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Rehab Industry in the Pandemic with Nancy Ham
Episode 35113th January 2021 • This Week Health: Conference • This Week Health
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 Thanks for joining us on this week in Health It Influence Today, Nancy Ham. The CEO of web PT joins us for a wide ranging conversation on physical therapy during the pandemic, uh, leadership, diversity and inclusion, and a lot of other topics. She is a . Phenomenal guest and I know you're gonna enjoy the conversation.

My name is Bill Russell, a former healthcare CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping health IT staff current and engaged. Special thanks to our influence show sponsors who are investing in our mission to develop the next generation of health IT leaders.

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It's about a . I don't know, six to eight minute episode. Uh, check it out. We're covering the JP Morgan conference right now. Little snippets, uh, all week. Uh, so, uh, I, again, phenomenal conference. We learned a ton of stuff. Uh, that's where you want to go to get the update on, on what we are hearing from hospital CEOs and CFOs.

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Wednesday we have an influence or solution showcase episode, and every Friday we do an influence episode like this one. Uh, be sure to check back for more great content. And now. Onto today's show. All right, today we have a returning guest, Nancy Ham, the CEO of WebPT, returning to the show. Good. Good morning, Nancy.

ike what we've experienced in:

You know, I went through the first dotcom crash, you know, I went through the Great recession. Um, but the confluence of economic issues, societal issues, technology, transformation, it's been quite the year. And then of course it's been a very interesting year because in those prior crises we were still working from the offices, but this time we've all been home in our dens or basements or offices or studios since March.

has been, uh, uh, this really:

Absolutely. So we're a SaaS-based technology company. We provide the electronic medical record practice management system and the suite of ancillary products to outpatient physical therapy. We have the honor of serving, uh, over 20,000 clinics, which is about 40% of. Wow. And, uh, you guys are PE backed. We are

war. Uh. That's been really exciting because Warburg has a real thesis around, uh, specialty specific EMR companies. And so they are investors in four, uh, including us, modernizing medicine, Qualifax and Xper. So we actually have a little, uh, club where we all get together and talk about topics and help one another out.

So that's been really, uh, really helpful during this year. I have my three brothers who are the CEOs of the other three companies, and we talk all the time about what are you doing about this? How are you responding to that? What are you doing about, you know, uh, uh, black Lives Matter. What are you doing about your sales forecast?

So that's been really a, a special thing, uh, to have this year. Yeah, it's, it's nice to have those communities that you can, uh, that you can talk to. What would you have done prior to. Coming together as a, a community like that, would you, would you have had those conversations with, with others, or who would you who on?

I really made networking kind of a hallmark of my career. Um, I enjoy people, I learned from people, and I've grown up in the industry with a cohort of people who are all now CEOs, so I, I just would've reached out to the people I've been working alongside and growing up with professionally for a long, long time.

What made that special is their companies are almost exactly like mine, right? Uh, they just, they just serve a different vertical, like urgent care or orthopedics instead of pt. Yeah. All right. So let's talk about the rehab industry a little bit. Since it's a, the place that you serve, um, how, how has the, how has that, that section of the industry been impacted?

has it progressed throughout:

And I mean, over a two week period. Wow. Boom, patient's gone. Uh, now PT was deemed essential, so it did stay open in all 50 states. And so, uh, the industry did a really good job of getting that message out, you know, reassuring patients about the safety protocols that they were taking. Um, one thing we were very proud of is people were able to use our automated patient messaging system to communicate, you know, what was happening.

We saw a tenfold increase in messages going out to patients, and so patients started coming back very steadily and we saw, you know, a climb really through early Thanksgiving until everyone was back in the 90% percentile of where they were pre covid. Now we're seeing it top back over. So last week we're already seeing visits down 10% again.

And there's a few reasons for that. You know, obviously you have elderly patients who are big consumers of physical therapy who are sheltering in place, um, you know, to protect themselves from. You have, uh, major disruptions to two feeders into physical therapy. So joint replacement surgeries, you know, it's, those elective surgeries got placed on hold for a number of months.

