November 3, 2025: What are healthcare IT leaders really concerned about? Fresh from three 229 Project summits across the country, Bill Russell, Sarah Richardson, and Drex DeFord pull back the curtain on the most pressing conversations happening right now. From simplifying AI governance with a two-track vendor approach to rethinking hiring strategies for an agent-driven future, this episode captures the pulse of healthcare leadership in real time. Discover why some organizations are solving hundreds of problems while others struggle with their first five, and learn the one-word qualities leaders are seeking in their next hires to thrive in today's rapidly changing landscape.

Key Points:

• 04:24 AI Success Factors
• 09:57 Balancing Moonshots and Practical Solutions
• 14:37 Sourcing Strategy and Engagement
• 22:32 Building Organizational Culture
• 26:27 Leadership and Succession Planning

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Newsday: The CxO Pulse - Insights and Lessons from 229 Summits with This Week Health

I'm Bill Russell, creator of this week Health, where our mission is to transform healthcare one connection at a time. Welcome to Newsday, breaking Down the Health it headlines that matter most. Let's jump into the news.

Bill Russell: All right. It is Newsday, and today I am joined by the visionary Sarah Richardson. And the um, let's see, what are we gonna call Drex This? Well, Sarah, I'm gonna let you what adjective would you use to describe Drex to Ford?

Sarah Richardson: Irreplaceable.

Bill Russell: Oh.

Sarah Richardson: Oh,

Bill Russell: that's perfect. Whatcha are gonna call Bill the pa. The panel has been convened and we are gonna do a Newsday.

I know it's gonna sound like. Well, you didn't know where you were, bill, is that what was I was in

Drex DeFord: the room right next to you.

Bill Russell: Exactly. Yeah. And it was a pretty rowdy room for security officers. Man. You guys were laughing and who hooting and hollering. I mean, people were even commenting on it.

Drex DeFord: It's great fun.

And you know, this was one of those really interesting, we usually have about half the room. Normally in a 2 29 summit, at least for me, about half are alumni and about half are new people. And so we continue to grow the community. In this particular instance two people were alumni and the rest of the room.

Bill Russell: That's awesome. Here's what we're gonna do. At the beginning of our meetings, we generally go up to a whiteboard and say, what's one topic you wanna make sure we discuss before we leave? I'm gonna take AI so you guys can't take ai. Um, And essentially what I'm gonna talk about is AI governance.

And governance is not a fun topic, but there was a, it was really interesting to me how some organizations were struggling with this and others had really simplified it. And made it something to go with. And the simple framework I thought that I'm going to, I told 'em I was gonna take this and run with it, is they have two AI governance frameworks.

And it was interesting because one organization, they were saying, Hey, look, I gotta get in front of this man. Our backlog is ridiculous. Like we, we won't even look at, you know, maybe three or four. Partners a month because we're moving this slow. And the other person essentially said, look, we split it into two.

We have a different process for trusted vendors. Your workdays, your service. Nows your, whoever your trusted partners happen to be, then your untrusted. And he said, we had the same problem you did. And he goes, now we just, we don't have a problem because our team that really does vet AI is very much focused on the untrusted vendors for strategic projects.

Sarah Richardson: It did, but it came up in terms of more of. When and what to automate, sort of the maturity pathway for healthcare.

But here's the deal. Governance is going to help you determine what's a quick win, what's potentially measured expansion, and what may be future state and how to create that decision tree. So it did different conversation than you, but definitely a, an important aspect of what was discussed.

Bill Russell: What do you think is going to be the foundation for.

AI success. You know, if we're sitting with an organization a year from now or two years from now, what's gonna differentiate the ones that are doing the right things now versus the ones that are maybe not figuring out what to do right now? Drex what are your thoughts?

Don't do it just because you can do it. Have a good reason to implement the, these technologies and take advantage of them. The way that you roll them out, the pressure that you put on end users to adopt them. All of that should really be focused on problems. And I think we have some folks who do that, but I also see some, you know, there's some Wildcats out there too.

Bill Russell: Some Wildcats. Sarah, what do you think is going to define the winners and losers in the next couple of years with regard to ai? I use losers kind of loosely there.

Sarah Richardson: Yeah. You. Those that stay. So an earlier conversation we had in a recent news day was the simplification process.

If it's low cost, can we automate it? And if it's not as high of a patient safety or risk issue, or go slower if those things are in there. And then do our clinicians and patients trust the process and how do we measure it objectively? But being able to connect those dots and create a really, a conversation starter inside of your organization determine, should I do this Now, how does this become autonomous for clinical ops?

And then really. Areas where your organization can truly measure it and go just beyond the IT element. And so better start doing it and start doing it now, but have a framework that's simple to follow and makes sense for people to understand. Biggest thing is removing all that fear, uncertainty, and doubt that goes around ai because it doesn't have to be scary.

