Today we're going to take a look at the impact of covid on Health IT and really the leadership ramifications for that and our leadership response to that. And today I have two great guests, former guests of the show, Sue Shade and David Mutz, principals at Starbridge Advisors. Good morning. Welcome back to the show.

Morning Bill. Morning David. Morning. Good morning. Glad to be here. It, Sue is in S Shade Red, and you're supporting some new artwork behind it. Oh yeah. Did you notice that? Yeah. I have a fabulous new piece of RBG art I bought at a silent auction for the Women's Fund of Rhode Island. Yep. Was that a local artist or is it a Yes, it's a local, it's a local artist.

It's a digital image that they did. And when I saw that, I'm like, okay, I'll bid. And then I watched until the end and I was still the top bidder. So , yeah, those, those bidding things make people, you go to this really fancy thing and people get dressed up and they look all civilized until the bidding starts and then people are hovering around and anyway, it's just, it's fun.

But No, that's great. That's fantastic and I'm glad you're in s Shade Red. So it means we're ready to talk about health. It just gets me going there and gets me fired up. It's been a, it's, it's actually been a while since we spoke. And I guess I, I wanna start with a pretty broad question, which is, what are you guys finding out there?

What are you finding in your practice and what's going on in health it? First off, I just wanna thank you again for doing this with us and what a, and, and tell you what a great, uh, service you are doing to the industry. I have listened to so many of your podcasts over the last six months in your field report series, and I am in awe and great respect for all the CIOs and their teams and everything they've been doing during this period.

I think what we're seeing is business slowed down because people focused on covid. That's what they needed to do. As business picked up and we got more calls, we're hearing people who still have their strategic initiatives and priorities on the agenda that they can start focusing on again. And in some respects those are are varying.

Yet there's some common themes, digital health being one of 'em. New ERP replacement system. Being another, obviously along with we're seeing an uptick in coaching, more people calling and looking for coaching, and we can talk more about that a little bit later, but it really varies what people are looking for as they get, it's hard to say, get past Covid when you see what's happening this fall, but as hospitals get back a bit to what else do we need to be focusing on and looking ahead to the future, those are the kinds of calls that we're starting to, to get from people.

Yeah, absolutely. Hey, thanks for the kind words, by the way. Uh, I appreciate it. And, and, and everybody who's come on the shows work, bill, they've just shared so much. Yeah. You know, I, we were spotted instinctually to Covid and, and did some amazing work work and I think to, and we'll talk about this a little bit as well, I think to a certain extent that's raised the expectations on health it, which is absolutely something that leadership's gotta deal with.

David, what, what are you finding? Yeah. What I've found is that. And by the way, I, I would repeat what Sue said, but she said it eloquently and we are very appreciative to what you give back. So I thank you for that. And we all are very much appreciative. And one of the things that you do is you're helping with the education process and you strength solutions.

And one of the things that I point out when I talk about vendors is the communities that they have. But you've created your own community that's been. I think that's one of the great places that builds trust. And with that trust, we talk about everything moves at the speed of trust, and so the ability to share those solutions is huge.

Fantastic. So that's our show for this week. Let me go ahead and tell you what I, I have found and what I, what's an interesting, missed opportunity. I think, uh, a lot of CIOs are missing out on, they have performed heroically and overused nowadays, but it's because there are so many opportunities to be a hero.

And it has done things that we have never seen done before at a pace that's never been imagined. And when you talk about it's the deployment of the technology or it's the expansion of the beds or it's the expansion of the services, it's really been extraordinary. And the I CIOs and their teams, and we know it's always a team effort, have built political capital and they're unaware of it.

I don't think they appreciate the gratitude that exists out in the community for what they've done. And so we have to be careful now not to try to go back to the pre covid world. Uh, the idea is use the political capital that you have to create a new roadmap for the future and focus on how you're gonna take advantage of the political capital that you've built.

Now you gotta balance that with . Expectations that, oh gosh, if you could do this so quickly, how can you do all these other things? And so as we get down the conversation about what we're advising clients, I'm happy to talk about that as well. But I do think, uh, that we now see the greatest opportunity rich environment for it I've ever seen.