You know, that new patient pipeline dried up and then they reopened and now they're getting crowded out again. And, and also athletics at all levels, um, when people are active and moving, which is awesome. They also get injured and need physical therapy. So the disruption of sports at every level, you know, from kids to pros, uh, has also had a negative impact.

Wow. Uh, yeah. You know, we did a, we did a show pretty early on in the, in the surge with Hospital for special surgery out of New York, and they had transitioned their entire hospital from doing orthopedic surgery to, uh, being a, uh, a med surg unit essentially for, for covid patients. Um, and, and so that, that sort of phenomenon happened, uh, clearly in New York it was necessary and needed to happen, but when we, we, we closed down the elective surgeries that really changed the game.

What, so. So moving forward, I mean, have, have we started to do things differently as an industry in order to, uh, to bring people back? And I, you gave, you gave us this quote the last time we were together and, and I've actually used it in that and, and, uh, you called it the 90% challenge and you said every year 128 million, uh, adults have, uh, mus musculoskeletal condition that.

That would benefit from physical therapy, but only 10% of them ever start physical therapy. Uh, so we call that the 90% challenge. 90% of the people are not getting help. Uh, you know, that was the case prior to the pandemic. Uh, we probably have a lot of people that are, are, are not seeking help. Now. How are we reaching them?

How are we, uh, besides just, you know, texting them and, and asking them, come in. Are there other methods we're using? Well, there has been a big change, uh, in physical therapy in that prior to Covid, uh, there was no reimbursement in physical therapy for Telerehab. And then all of a sudden there was, you know, under the public health emergency, Medicare approved it.

And then virtually all the private payers followed suit. So all of a sudden you could communicate like you and I are right now with patients at home. The industry did a magnificent job pivoting. Some people went from 0% to a hundred percent telerehab in a matter of a couple of weeks. And I think, um, people have been pleasantly surprised.

You know, it's not a substitute for manual therapy. You know, physical therapy is hands on, but you can support patients in their journey to their best health remotely. By checking in with them, observing them, doing their exercises, correcting them. And so we saw a huge adoption in Telerehab. Now we're gonna have a permanent reimbursement issue.

Uh, there's only temporary reimbursement during the public health emergency, so we need it to become permanent, and then we need it to be reimbursed at a level that's closer to what an in-clinic visit is. Um, what, what's it, what's it at now? It's about a third of an inpatient, uh, an in clinic visit, which is too big a gap.

And so we need to work on appropriate reimbursement. But patients loved it. Um, there've been some early studies that have come out, like in base state that said, patient satisfaction is very high and, um, quality was high. I did tele rehab during covid. And it was fantastic. I didn't have to get in my car, uh, I didn't have to risk walking into the hospital, which is where my PT is.

And you know, I, I, I got, well, so I, I hope that's gonna be a permanent change 'cause that's a big part of how we impact that 90%. 'cause PT is inconvenient and expensive. You have to get in your car drive there. Be there for an hour, drive home, you know, two times a week or three times a week. And for a lot of people, that just doesn't work.

They're single parents, they're working families. They can't take the time off from work. They can't afford, you know, all those out-of-pockets. So I'm really hopeful that this is a sea change, a permanent change in the future of this industry. And that's how we're going to, you know, in 10 years, double that.

Pitiful 10% of patients coming to physical therapy to 20% would be a great goal. Are are physical therapists. So I'm, I'm, I'm sort of curious, uh, more than anything on this, uh, do they see Covid patients or do they wait until they, they have, you know, essentially moved past the. Infectious, uh, part of the disease, I mean, are, how, how do the physical therapist sort of approach this?

Well, so one, you know, they all have their PPE. They're just like any caregiver, they have to protect themselves because the patient could be asymptomatic in carrying covid and not know it. So there's a tremendous amount of, uh, PPE and safety protocols and cleaning protocols that the industry is following.

But, um, I ideally, no, they're not treating people who are actively symptomatic. Um, it's usually, um, fine clinically to not have, you know, those visits during that 10 or 14 day period. But at the. Other side. There's this phenomenon of long haul patients. Um, so many people who have covid, not so much the ones who are asymptomatic, but people who are symptomatic and for sure people who are hospitalized, they need physical therapy afterwards, um, to recover their strength.