And by the way, it's already happening, so get your arms around it sooner than later. You know,

Drex DeFord: perfect, is the enemy of good part of this, right? Yeah. The whole

Sarah Richardson: human loop. Hundred percent.

Drex DeFord: Don't try to have a plan to solve world hunger. Just like, pick a problem and start working on it.

Sarah Richardson: Yeah.

When people feel like they're part of the decision making process goes back to all the OCM principles, we know well then those are the ones that'll win faster than others.

Bill Russell: All right. Only because our production people asked me to be more adversarial, which can you imagine they would ask me to do that, like on purpose?

It's crazy. you, You are mostly right. Both of you are mostly right. This is me being my doing the old McLaughlin factor. I don't know if you guys are an old enough for that. Are you? Oh, yeah.

Drex DeFord: No, I know McLaughlin. Yeah. Yeah. Oh, okay.

Bill Russell: Yeah. Oh. You are wrong, Morton. Sorry. But the, you know, I think it's gonna be those who recognize that this is an organizational change management project period.

Sarah you mentioned the measuring the outcomes and those kinds of things. Every good organizational change management project understands that it's built on a foundation of trust and the trust comes from solving the problems that people really have. And then measuring those problems and showing them that they pro that you solved them, and then they say, okay, yeah, go ahead and do the next one, and the next one and the next one.

And I think we're gonna see, in two years, we're gonna see some organizations have solved, you know. A hundred problems and some are still working to solve their first five. And people are worried about the policies, they're worried about education and all these things are important.

They're absolutely important, but I'm not even sure they're starting correctly. The best start I heard was from Shakib over at children's Hospital of Philadelphia. When he said he said, I can't manage to all these different expectations. So he brought his entire leadership not his IT leadership, his.

We gotta go faster, bigger use AI for everything. And so he goes, you know, the only problem with that is I can't manage to that. Like, I, you as an organization, we can't be one to 12. We've gotta sort of hone in on what we're going to be. And at the end of that meeting, they honed in as an organization, we're gonna be this.

And I like it when you find that agreement. because you know, there's I've seen CIOs walk in and go, well, we're gonna be fast followers, or we're gonna be early adopters, or whatever. I'm like. Does everybody agree with that? Or are you just getting yourself out on the ledge? 'cause you know, you've made a decision, but have you brought it again, it's an organizational change management, so it's just, you gotta bring everybody along.

Most of the organization knows really about solving problems and measuring. How we improved or how we made the situation better for patients and families. Can you do both those things at the same time?

Bill Russell: There's certain days you would ask me that question, I would answer one way and certain days I'd ask and answer it another.

And I'm think I'm quoting you, who was quoting somebody else where he said, Hey, we don't have as much money anymore to make these bets. You know, that was

Sarah Richardson: for Palo Alto Dinner of Interesting that, that quote came from Silicon Valley.

Drex DeFord: And it came from A CFO I, I don't ha, I can't, everything that I place a bet on today has to be a sure thing.

I don't have the financial wherewithal to place bets on things that might not pay off. And it's a really interesting, you know, way of think. I think it's the macroeconomic pressures of the environment and the regulatory environment, the political environment, everything that's going on right now that.

We see folks pulling in their horns and being way more conservative about what they're gonna do and how they're gonna do it, which I think is a really great reason to, you know, focus on those. What are those small things you can fix and make progress on? That's really where you should be putting energy.

Bill Russell: Dude I just interviewed Stefan Proctor over at Chop. It just so happened and him and like one other person used FHIR and all these things to pull in the information and create a way of interrogating the medical record just through using tools that all this stuff that already exists for interoperability and the large language model.

And I think these bets, like we don't have to make the multimillion dollar bets. We just have to give people margin, give them time and let the, like encourage their creativity and say, look. I'm pretty sure, and I give him a lot of credit and I know the last time I talked to him I think I slammed him pretty hard.

Drex DeFord: Sarah and I, you and I talk about this all the time too.

The

Drex DeFord (2): the real epitome of innovation is a lack of resources. That's when you get really creative. Go back to the space example of Apollo

11.

What is it, the movie where they're like, okay, we have to create a filter to filter the air, and here's Apol.

Bill Russell: 13. 13, thank you. Un unlucky. 13 is how you remember it.

Yes,

Drex DeFord: exactly. And so it was like they dump the box out, this is what we have on the spacecraft. How are you gonna make an air filter outta that? People get super innovative. I think it's the same with you and a lot of your experiences.

Sarah Richardson: I left 'cause that's how I used to hire. PC text at the county, I just dump a bunch of parts on a table.

I'm like, if you can make this thing and sometimes there was enough stuff in the box and sometimes there wasn't. And then the one turn that into a computer. Hey, there's not enough. But I'll tell you G and I used to call those the hold my beer moments and I had a little team of humans that like super smart so they could get through their work in like 30 hours or less a week and they'll like, what should we do with our 10 hours?

