The Healthcare Leadership Experience Radio Show

Storage in healthcare is often seen as a low priority. Brad Fitzpatrick of FitzRight Storage Solutions explains why it plays a critical role for hospitals to Jim Cagliostro.    Episode Introduction Brad explains why he is potentially in the business of ‘'life and death,'' how Covid changed the storage landscape and the opposing views of storage as luxury versus necessity. He also highlights the positive impact of storage on hospital margins, and shares why success in business comes from a focus on customers and ‘'attracting'', not chasing.  Show Topics   Two common storage pitfalls The impact of Covid-19 Storage is ‘'potentially life and death'' Convincing the C-Suite Transforming relationships: A storage success story  Leadership tip: Focus on your passion      04:15 Two common storage pitfalls Brad explained why hospitals push storage down the list of priorities.   ‘'I would say probably the number one would just be the misconception that optimizing your storage is more of a luxury than a necessity. And everybody has different reasons for not moving forward, or for lack of a better word, neglecting. Whether it be, "Well, we intend on doing that one day." Or, "It's out of the budget." Those two are usually the biggest ones. But the one day is a slippery slope because you don't want to wait until you have a fire till you get the sprinklers installed. ‘One day we'll do it.' ‘'   05:50 The impact of Covid-19 Brad said the storage landscape changed a lot after the pandemic.  ‘'I'm sure this applies to everything, and it won't surprise you when I say it, but Covid. Once Covid happened, and the pressure came on unexpectedly, I think everybody was able to assess how prepared or unprepared they were when the chips were down. And then, once that dust settled, there were some hospitals that said, "Okay, we never want to be caught off guard like that again. What areas can we fix? How can we fix it?" But then, there were other facilities that said, "We'll wait until the wheels fall off." And, actually, there is one hospital I spoke to recently, and they were told that, "Well, wait until the wheels literally fall off and then we'll redo the room." 11:25 Storage is ‘'potentially life and death''  Brad said access to supplies and equipment can improve patient outcomes.  ‘'Yeah, I don't think it would surprise you that, first and foremost, I think it impacts patients with reduced delays. We're in the business of potentially being life and death. So quick access to supplies and equipment, it minimizes any treatment delays, and that also improves patient outcomes. That said, also, I think the professional environment, a well-oiled machine doesn't work as well if the gears aren't where they should be. A well-organized hospital creates more of a professional and a reassuring environment which, for their patients and their families, can really go a long way. But hospitals aren't exclusive. A library runs a lot better when it's organized. A restaurant, a law firm, everything works better when things are where they should be and there's no surprises.''   15:09 Convincing the C-Suite  Brad explained the advantages for leadership in recognizing the value of storage.  ‘'I don't really see myself as the type of salesman who's really trying to convince anymore. I'm more of attract, don't chase. But that said, when I come in, I can read the room. I know when I'm here to give a bandaid, and then I know when I'm here to give open heart surgery. But that said, there's an increasing number of individuals who see the value in storage after years of working with me. And some of the best projects I have are when these individuals, they get relocated to a new facility with a higher role. And then they have a whole clear canvas that they're able to paint and make their own baby and really create. And I don't think it's a coincidence that the individuals who prioritize organization and storage are the ones who are finding themselves getting these new roles and being scouted for them. It speaks for itself, I think.''   18:14 Transforming relationships: A storage success story Brad shared an example of how storage transformed a customer relationship.  ‘'One comes to mind, is a big hospital system of maybe about 13 hospitals there. Clean supply rooms were all converted over to a system, I won't mention them because I don't want to throw dirt on anybody. But they were sold on the concept on paper. It seemed great. So they went live with it. And out of the gate, they just had a lot of trouble, and they were ghosted by the customer service. And as we said, not to be overdramatic or put my theatrics, but, sometimes, it is potentially life and death. And they just didn't have the margin for error with this system, so they had to take the financial loss. And then they brought me in to convert over to my storage systems. And we had to come in and work weekends when cases weren't going on, and we had to act fast because it's not like one supply room per hospital. It's every floor has a supply room. So I didn't have much of a social life during this conversion, but I learned a lot about my products. I learned a lot about my customer. I like to think that my customer service was put on display, and my relationship with that hospital system became stronger than oak.''   20:24 Leadership tip: Focus on your passion Brad said success in business isn't all about the numbers.  ‘'Obviously, I know that I'm not like everybody else. And I zig when everybody else zags sometimes. But I discovered, around 2018, that storage was my passion. And not to sound too corny, but I think it's my purpose in life is working in hospitals, and getting them organized, and helping them run more efficiently. And as I said to you, my numbers are no longer my motivator. I'm not looking at the numbers and saying, "Oh, is this a good month or a bad month, financially?" I don't watch the pot boil. I just focus on taking care of myself. I take care of my customers, and I think the rest just takes care of itself. I'm more mindful and attentive of what my customers are saying, and I'm not trying to push the most profitable product. I'm trying to, if they have a square hole, I have a square peg. If they have a round hole, I have a round peg. I think that that goes a long way. And my relationships, I think, have just really been cemented, especially the last year, ever since I was able to start FitzRight, and really engrave that culture into the company. I feel that my solid relationships have gotten even more concrete with my customers. And where thoughts go, energy flows, and I know that that's a pretty cliche line, but I like to think that my customers can see that. There's a sense of trust. And, again, it's more of attracting, not chasing.''     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Brad Fitzpatrick on LinkedIn   Check out SpendMend    You'll also hear:    Seeing things in a different light; Brad's career journey to Fitzright Storage Solutions: ‘'I always marched to the beat of my own drum. I know I don't really have the same energy as a lot of people out there, but I always found that I saw things in a different light. … then, in my old age, I became focused in on the relationships with my customers, and pushing more of a solution than one particular product.''   Luxury versus necessity; two opposing views of storage: ‘'I have customers who I've had a long relationship, who know the value of getting everything in order and the benefits of it. But then, also, when I'm called in, I also know that if I'm called in because Joint Commission was just in, I'm not there to totally redo the thing. I'm there to put a bandaid on it so they could get Joint Commission or inspection off their back.''   The positive impact of storage on a hospital's bottom line: ‘'Efficient use of the storage space can reduce need for additional storage spaces. And in tow, that means a better inventory management, avoiding unnecessary purchases, or stocking up on materials that can expire, and overstocking on those types.'' What To Do Next:       Subscribe to The Economics of Healthcare.       2.        There are three ways to work with SpendMend: Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  SpendMend can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.      3. If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or Jim Cagliostro at jcagliostro@spendmend.com. .  

Success in every industry is about effective leadership. Business coach and author Steve Lover explains how every organization can inspire world-class performance to Jim Cagliostro.    Episode Introduction Steve explains why confidence is the #1 priority for every employee, outlines the five keys to effective hiring and the three factors to fuel world-class performance and explains why customer service is dead. He also outlines why motivation doesn't work, why organizations need to get messaging out of the marketing department and why everything happens on the other side of fear.    Show Topics   Defining ‘'world-class'' Five keys to effective hiring 3 ways to ignite world-class performance Fear and courage aren't opposites  ‘'Customer service is dead'' Messaging needs to come from something real  Leadership tip: step into the fear     07:07 Defining ‘'world-class''  Steve explained why success in every industry is all about leadership.  ‘'I like to say, and this is really, I've said that I say this in two different places in my book, but it's really interesting speaking to a medical group of people. When you walk into a doctor's office, sometimes you'll walk in, and the staff is pleasant and they're nice and they're welcoming and they're caring. And you walk into another office, and you feel like they're doing you the biggest favor by just showing up to work in the morning. Very often they're sour faced, sometimes they're even nasty. Well, I believe that that comes from the doctor. A doctor that really cares how his patients are treated, that's the first office you went to. A doctor that's really worried about what the money in the business is looking or other things or efficiencies. That's the second business. So people have to be, they're going to follow you and how you lead them. And what Willink came out in his book was in the good leader over there, everybody had extreme ownership of what they were doing. And the other one, they didn't. And so really, you had mentioned something earlier, what world-class is. And to me, the definition of world-class is when you decide you want to do something, and you can fulfill it. So we say we want to get this done as a company. The fact that we can get that done based on what we said we wanted is what world-class is about. And when it comes to having people work for you and getting them on the program and then getting them involved and getting them excited, it's a whole different ballpark on how you're going to have those discussions.''   