It's a very, um, debilitating disease for some people. We don't understand why some people seem to sail through it and other others don't. But there are now entire units at hospitals devoted to long-haul covid patients, helping them recover after they've technically, you know, finished the, the, the course of covid itself.

And so there is going to be an regrettably a boom of patients needing that long-term physical therapy after Covid. So I'm technology here in. My my last question on this is, so, so the, you, you sort of touched on this a little bit, but, um, what, what's the lasting impact on, on, on, um, physical therapy going to be as a result of the pandemic, do you think?

Well, one, I do think there is a new class of patients, these long haul covid patients that we need to understand how to outreach to them and care for them and support them over what is a mini month journey back to their full health. But I think tele rehab. It's just got to stick and get to an appropriate level of reimbursement and it took other, um, disciplines like primary care, you know, quite a few years to really figure it out and get the 50 state licensing issue resolved and get the reimbursement resolved.

But I think it's gonna be a major impetus to make that change and that's gonna help PT reach more patients. And it's also gonna help them reach more patients who are, uh, in, uh, socioeconomic classes that are challenged because it'll be more accessible and cheaper, uh, which will help, you know, reach people who don't have the same access to physical therapy as you and I might.

Yeah. So, so let's talk about technology. Let's, let's, let's start with your.

Uh, and work from home and, and, and whatnot. But, uh, were there any specific requirements that you, you just, uh, immediately outta the shoot they were, Hey, we need these kinds of changes made to your product to, to the, uh, the, the system of record? Well, first of all, we had to launch tele rehab, which we did in seven days.

I'm seven days. Seven days. It was, uh, quite, quite an intense seven days. But it's not just the ability to, you know, see the patient visually, it's now you can bill for it. What are the codes? How do you get that to flow through revenue cycle management? How do you include it in your analytics? So it wasn't just, let me get a Zoom session spun up.

There's a lot of other things around it. So we launched virtual visits. We also have launched, uh, touchless intake because, you know, people don't wanna touch pieces of paper, they don't wanna touch clipboards or tablets. And so we had been working on it fortunately because we couldn't have done it in seven days.

Uh, we've been working on it for quite a while. So we launched Touchless Digital Intake. We saw, as I said, a huge uptick in using our patient, uh, relationship management software. There's just such an urgency to communicate with patients, communicate you're open, what your protocols are, that it's safe to come into therapy, but what's different?

Like wait in your car, we'll text you when you know it's time to come in. And we launched a lot of new technology around how do we work with our customers virtually. So normally if we were taking live a big customer, we would be on site. We can't do that right now. So, uh, a whole suite of innovation around our learning management system and how we train clinicians virtually, how we do a, a go live day virtually.

That's been super interesting. Wow. I, I, so I want to, I want to jump into each of those. Um, it's, it's interesting. So the, the one that jumped out at me the most was patient relationship management. Uh.

Was an ER vendor and we were sort of talking about, Hey, we're Salesforce. Why doing does. I'm not sure you understand what relationship management are, so I'm gonna put you on the spot here. Um, because you, you know, when we talk about CRM customer relationship, we're, we're talking about outreach, meeting them, where they're at, uh, multi-channel, those kind of things.

What kind of things did you, uh, put in there so that your, uh, your clients could interact with their, with their patients, uh, where they live? So first of all, it's of course integrated with the EHR, so we know everything about you. We know, you know, why you came to us, what body part you know is injured. We know your age, we know your gender, so we know your whole persona.

So we're able to communicate with you throughout your patient journey in a personalized, clinically relevant way, which Salesforce cannot do. Yeah. And so let's say you, you threw out your back. So the first message might be, we're so sorry. First of all that you threw out your back. We're looking forward to your first visit.

Here's what to expect. Here's information about low back pain. Here's information about how your treatment's gonna go. Um, and then we're gonna communicate with you all along the way, checking in with you, encouraging you, motivating you to complete your course of care. And then we're gonna stay in touch.

We can do that in a really personalized way. Maybe we met you because you're a runner and you injured yourself, and so you might get drips about how, you know, great stretches to do for running or how to train for a marathon safely. So we're able to really, um, engage with you. We also send you on our mobile app home exercises.