Think about all three of us have either won or sometimes lost by just putting it all out there sometimes. 'cause we're willing to take appropriate risks. But if leadership doesn't like it, you know, so be it. But sometimes those have been the biggest hallmarks of our career and it wasn't because we wanted the glory.

It's because look what our teams could do.

Bill Russell: Sarah, something from your board. What was on your board that you wanna throw out? Oh

Sarah Richardson: I loved this because it's actually gonna be a topic for an upcoming podcast on Flourish, and that's sourcing strategy, that whole sourcing strategy with engagement. So you've got sort of three tiers of work.

Then it becomes more about. The elevation of the work, not elimination of the work. And you know, how do you do more offshoring, nearshoring, or even outsourcing to a degree without disengaging your team or compromising with your clinicians, your peers, and even your patient's value. That is a strategic analysis of those types of tiers of work, but people are being asked to do it more and more.

It is not a one and done. And the thing that I believe is most important other than the OCM aspect of it is truly if you just pump something over the fence to a degree, it takes a very long time to rebuild that if it turns out to have been a bad decision. And so you really gotta have the right evaluation criteria of what you're staffing and how you're staffing it appropriately.

Sarah Richardson: The question I would ask, even both of you, if you put your CIO hats back on, is how are you determining the right work to be sourced accordingly without either disengaging your team or compromising value in your organization?

Bill Russell: Yeah, Drexel, you go first.

Drex DeFord: Well, I'm just sitting here thinking open ended,

Sarah Richardson: so, you know.

Drex DeFord: Yeah, I'm just thinking about the stuff that I have a hard time hiring for. I have a hard time retaining people for, and the third category is kind of the work that is the boring grindy stuff that people have to do every day and sometimes they don't.

And those organizations can do it for multiple organizations. And since they can do that, we probably also benefit from that crowdsourcing of information that they get across multiple organizations. So, you know, I'm always looking for. I mean, it goes back to the problem where am I really having problems running things and be, because it's probably tied to some sort of a personnel or skill problem.

And then how do I figure out how to make that a better situation?

Bill Russell: I'm not sure. I'm thinking offshore, nearshore I'm thinking AI agents is what I'm thinking right now. If I can offshore it or nearshore it, there's a potential that I'm gonna be doing it with AI agents.

Like, you know, just make sure you clean this up and do this thing that agents will do fairly well. And when you put an AI engine on top of that agent, it will only get smarter. I shared the concern about how do you introduce this in a way. That doesn't disrupt the culture of your organization.

Because I think we're getting platitudes right now of people saying, well, we're not gonna, we're just going to, you know, create more margin for this staff to do more things or, you know, whatever. We're not gonna get rid of any staff. I think that could be true in a lot of organizations.

I don't think it's gonna be true in all organizations. So I think there's a lot of places

Bill Russell: But Sarah, don't you, don't you think there's more work? I mean, the pipeline of work is insatiable. So if we could really offload some work, couldn't we actually get more stuff done? Yeah.

Sarah Richardson: You can, but remember, there's a whole side of upskilling. And so everywhere I've ever gone, I've had to flip the table and sometimes I've been appreciated for it and a lot of times not always, and depending on who's doing the asking, but you don't go into completely transform something with all the technological benefits that may be current state, which is usually why you hire a new CIO as to modernize your organization unless the one's staying up to date.

But that always comes with a disruption of humans. Now, the thing we don't talk about is. Hey, we exited 20 people, but hired five. So the 10 x or aspect of like, the skillset of certain humans that are needed to do the work. Even when you hear about Accenture laying off 12,000 people, they hired 5,000. They laid off, so the net was seven.

Bill Russell: how they upskilled. They laid off 12,000, hired 5,000 people with greater skills. That is, I mean, that's interesting. I've done

Sarah Richardson: it at, to several organizations and the thing is, when you say, yeah, you might be affected, people will either step up or just play possum and some people self-select.

I mean, it's harsh. It's, but it's reality. I mean, I've been eliminated. I've been like, I mean, heck, you consolidations and mergers, sometimes you're picked, sometimes you're not. And that consolidation or merger can be inclusive of advanced technologies. And so it's just our responsibility as leaders to make sure that it's empathetic and humane.

But also we're getting hired to run a company and be thoughtful and respectful of human beings in the process. Now you're gonna do that by running agents as well, and so it just takes on a whole new aspect of the first part of being a true leader, and that's understand where your people are coming from.

So from a business leader aspect, you have to. Totally think about that. And there was a time coming, we're gonna lay off 5,000, we're gonna hire 5,000 agents. May not, maybe not all at the same time, but that's essentially gonna be the effect.