12:12 Five keys to effective hiring  Steve outlined what every employer needs to look for in a new hire.  ‘'I believe there's five things that you need in a good employee, and they're not the five things most people look for. The first one is, do they have an aptitude for the business? Now, you might have a business that needs a certain amount of skill that they've learned, but experience is never what it's at because very often you have to unteach them. And so do they have the aptitude? Do they have the ability to do this work? Is this work a good job for them? Number two, the most important of the five is, do they have the right attitude? Are they people that are going to be upbeat, optimistic, go, and with a gusto to the business? The third one, the hardest one to find is, do they have a good work ethic? Most people today do not have a good work ethic. And so finding people that have a good work ethic or would like to develop it, as a third one, that's the hardest one to find. The next one would be, are they coachable? Is this somebody that you're going to be able to have a real discussion, help them get better? And they're going to be willing to take that discussion. If they're not coachable, it's a mistake. And then finally, are they a good fit for your culture? If they're not a good fit for the culture, that's going to create waves. …. And if those five things are in place, I believe you can overcome almost anything.''   14:57 3 ways to ignite world-class performance  Steve explained why he prefers inspiration to motivation. ‘'That's really what the whole third section of the book is about. The shortcut is I told you there's three things that are in place to create confidence, which were taking on a big challenge, doing deliberate work on it, and getting results. So the corollary for the manager or leader is to inspire the challenge, encourage the efforts, and to celebrate the results. And there's a lot to unpack there because first off, I do not like motivation. I believe motivation is totally the wrong thing. Motivate means I get you to do things that I want you to do for my reasons. Whereas if I inspire you, I get you to do things that you want to do for your own reasons. And if you think about what people really want, like the salesman example, I can come to them and say, "Listen, we really need you to do this because this is what our company needs right now." Or you can say, "You'd like to have that extra money? Wouldn't you like to go on vacation this summer and you'd like to get that new car?" Which one do you think is going to help them take on the challenge and do it better? Right, inspiration. So I don't believe in motivation. I always see inspire. Second off, when it comes to the work, anytime somebody's doing something difficult that's off the charts for them that they haven't done before, it's scary. ‘'   16:40 Fear and courage aren't opposites Steve said leaders need to encourage employees through challenging times.  ‘'A lot of people think that fear and courage are opposites. Couldn't be further from the truth. They're brothers. If you're not fearful, you don't need courage. Courage is only around if you're fearful. If you're not fearful, I don't have to be courageous about anything. But if I am fearful, that's when I get to put on my courage pants or my courage jacket, whatever is, and go do things. And so what they need is to be encouraged. The word encourage means to give somebody else your courage. Now, I'm not doing the hard work. It's easy for me to encourage them. And I like to use example of the guy who's working out and he's doing bench pressing and he takes on a new weight that's higher than he's ever done before and some guy's spotting him and he gets number eight, and it goes tough in nine. He's struggling and the guy spotting him says, "It's all you. Come on, you got it. I'm here for you. Just go a little. Push a little more, push a little more." And he gets his 10 reps because the encouragement.  And that's the same thing that a leader has to do. They have to encourage their people when things are going tough. Not necessarily push them, not necessarily hang it over them, not necessarily berate them, but just the opposite. You have to encourage them. Get them to keep the picture of what they want to do, what inspired them to go do it better. And then probably the most important is to celebrate the results. And most business owners absolutely are horrible at celebrations. They just don't know how to help a person see it. And I'll just give you an example for a kid. A kid comes home with a 99 on a math test and dad could say, "Wow, great job, kid." That's almost not even a compliment, let alone on a celebration.''   