You know, pt, you have to do your homework, so you have to do your home exercises between visits. So that's part of this patient automation. And then we did something really different recently. Um, a lot of the outpatient specialties are, uh, looking forward to, to big cuts to reimbursement. Uh, come January the first 9% for Medicare for physical therapy.

So we put out messaging to patients to said, would you mind letting your congressperson know that PT is important to you? And, uh, you oppose the cut? We've never tried it, anything like that before. And in one week we helped generate over 16,000 letters to Congress. Wow. So it, it's, it's hugely important.

And Salesforce, I mean, we use Salesforce as a.

Clinically specific and relevant and timely. By the way, thanks for taking that question in that manner it was meant, which was more informative than, than a challenge. I think you're right. It's, you know, Salesforce is a generic tool and you have to teach healthcare. Whereas you have a healthcare tool and you just have to teach it.

Modes of communication, right? So you have to teach it the multi-channel, you have to teach it. Um, you know, you essentially have to say, look, we have all this information. We could build experiences around it. Whereas, uh, Salesforce, you would have to, first of all, you'd have to lift all that information and move it over to Salesforce.

You'd have to make meaning of it in Salesforce.

It's, it's another license that you have to buy. Yep. And we have a similar tool for referral relationship management. Same thing. Instead of using a generic tool like Salesforce, use a tool that's built for physical therapy. 'cause we understand what kinds of people send referrals and what information do they want back.

So now we are able to say, thank you for sending us a hundred referrals. This many patients started their therapy. Here's their net promoter score. Here's their outcomes. You know, I'm doing a, a really good job with these patients. And so it closes the clinical loop, which I think is really important. Yeah.

So, you know, you're, you're, uh, your telehealth solution. We talked a lot of health systems that essentially early on. Sort of caught flatfooted and they, they said, you know, any way we can instantiate a video visit, that's what we're gonna do. And they're gonna have, on this screen, they're gonna have the EHR on this screen, they're gonna have the, the video visit.

And, you know, given where they were at and what they were trying to do, uh, you know, that was, that was really acceptable. I love the fact.

Yeah, I mean that's like, that's the base instantiating the video visit is really the easy part. It's, it's, you know, how are you gonna track it? How are you gonna get those codes in there and whatnot. So talk a little bit about that process. How did you think about the, uh, how did you think about, and how did you knit together the entire experience so that the experience for the, the care provider as well as the, uh, as seamless.

And really, really, you know, beyond acceptable, really, uh, desired or preferred. Yeah. I, I think the key was the team that was assembled. So the, from the moment we started working on it, we had people representing each of our product lines. Um, we think about products with something we call the golden thread, which is products don't stand alone anymore.

And so you can't just run off and instantiate the video visit without engaging all of the other products and understanding that, well now what? You had the visit, how does the data flow? Um, how does the patient experience flow? How do I need new messages, uh, in patient automation, uh, messaging? Because what I wanna tell you pre and post a virtual visit is very different than your clinic visit.

So it was really just having the right people in the room, I think from the launch. And remembering it was gonna mess up everybody's analytics because, uh, PT maybe more so than a lot of other parts of healthcare is extraordinarily kpi. I focused like they all know their KPIs and we knew it was gonna completely mess up all the KPIs, but introducing this new category of visits at this dramatically different reimbursement point.

And so we knew, like from the moment we had their first meeting, if we didn't fix the analytics. We were getting a lot of support calls, so we had to fix it from the beginning. Yeah, I, I, I love that concept of the, the golden thread. Um, let, let's, let's talk about, uh, tech startup for a second. Um, because you're one of the, one of the people I'd love to ask these questions, uh, of, so organizations were at really different stages of their journey with regard to being a tech startup.

Some could.


The good news is though, there weren't so many of those this time around, like in the first crash or in oh eight, there were lots of people who were on fumes and they went under, but the funding environment has been so robust and people have been raising more money, you know, than they used to. So instead of raising a few million, they're going for 20.

So, um, the portfolios of venture startup, uh, companies that I'm associated with, by and large, they were all fine, uh, financially. You know, they had to tighten their belts. They did what they did, but they weren't at risk of just running outta money. So setting that aside, I think it's people who had have long enterprise sales cycles because you just lost a year basically.