So I'm very optimistic about a much, not new normal 'cause I don't like the, the idea of using the word normal again, but a much brighter future. It's interesting because we, I've heard it talked about so many times of we need a seat at the table. Covid absolutely invited it to the table. We were in, in those, uh, rooms where we were doing the prep, we were doing the escalation rooms.

We were in, we were in executive leadership. So there is that visibility. And I know in my work, I'm, I'm talking to, uh, COOs and others and they're . Incredibly, uh, appreciative of what it has done. And they're, some are actually amazed. They're like, I, I knew we were throwing money at 'em. I didn't know they'd be able to respond this way.

And it's pretty, pretty interesting. But before we get too far, I realize I've had you guys on the show a bunch of times, so we haven't really talked about Starbridge and what you guys do, and it'll probably give people context for the things we're talking about and the the type of work you're doing. Sue, can you give us a little context on Starbridge?

Sure, sure. So Starbridge Advisors is a health IT advisory firm. We've actually been around now for four years. We had our fourth birthday or anniversary, whatever you wanna call it, what, two weeks ago. And our focus is on providing interim management at all the senior health IT leadership levels, doing IT consulting and advisory services on a range of areas really, in terms of our expertise and leadership coaching.

We've got . Over 40 advisors who, uh, are on the team. They're at that senior level for the most part, as C-I-O-C-T-O, cso, C-M-I-O-C-N-I-O, VP of Apps. And they're available to do interim work or as I said, a range of advisory work. I think what. Differentiates us in the market because you, there's a lot of consulting firms out there you can call, we're small, we're nimble, we've been there, we've done it.

So we've sat in the seats and we come in for relatively short engagements and help out CIOs and their teams and are just very honest with our feedback and our approach again, 'cause we've been there, done it. So that's the long and short on us. I don't know if David wants to add anything to that.

Perfect. Well, and we, and we've had a, so we've had a fair number of your advisors on, they're experts in, uh, specific fields. Amy Maner was just on, we talked on usability. Nancy Beal was on. We had Terry, I always struggle with his last name, ZM. Niac, who's a security. Do some security projects for you? I think we've had others.

I just, rich Pollock maybe. Rich Pollock as well. Absolutely. Yeah. So it's a lot of people who have been there, done that, a lot of expertise in, in some core fields. Let's, so let's focus in on, on the health IT space right now. What's the number one thing that you are, uh, communicating to, to your clients and to leaders and what areas are they finding, uh, the most need right now?

So you want me to jump in? Sure. So in in ter, I don't think there's any one specific area. And in terms of what we're communicating, , I'll tell you, and Bill, you and I have had conversations like this over the years. It's all about relationships. If people know us and they know what we're capable of doing when the need arises.

We're gonna get the call, and I've talked to people in the recent period who want help with security assessments, with cloud strategy, with their enterprise data strategy, analytics, digital health, ERP, valuation, as they focus on that. Just really a lot of different areas. And I think one of the things that I know I'm trying to emphasize when I talk to CIOs is we can be flexible.

I know budgets are constrained right now, so sorry. And there's the clients reaching out right now as we speak. I don't recognize the number. I don't know what it's, um, it's either spam or Yeah. Someone that, uh, needs us. I'm sorry about that. What I emphasize is that we can be flexible. I know budgets are tight, so if you have a need, you wanna bring us in, you wanna bring us in some reduced way just to get some initial work done.

We're just, we're willing to be flexible and, and go wherever they need us to go. Yeah. Yeah. I, what I'm telling people is conversations with me are free, right? So if you just wanna call and have a conversation, Hey, how are things going? How can we help? Or just talk about how I've addressed that problem, or how people in our organization have addressed that.

That's, we have those conversations five times a week, but when it, when it turns into, Hey, can you do something for me? That's when it turns into a project. But, and you guys are doing a lot of that. Allowing people to reach out and tap into your expertise. I think that's an excellent point. I do those calls too, and when someone says, this has been really a good call, let's talk again in three months, and we just schedule more time, they might want me to be a sounding board on something and like you say, if it turns into more than we try to shape that again, I go ahead and just expound on one thing that you talked about, what's going on in the health IT space and right now the budget constraints and this is what we talked about, Sue.