Bill Russell: I, and

Drex DeFord: it's

Sarah Richardson: always

Drex DeFord: tough

Sarah Richardson: when you do it.

Bill Russell: Direction. I want to hear yours.

I mean, the thing I will say about this is I'm more and more convinced that leaders. Within the organization, I think we're gonna have more top heavy organizations who are overseeing agents and other things, but these people are gonna have to have skills, like operational skills could be project management, like you're overseeing a team of, I don't know, a hundred agents or whatever it happens to be.

But it also could be whatever. I'm not even sure entirely what it is, but I think more and more when you're overseeing this stuff. It is not going to be a situation where it's, you're gonna have to know some things. Right. I think

You're really gonna have to understand how the workflow works, and it's gonna be a whole different skill, right? Supervising people. You're gonna be supervising agents who may be spawning their own agents as part of a project, and you need to understand how that really works and what kind of tasks they're getting, and where do they need to be supervised?

How do you have the human in the loop? Where is the right place?

Bill Russell: Really understand the workflow, really understand the data. Yes, absolutely. Drex. What was. What was what was on the board for the

Bill Russell: Just outta curiosity, for the two of you, what's the number one word? Like you're hiring a new. Person, I know there's 10 in your head, but just the one word to make sure that your culture becomes what you want it to be in order to continue to thrive in this AI world.

Drex DeFord: Agility. I mean, you know, don't not building something that's brittle. You have to be able to move and change, and that has to be a good thing. And bridge that change management.

Bill Russell: So in an interview process, you're looking for agility in the next person you hire, like they're, they don't fall in love with any one thing.

Sarah Richardson: Ambiguity.

Being able to handle it or being able to create it.

Typically handle it, although but sometimes you want The creator, but then please check in with me first. But for the most part everywhere I've worked, change is daily. Doesn't matter what size of your organization. Are you okay with that? And how do you handle it? And if you don't handle that like rapid, almost like questionable change on a daily basis, you're probably not gonna do well in an organization where I am.

Drex DeFord: We talk about that as being comfortable with your uncomfortableness. Yeah. That is the world that we live in today. All the way around.

Bill Russell: I don't know what my word is. I'm struggling, first of all, 'cause you guys put this thing at five 30 at night and I'm more of a morning person. But the I'm struggling with the word 'cause I used to think, you know, I want problem solvers, but more and more I want problem solvers that solve problems.

Drex DeFord: I, yeah, that's a disruptor. I mean, I think about is this army knife?

Bill Russell: Yeah, I, well, good. You guys are struggling with the words too. And you're on the West coast, so, what do you, listeners think the right word is?

Sarah Richardson: put it in our chat or put it in our dms. Let us know.

Bill Russell: I have a lot of, I, I just, a lot of experience with people who solve problems and I, and when I come in and I look at how they solve the problem, I'm like, okay, I don't have time right now, but we're gonna solve this. We're gonna solve the problem you just solved. Because it's gonna create another problem down here.

And I already see it like we will, but I don't have time right now. But in six months, I know this is gonna blow up. We'll just, we'll get to it. I want people who solve problems permanently.

Sarah Richardson: We do both for you now, don't we? Isn't that why you hired us?

For Sarah and I, oh, I think

Drex DeFord: that was the question, the like, how do you build that kind of culture in your organization so that when one person leaves or you leave, that the world can just continue to run without a huge disruption.

Bill Russell: Well, we'll keep picking on 'em. So, 'cause we already mentioned them once.

So, Sarah, if you lost G who is arguably brilliant from an architecture standpoint, what are you gonna do?

Sarah Richardson: The cool thing about G is he has a whole band of me men that follow him around and who are selectively available for different types of engagements. So I always said who are the two or three people on your team or like you that I can always rely on just in case something happens?

And so I believe it's important to always know who else in your organization can answer those questions. That's as much about internal, you know, BCDR from a human perspective as it. Succession planning. So there should not ever be one person who can answer only one person who can answer the question.

Bill Russell: The organization's gonna push back on this, by the way. Either the person with the knowledge, it doesn't wanna impart it, or the people you're asking to cross train or overlap, whatever it is within an organization, but it's just been over decades of people looking at me saying no, I wanna expand what I do, and that kinda stuff.

You don't want that bottled into one person. How dangerous is that for, which

Sarah Richardson: is why I can leave you guys to go host an HCSP interview and you guys can finish up the the.

Bill Russell: is that you?

Sarah Richardson: That's in my exit statement. I'm gonna go interview an overtimer.

Bill Russell: Wow. Fantastic. Well, all right, I guess we're done. Sarah says we're done. We're done. Thanks everybody. Thanks Sarah.

That's Newsday. Stay informed between episodes with our Daily Insights email. And remember, every healthcare leader needs a community they can lean on and learn from. Subscribe at this week, health.com/subscribe. Thanks for listening. That's all for now.