People weren't in the market to buy new, new technology. They, you know, slashed their budgets for innovation. They postpone go lives. And so if you're in that sort of million dollar plus or maybe even $500,000 plus enterprise cycle, your world just stopped. And, uh, you, you literally lost a year. And that's really discouraging because startups need that positive momentum.

But lots of other companies flourished. Bill on the other side, a lot of people went great gangbusters. Yeah. And that's, uh, yeah. So let's explore that side. You know, what, what startups did benefit the most. I, I've heard health systems talk about the, the silver linings that we don't wanna really talk about a pandemic, like, Hey, this was good for this.

But it did create an environment where they could thrive because they were supporting, uh, the clinicians, they were supporting contactless, uh, care, they all sorts of things. So what kind of startups benefited the most, do you think? Well, certainly anything tele or contactless, uh, you know, went off the charts as we saw.

But companies who deal with mental health. Stress, resiliency, um, just boomed because whether people were buying it for their own employees or, you know, buying it for their beneficiaries or their patients, uh, that whole group, uh, did tremendously well. And I'm a little embarrassed to say that EMRs like-minded really well because, um, ironically, when your patient volume drops to a historic low.

If you're thinking about making any technology changes, that's actually a really good time to do it, um, because you have the time and the space. And so we took a lot of people live this year, and I hear that from other people in other, you know, specialty EMR verticals. So one of our themes was, well, you can't work in your business right now because you're closed or you have very low volume, but you can work on your business.

That will make you stronger and, and rebound faster. And, and that's a message that actually really resonated well. So C-E-O-C-E-O of an organization, talk me through when did it become apparent to you, uh, that, hey, this is gonna be a different year? Things that the Pan pandemic. I, I, I mean, we were talking about the pandemic in late.

It felt like it became more real early on in the year. When did it become real to you, and then what steps did you have to take as ACEO, uh, early on in the process? Well, I think it hit us all in March, right? Yeah. You went from planning and worrying about it to boom, it's here and we have to do all these things right now, and that, that changed in about a four day period.

Honestly. I remember distinctly on Monday, I was talking to my project team about a three or four week project to get everyone home. And then on Tuesday I told 'em they had to do it by Friday. So it was, yeah, I remember that week really clearly. So first of all, of course, shift everybody home. Uh, that was easy for part of our company.

You know, your developer take your laptop and go. But for other parts of the company, like revenue cycle management, that was a little different. We got everybody home. Then we had to reinvent workflows because, uh, revenue cycle management for, for example, can be very paper intensive. And we said, well, but you, you don't get to have a printer at home.

Uh, 'cause that's not HIPAA compliant and there's not a shredder in your house. So we need to be 100% paperless. By Monday. So let's figure that out. Oh gosh. And then we had to re-engineer, like the culture of the company. You know, we had a very strong in-office culture. That's how we work, that's how we have fun, that's how we collaborate.

And so, uh, moving to Zoom, uh, you know, we had to figure that out, but I think it's made us stronger in a lot of ways. Um. Almost every team has a daily standup now, and you're all equal on Zoom. You know, before you might've had some people in the office, some people on the phone, somebody might remember to turn a camera on.

But now being all equal and present on Zoom, uh, has leveled the playing field. I think the communication from our teams has skyrocketed. Um, people have learned how to have fun on Zoom. Our employee net promoter score doubled, um, during this period, which is not something I would've anticipated. And I mean, the outpouring of communication, I, I think every CEO this year, however much communication they were doing it, it's up by 10 x and it needs to stay up by 10 x.

That's the new normal. Yeah, we're, we're seeing that, we're seeing that, uh, uh, employee satisfaction, net promoter score or what, however they're measuring their employee satisfaction. We're seeing at least, uh, you know, a seven per seven to 10% bump this year. And, uh, you, you wouldn't anticipate that in, in this environment.

And part of it's probably that communication. Part of it's obviously people have a little bit more autonomy. They can see their kids a. Um, and those kind of things. But I think we've also, I, I don't know about your environment, but it's, it's not uncommon for me to have a, a conversation with somebody and their kids are in the background or, uh, or those kind of things.