Are huge and yet they're not misplaced. That's an appropriate thing to do. On the other hand, the thing you don't wanna do is ignore the revenue opportunities, uh, that exist out there and new ways to deliver care and in a telehealth is a great example. And just last week, CMS approved 11 new coverages for telehealth, uh, care.

And so it's expanding and you know, we just have to figure out far better ways to do things. I think one of the things that I see that we are gonna have to talk about to the people as we develop this new brighter future is change management. We, we have to go back to the really basic thing because the way that we're gonna conduct business going forward is not gonna be the way that we're gonna conduct business or deliver care going forward.

The hospital at home is a term that we hear a lot, but my wife happens to be a hospice nurse. She says, you know, that's a 70 year old concept. And she's been doing acute care in the home for a long time, but with the ability to extend the technology and to do things that are, that were very challenging before, 'cause you didn't have the connection back to the, to the physician anyway, it creates an an entirely different approach.

So I think the key is to try to balance how much you're gonna try to take out of it versus how much you're gonna invest in it in order to the revenues in the. See, and this is one of the, again, big opportunity for CIOs is to change the way that people think about them. And you were referencing this bill talking about want to get a seat at the table.

I've always had a seat at the table, but I, one of my former employee employers, when something would break, I would always be the technology guy who would go up and fix it. The AV guy that I used to be in high school. When I went to my second employer, I recognized that I didn't want to be looked at as the technology guy.

So when something would break in the room, they'd look at me and I'd go, let me call the help desk and field services and get 'em over there. So the idea as part of the change management is to change the image that you have now as the technology person and come in as the business person who knows how to work with the technology to get it installed and get it in place.

And I think Covid has shown. Are giving us the opportunity to do that because I think a lot of CIOs are trying to pivot from just technology now to focus on business, and that's a great opportunity. You know, I, I had two conversations in the past week, which were interesting. One, we were talking about the influx of people from the outside.

So you have Novan hired somebody from the outside. You have Common Spirit hired somebody from the outside. I, and I just had heard of another one, which is a pretty significant organization that hired somebody from the outside. And, and actually both of those other organizations are significant organizations as well, where they're, they're bringing people in and I think part of it is what you just described, it's they're looking for the business IT person that's gonna sit down and talk about transforming the business and those things.

I, and I find that that conversation in of itself is interesting. And then I had another conversation with a pretty high up. Leader within a health organization and they were saying essentially that, you know, hey, the CIO's really excellent tactically running the business of it, but we're not. I I, basically, what they were saying is, I'm not sure they're ready to be the strategy person that the person who's looking five years out and being the strategy person.

I sat back and I thought, I wonder if that . Distinctions going on all over the place and CIOs are trying to figure out how do I get positioned as a strategy person within it, within an organization. And organizations are saying, Hey, who's gonna fill this void of really the digital strategy. And so you mentioned digital as one of the, one of the areas that people are looking at.

How are you coaching CIOs in that area? How are you helping them to, to start to think digital, to think business, and to, to get out in front of it? Yeah. Do you wanna take it? You want me to take it? Yeah, no, I, I'll go ahead and jump in. One of the things, bill, that I'm trying to do is to try, I know this sounds silly, but what's in the name?

That's an important question to answer, and I've suggested that all the people that I'm talking to change the term get it or information services out of the name and use the term digital services going forward. The whole point is to try to take ownership of the digital strategy. And too often people conflate the word consumerism and thinking that consumerism and digital health are the same thing, and they're so radically different.

Digital services sits in digital health and consumerism is just a small part. And the reason that people are going outside to look for those CIOs from, uh, consumer oriented organizations is because they do . The two together. And so it's really critical that you come up with a strategy that gives people a much broader understanding of what digital health is, what it means to be a digital health system.

And the idea is you want a digital experience, but there's gotta be that analog human part of it. And so I appreciate that there are many smart people outside of healthcare who can bring a lot of creativity and innovation analytics in. But this deep understanding of healthcare and what it means in terms of analog versus digital is together.

And so a digital health system needs to figure out how to put both the analog and digital together in a way that's gonna give her, give care. That's both high, high tech. That's a tried, kind of a tried term. That's something that really is important and I see that element of analog missing, the the need for digital going too far.