We've become more, uh, tolerance not even the right word. We've become more accepting of the fact that people are working in their homes, they have a family life. It's almost more real to us. These are people and they have a, they have a life and we've become, I don't know, just more empathetic to people's situations.

That's, that's what it feels like to me at this point. We've definitely become more human. You know, before this started, I knew maybe 10 employees, the names of their dogs. 'cause we had a dog from Friendly Workplace. I know a lot of dogs and cats and kids and spouses now, and I think that's awesome. Thank you.

And the other thing that's been different, at least for us this year, you know, in the past I didn't communicate a lot emotionally. I didn't talk about love. I didn't talk about our family, I didn't talk about myself that much. And all that's changed. We're all now much more authentic, who we are. And I'm a much more, I'll say, emotional leader, and I think that's been really important.

Um, we have some videographers who work for us and normally they're at trade shows doing things, but since there are no trade shows to go to anymore, they've started some web PTTV series. Um, one is every Friday, it's where we work. They film somebody you know at their house, you know, they film through Zoom.

You learn all about them, which is really cool. And then they started a series called the Feel Good Files in which employees share like the most amazing raw, authentic emotions. And the message is, it's okay that we're not okay. Nobody's okay. Like don't put up a fake facade. Nobody is okay this year. And I think that's been really different too.

People. You know, senior leaders in our company being very, sharing about their own struggles has been moving and powerful, I think. Yeah, I think, uh, you know, when we have a, a healthcare podcast, I think we focus in a lot on the pandemic, but we, we also had, we had an election, we had black lives mattered. We had, um, uh, just a lot of diversity.

Um, talk about, if you could talk about your journey, uh, in that area. What, what are you guys doing? How are you approaching it as a leader? Well, one, I think it was a huge wake up call for us, because I think we prided ourselves before George Floyd, that we were a diverse, inclusive, welcoming company, but we realized we were not

Equally focused on all communities. And so we were overinvested in some and not at all invested in others. So it's been a huge effort for us. So we are committed to it as a company. I signed ACEO, um, you know, action pledge with uh, p wc. We have rolled out unconscious bias training. We've rolled out workshops.

We now have nine or 10 new employee research groups that. People of color, but also to veterans and people of faith. So back to, you know, everybody's in a community and we need to embrace and celebrate all those communities. Um, in our regular, uh, company meetings, we spotlight different holidays like it's

Native American month, and let's have a Native American employee talk about what does that mean to them, um, or write about it in the digest. So we've all learned a lot more. I, I'll tell you the one that was the most interesting. So we put all these holidays on our corporate calendar and along came National Left-Hander Day

And the dialogue and stuff. I'm, I'm sorry, I didn't mean to offend any left-handers out there, it just struck me as, as I didn't know there was a day for that. Well, I know, but the dialogue that sprung up in, uh, slack, uh, showed it was such a path to empathy. People said, well, you know, I always feel like I don't fit in the world's made for righties and I have to do.

Then people started thinking, wow, how much harder then for all these other kinds of people to fit into a world that's not made for them? It was the most incredible on-ramp to empathy. That one small thing. Is that really true? That the world is designed for, right-handed people? Is that I, I, I, I really hadn't thought about that.

Well, it's, the world is designed for the majority, so Yes. Right. Yeah. And you know, the other thing though that I think has been really important for healthcare is there's a direct correlation between racial inequality and health inequality. We see it in socioeconomic determinants of health. Your zip code, your genetic code, uh, are the two most powerful indicators of your risk.

You know, it's not the actual healthcare. We see covid impacting communities of color at rates of, you know, 200%, 300% more than, uh, non communities of color. And so there is this direct linkage between racial inequality and health inequality that I think is very important for us as a healthcare community to keep a focus on, keep talking about, and this can't be a moment.

This seems to be a permanent movement. And I'm seeing so much amazing work starting to happen, uh, in payers, in providers, in tech vendors really recognizing that. And so I hope that that's a permanent change. And I'll pick on physical therapy. Not a very diverse, uh, industry. And so the support from the industry now to recruit more minority students to help them start their practices.