And the other thing is. I don't wanna get too much on those social soapbox, but there is a digital divide that exists in the country and, um, I live in Austin, and access to connections is really important. And yet in many of the underserved communities here, there's not a digital connection. So if you look at just it as the approach, without including the analog part, you're gonna miss a huge part of the population than the one who consumes more healthcare than anybody else.

So that conversation needs to be changed. And by the way, what they did here in Austin is they put wifi, wifi connections into school buses and drove them to the underserved communities, which worked for a while. But now that school is taking back, coming back into place, the buses are no longer available.

Digital health has to look across the digital divide. And there are ways to do that because there is nobody I know, and I'm sure there are some exception to this. Who doesn't have at least a digital fund. Uh, and so when you're designing fancy systems, text only has to be a, an option, and it's our obligation to cover not just the digitally sophisticated, but the digitally incapable as well.

It's, it's interesting, Sue. Yeah. If I can just build on, if I can just build on the, the, the point about what are we advising CIOs at this point? There's no one size fits all. If I'm talking to ACIO and they're struggling with how to expand their role, versus the organization's already decided they're bringing in a chief digital officer, and where do they fit in that?

It's, it's where are they at? What do they wanna be doing? How comfortable are they with that? Expanded role. Where's the organization at? Where are they in relationship to the executive team and what they're able to bring forward. So it's really trying to understand their situation and advise 'em, because I don't think it's one size fits all.

Not every organization is approaching this in the same way. So you see all sorts of models at this point in terms of CIOs and expanding roles. The other thing, I wanna just make a plug as we talk about digital health, David has done really an excellent, are we at four part or five part soon to be five part we four.

We're waiting for five next week series. Blog series on the Starbridge Advisors blog view from the Bridge on Digital Health. And it's worth checking out. Absolutely. I, I saw you. So what, what are some of the topics on that? You did, uh, you did governance, I think that's one of the places you started. What, what other topics have you covered on, on digital?

The most recent one was, I think language I get mixed up 'cause there's so many of 'em. But it's, you know, what does it mean to be a digital health system? How do you get there? The governance associated with it. But there are so many areas and this is such a, such an interesting fabric as you put together your plans.

So I'm very hopeful that people will. I take take on the responsibility of being a digital health officer without having to have a separate digital health officer. For the CIO role, I like to see transform to become digital health services, CIO type. I wanted to touch on this with you guys 'cause I think you have a lot of, uh, experience with your clients around this.

We saw an uptick of ERP work just prior to Covid, and it was, Hey, we did all the clinical work. We did all the, all the EHR work for the last decade and we led our ERP systems atrophy. It's probably the best word for it. And, uh, we saw that those projects kick off pre covid. Have they started to, to resume?

Are we starting to see that work come back? we are significantly. And when I talk about the expense reduction, one ripest for it is supply chain management. And you'll read articles. I read one today talking about how the revenue managing, I'm sorry, how to manage the supplies, increases the amount of cash that's available to an organization.

And you know, it's really difficult to do that with the old kind of disconnected, ignored systems. And so people are rushing toward ERPs and we have developed a very good set of tools that will help us choose this. They're not one of those 40 people that we have that hasn't been through multiple implementations of ERPs, um, both in the past and the present, and.

It's astonishing what a different kind of experience a new ERP is for the employees and the staff. And there is, the fact is that it's to to state the obvious human capital management supply, change management and financial management and human capital management touches every single employee in the enterprise and often, uh, has to reach over and take care of the providers as well who are.

Sometimes employed, the impact of those can't be understated, and the enthusiasm is great. The, the selection of those tools to me has always been fascinating because you just touched on finance and human capital, and so you're bringing those teams together to do a an RFP process. And I, I don't know about you guys, but it has felt to me like there's a lot of give and take.

In that selection process. 'cause either one does the human capital really well and the finance okay. Or they do the finance really well and the human capital is like just a module that's bolted onto it. And so in some senses, somebody's walking away not really happy with the decision. Is that what you're finding or are, are tools starting to get really start to bridge that divide?

Uh, let me, I think the tools are evolving and, and bridging that, but if I talk about it from a, a buyer's perspective and organization that we are working with now, we just finished the ERP selection. It was great to see the collaboration between the domain leads and the recognition that, you know, in the end, the product that they were gonna go with

Had strengths in some areas and not as much in others, but for the greater good of the organization and an integrated single solution, they were okay to move forward. So I think what you're seeing is in that whole space, a similar process and decision making. As you saw with the EHRs, there's give and take.

Some areas might be strong, some areas might be weak. But if we're committed as an organization to go with a single integrated solution, then this is what we're gonna do. Yeah. And I think that's perfect. And one of the things I would say is one of the other trends we're seeing is instead of operating as a loose confederation of facilities, now systemness has become something everybody embraces, and we see great embrace of that.

It's not like one group does and one group doesn't. Every single interview that we did with all the leaders in all the areas said the same thing without knowing what the other was going to say. And so, um, wanting to function as a team doesn't now become the norm, not something you really have to fight for.

And as you're doing change management, knowing that you wanna operate collaboratively really changes the enthusiasm around change management. So we saw huge telehealth gains. What, what's the CIO's role in telehealth do you feel moving forward? Sue, you're coaching and talking to a lot of people. Is the CIO role just the technology foundation or are they part of a, and if they're part of a larger team, who else is in that team that's really determining the, the direction of telehealth?

So, so what I would say is. It's amazing how organizations were able to scale quickly with telehealth. Can you hear me? Yeah, you can hear me okay. Okay. Because they had the foundation in place, though, they were doing small numbers and it was really about adoption and workflow with the clinicians. I think the technologies there, and I think that the role of the CIO to really make it stick at this point is probably very much connected to the

Work of the CMIO, as well as the, the ambulatory leaders and the patient experience leaders to make sure that those workflows and access workflows for the clinicians and the patient and the access is there in a seamless way. So people wanna continue to do it. It's easy, it's convenient, versus, okay, we did that 'cause of covid, but now we're gonna go back to the office.

The word I heard the most during Covid was focus right in, in it. It's like we, we were focused in on three things. Get people to work from home, stand up, telehealth, and security, making sure that there, there was no gaps during that process. It was like heads down, focus, uh. Are we gonna be, is that one of the roles of the CIO at this point is to try to maintain some of that focus around telehealth to say, look, there's a great opportunity here and we've done a lot of really great work that we can build on.

Is is, is their role as a champion of sustaining the telehealth gains? ? Yeah. I, I think so. And it also depends within the organization, is telehealth totally their peer review or is it off somewhere with a, a chief digital officer that they're partnering with or a whole separate telehealth area. But can I key in on another point you just made that's not telehealth and that's focus.

Mm-Hmm. . When as I listened to all the field report series, what people said over and over again, we were able to get things done in a matter of days, not . Months, years. And it had to do with focus. It had to do with decision making, quick decision making. And we all know the painful decision making organizations.

Right? So I think regardless of the project and the initiative, those are some of the really important things that CIOs and and healthcare organization leaders really need to make. Stick that you can focus. 'cause you can . Easily get on way too many projects and none of 'em are going as fast as you want 'em to.

And then that deci that rapid decision making. Uh, can I jump on that one too? Because to me, focus is, requires better governance or more focus on , if you will, to use the word. And that has become really apparent. And getting the CMO involved as well is really important because I have seen . The champions for telehealth moved to other places, but the technology still is a requirement in making sure that the work process is done.

And I used to say something, and it sounds like what a high school coach would say, especially if you're from Texas. But the idea is we can do anything. We can't do everything. And right now the demand for everything is back on the burner again. It's like, well, you did all this in such a short period of time, I'm gonna.

Uh, demand back on the request, uh, queue. And again, good governance. Getting everybody represented well is really important. Multidisciplinary and inter. Any anyway. I think that's the most critical part right now. All, I'm gonna get everybody some free coaching here. So the three of us are gonna take turns on this, then we're gonna act as a coach.

I'm gonna give three different categories as we move through. Let's start with academic medical centers. So we've all done work for, or been a part of academic medical centers. If you're talking to an A-M-C-C-I-O right now, what's one piece of coaching that you would give them? And David, we'll start with you.

Um, certainly politics. People always say they hate politics, and if you hate politics, you're not gonna be a successful CIO. And the idea is to make sure that you are seen as the peacemaker and that you figure out how to get people to do the things they don't want to do. And that takes some finesse and a bulldog approach.