Engage more, engage with patients of color, who a lot of whom are in that 90%. I, I think it's a really permanent positive change and I'm pretty excited about it. Well, it's interesting that you're, you're fostering those conversations amongst your staff. Um, yeah, I mean, 'cause there's so many, so many questions I would imagine that people have.

It's like, you know what, what can I do? You know? It's not, it's not like people can't watch the. A lot of it is, is translating into, okay, wow, this is a huge problem. How do I even start, how do I get engaged? How do I, um, how do I become a part of the solution and what does it look like? I mean, there, there has to be, and, and that's just the tip of the iceberg for the questions I'm sure that people have.

Yeah, I was raised in a, you know, big companies where you didn't talk about certain things at work and all of a sudden these are the most important things to talk about at work. So it was new for me to. You know, moderate, uh, zoom with a hundred employees talking about race and talking about our company and are we doing enough and what can they do as individuals?

And it's a very interesting con conversation for us because so many of our employees come from internal referrals. And so I put a challenge out to all of our employees. You need to broaden your own networks. If you want us to be a more diverse company, you need to bring that diversity in through your own personal relationships and the referrals that you make.

You can change the needle because we hire employee referrals at a much higher rate than people we interview from the outside world. So that was just one very specific thing to get them thinking about. But we also talk a lot about inclusion versus diversity and um, I heard a great, um, way to think about it recently.

And I'm sorry I don't remember who to attribute to, but diversity is, you're invited to the dance. Inclusion is you are invited onto the dance floor. Um, equality is, you got to help pick all the music and at the end of the day, how did you feel when you went home from the dance? So one thing I do talk about with the company, diversity is actually rather easy, but inclusion's very hard.

'cause inclusion is human and personal and. Every individual can make more of an effort to be more inclusive, and Zoom actually helps you do that. It's easier to get all everybody on the Zoom talking and contributing equally. All right, so closing question. What's the coolest thing you guys have done on Zoom?

Although, my gosh, using your videographers than to tell those stories. That's that's gold right there. I mean that's, that's, I hope every organization is doing something to that effect. Have you, have you guys done, I mean, I've seen people talk about scavenger hunts and different things that they've, they've done on Zoom calls.

What's the most fun things that, that your team has done? Um, we did an incredible trivia contest and the team that put it all on, put so much thought into the questions, the music, the backdrops, like it was a full on produced show, kind of like who wants to be a Millionaire was really fun. Um, uh, cooking class Oh wow.

Was really fun. You know, all the ingredients sent out ahead of time. Everybody learns to cook the meal together, I think was a good one. Um, painting together, you know, again, you send out the supplies and you sit there and, you know, paint and drink your wine is very fun. Um, today my team's doing a virtual wide elephant, so we'll see how that goes.

virtual, so you just, you send to somebody else's turn. No, you actually, you, uh, set up your gifts as virtual gifts. You just take the URL of what it is, and then you wrap it and put it into the game. And then, you know, you go through the usual picking and swapping and laughing and teasing, and at the end, whichever gift you end up with get shipped to you.

Yeah. Wow. You have a creative lot you work with. That's, that's, that's a. Well, our marketing department, who is also not going to trade shows right now, they curated a list of more than 50, uh, activities that you can do virtually so that each team didn't have to figure it out for themselves. So people who have event teams, that's a good thing for your event teams to be working on right now.

Yeah. That's fantastic. Uh, you know what, Nancy, I, um, I love having conversations with you. You have challenged me. You have educated me and, uh, I, I just, I, I enjoy, I, I, I enjoy our conversations. This is, this, this show isn't gonna air until January. So some people are dated. Just because we were having this conversation, uh, a little bit before, uh, before the holidays, so, uh, uh, I just wanted to put the timestamp on there so people don't, they, they'll recognize that, uh, we're, we're talking a little bit, um, before the new year actually kicks in.

Thanks. Thanks again for your time. I really appreciate you coming on the show. I always love it. You're so thoughtful about the questions and the topics, and I love that. I never know quite where we're gonna go. That keeps it fresh and fun. Have an awesome holiday, bill. Thank you very much. What a great discussion.

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