And I've seen the political approach, and I think the political approach is far more important. So it's not to ignore the, the politics or try to increase it. But to try to use it for the appropriate reasons, Sue A-M-C-C-I-O. What are you telling them these days? That's a great question. I'm gonna take it from the angle of AMCs that are closely affiliated with, or part of potentially a university system.

And I think you see a lot of different models there in terms of separate CIOs or combined CIOs or the university taking over. And again, it's looking at where's your organization out, what's the politics of your organization? . And doing the integration and shared services where it makes sense, but never losing sight of the primary focus that the health delivery system within that overall ecosystem has to deliver care to patients.

And it's very different than the university side of that equation, if you will. Yeah. If I were coaching an A-M-C-C-I-O right now, I would say make a list of.

Start generating revenue. David, getting back to what you said earlier, uh, I think AMCs have the unique opportunity right now. I saw that Southwest named Stanford as their partner in determining what their policies were for go back to work and those kind of things. And I think those, that's just the typically iceberg of what, uh.

Recognition, the research, the, the tie with, there's just so many opportunities. So that's where I would go. Okay, we're gonna go second category and Sue, we'll go, we'll go to you and I'll lead off the third one. I've never been on a game show pressure, keep doing this to you guys. So the second one is, you know, let, let's just call it a, a medium sized IDN maybe, maybe 10 hospitals.

That's a big, that's fairly sizable. Let's say six hospitals serving a region. Region and maybe even one of the primary providers in their state. What are you saying to that kind? They have a decent organization, a decent ized budget. Probably not enough. And, but they have a decent size and they have a good market share.

Sue, what are you saying to that? Ccio? Is there a particular problem they're trying to solve? So that, that's where you would start is what's the challenge? I, I think based, if I may, based on the profile and the size of the organization you just defined, they may well be looking for partners. Within that region.

And if there's merger and acquisition activity going on, the CIO's gotta be front and center and part of that team looking carefully at that. And maybe they're looking at how they can help increase revenue and bring value to the growth of that organization in that market. Short of a a, a merger. Yeah. So the middle size.

The middle size, IDN. I, I think these are the CIOs that are struggling to step up as digital leaders. They're really good. I have clinical informatics. The, the, the EHR is probably functioning really well. They, they probably have a decent IT team. The systems don't go down. Good vendor, decent vendor management and those kind of things.

And I think the next step for them is to step into this digital side and the organization saying, okay, look, we, we got it, the EHRs functioning, and we PAC Systems run and we can share information across our network. This is great. What's next? I, I'd like to, I I, I would like to encourage them to start to step into that by creating, you know, a digital roadmap.

Create a digital roadmap and share it with a couple people and see, get some feedback. The cheerleader. If you'll on that. David, where, where would you take the, the middle market? CIO? Yeah. One of the, and I know this is gonna be an unpopular opinion, but the fact is I do believe that much of it has reached commodity status.

And so if you want to have focus, if you wanna be seen as a business leader, you should think about some source of selective outsourcing. In order to make sure that somebody else can have the headaches that are associated with keeping the lights on so that you can focus on the things that are more creative and innovative.

And there are, it's possible by managed services to replace small portions of it. My whole career I did select outsourcing and find it to be very popular or very effective, and I was always asked by my CEO to, can we outsource you? So I would always go out and say, let's try to outsource the whole shop and.

Able to prove that we could do it cheaper, but there were portions of the organization that could do it better outside. And so I think that, uh, looking at managed services is the smart thing for people to do in those middle markets in order to enable 'em to do exactly what you two said. Yeah. Uh, so the last group I'm gonna give you is the Rural Health System.

And we all know this. These are the people I so. Small organizations serving , sometimes serving larger geo geographic areas than some of the significant health systems that we're used to dealing with. Plus, I think this is also one of the loneliest jobs in the world in that there isn't a potentially a strong peer network for them to bounce ideas off of.

And these could be people with 10 people on their IT staff. I've heard one of that had five people on their it. And, and that just boggles my mind when you think about the regulatory challenges, the clinical informatics, the reporting, all those things. And, and I think what I'm saying to that group is, gosh, again, I, I would start with empathy and I'm not sure I'd get past it, but it would be, I try to make as much of your budget.

Uh, fixed as possible. And I know that's the opposite of what I would tell some of the larger health systems, but the reason I tell the smaller health systems to fix their budget, like a certain amount to a vendor for, for analytics or something to that effect, is because when the, your health system goes up and down with the economy and you want to keep people from cutting things that they just shouldn't cut.

And, and one of the ways to do that is to have a three-year agreement or a five-year agreement so that they don't come in and go, Hey, we need to cut, we need you to cut back on security. Well, we can't cut back on security. We can't cut back on any, you can't cut back on any of that stuff. So to a certain extent I would, I think I'd coach them to make that fix.

And I don't know if that's good advice or not. Let's see who goes second on this one? David, you go second on this one. What telling the CIO at this point? Actually, I can give you some anecdotal evidence 'cause I'm working with a. Access hospital, and it's essentially what you said you have to outsource and what you do.

They don't have a an IT staff. They have, you know, three people essentially taking care of things. And the nice thing about, and by the way, I, I came up in a smaller hospital and work with rural facilities and the large systems. The thing that's nice about that is that people there know everything and there's so few handoffs.

And so there's much more generalization of understanding of operations. So they're, they do have an advantage in that regard, but the capital requirements are a killer. And so the idea is, I suggest that you don't look at just at three five, but you look at seven and 10 year relationships. And the one thing I've coached, everybody who I talk to, and this is regardless of size, is make sure that you have.

Volume adjustment that allows you to go down when the cost, when your, when your scale goes down. So if you have to reduce the number of beds, then your monthly, uh, fixed fee will go down. But fixed fee is the only way for somebody to manage that, and they have to make partnership with somebody else and a larger system to get the technical expertise that they need.

And as you pointed out, it doesn't matter what size your organization, the regulations don't say. If you're this size, you get to do this little security. Everything is gonna be the same quality is the same. Expectations in your, of your, of your patients are the same. So you, you really have to have a long-term partnership.

And there are vendors out there, and I won't mention them, but there are vendors who make special allowances to support the rural communities. And so those are the commu, those are the partners I would seek out first. Sue Rural Healthcare. What? What? How'd you coach ACIO there? I'll give three points. One you've already mentioned, bill, in saying it's a lonely job.

There's lots of resources to network with and learn from, even though you may feel like you're the only one doing this and you're isolated as ACIO. Secondly, so take advantage of that. Secondly, I. If there are talks, if it's not gonna be an independent rural community hospital, part of some merger activity, don't view that as a threat, but view that as an opportunity for you and your team and, and lastly, with the positive nature of work from home that greatly expands the talent pool.

For people who are trying to hire in small, more isolated areas, because you can hire people elsewhere, that're gonna be on your team virtually. So I think that could be a real positive opportunity. Fantastic. As always, you guys do not disappoint. Hey, if people wanted to get in touch with you around coaching, around the work that Starbridge does, so many different areas, security, interim leadership E, and how.

Check on our website, starbridge advisors.com. We've got a blog there. I've got a blog, s shade.com. Reach out to us on LinkedIn. You follow me on Twitter? SG shade is my handle, David. Oh yeah, it is at David months is my Twitter handle. And by the way, our email addresses are easy, . First name, last name@starbridgeadvisors.com.

I'm happy to. And by the way, shade is S-C-H-A-P-E. Yes. So absolutely. Hey, thanks again for, for coming on the show. I think this is, again, invaluable. I was telling you guys earlier that one of your shows that was six months old got a huge spike and I, I, I, I think it, it speaks to the value of it. I think I, I'm speculating that a college professor essentially is saying, Hey,

Or potentially a master's program is saying, Hey, listen to this. There's a lot of great information in this. 'cause that doesn't usually happen. You don't usually have a big uptick six months after a podcast goes live. So I, I think that speaks to your experience and your wisdom. So you started by praising the show.

I'm returning the favor, and I really appreciate your wisdom and the work that you're doing in the, in healthcare. So thanks again for coming on the show. Thank you, bill. Thanks so much, bill. That's all for this week. Don't forget to sign up for clip notes. Send an email, hit the website. We wanna make you and your system more productive.

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