26:22 ‘'Customer service is dead'' Steve said the customer experience is much more important than ‘'customer service.'' ‘'But the bottom line is the customer journey is everything. It's a very funny thing, the words “customer service” is part of our lexicon for so long because it was so important, but actually customer service is dead because customer service is about remedial. When something goes wrong, what do I do to fix it? And although you still have to have that, there's something much, much more important, and that's called customer experience. And the way I like to explain it like this, you go to a restaurant and the ambience is beautiful and it looks nice, and the waiters are well-trained. They stay close enough that you can get them if you need anything, but far enough away that they're not intruding on your meal. You look at the menu, everything sounds so good, and the prices are really reasonable. The meals come out, it looks better than it sounded, and it tastes better than it looks, which is usually not the case….You are floating, cloud nine, this was such a great client experience, customer experience, can't wait to tell all your friends. Before you leave, you go to use the bathroom and the bathroom's dirty. Filthy. What just happened to your entire experience of that night out? Instead of telling your friends about the restaurant is, they're going to say, "Don't use the bathroom if you go there…Here's the real funny thing in my example, the bathroom experience has nothing to do with the dining experience. It's a necessary evil. You have to have it there for them, but this is not... They're coming for all the things you did right, but the non-central part that wasn't right is going to screw up the whole experience.''   30:34 Messaging needs to come from something real  Steve said most mission statements are written for marketing purposes.  ‘'So I think that really starting with the message is putting the cart before horse. And the reason I say that is there are three things, and every time I mention them, of course everybody rolls their eyes. That's a mission statement, the vision statement and the value statements. And the reason they roll their eyes, everybody's heard it a million times before. But the problem is all those statements have usually been taken over by the marketing department. They've been hijacked. And the marketing department writes those things for brochures, for websites, and for walls — not for what's really how the company works. So if you want to look up something really interesting, go look up Enron's value statement. That's in the book. Because it has nothing whatsoever to do with what Enron really was as a company. It's like it's laughable, integrity, you know what I mean? Honesty. It's baloney. And so any messaging that's not coming from something real is going to be a problem. So when people say, "Listen, our most valuable resource is our people," and then they blow up at them or they embarrass them at a meeting or they treat them like garbage in some other way, it's not the messaging. It's who they are as people.''    35:56 Leadership tip: step into the fear.  Steve said the other side of fear is where everything happens.  ‘'By the way, when you fail, no one's going to remember anyways five minutes later because they're thinking about their toenail, not about what you did point. And so it's about stepping up and going to do that thing you fear, because the other side of fear is where everything happens. And we've gotten so fearful of making a mistake, of being thought of as an imposter. There's another sentence, I love this a lot: You'll stop worrying about what people think about you when you realize how little they do. And so stepping out, taking the plunge, and doing the thing that you really want to do and you're afraid to do, that's where magic happens. And that's where magic happens for leaders and followers and everybody. But when you get that going, then the second thing is, I'm a big believer in a 90-day cycle. Every 90 days you pick on something new that you're working on, and you take that challenge that you've never done before that's frightening, and you're going to have to do it. And figure out what the actions you're going to take and what the celebration's going to look like. And so you're going through those 90 days. Well, if you have a company and you have employees and every 90 days everybody's upgrading who they are as either people or employees, and they're not separated, you end up with a different company a year later. They've gone through four iterations at the end of the year, and there's no way your company looks the same.'' Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Steve Lover on LinkedIn   Check out SpendMend    You'll also hear:    Steve's journey from rabbi to business coach and author: ‘'I got into coaching, and I found the missing thing. Sometimes you got to have a guy who is afraid to pick up the phone and he can have all the knowledge, skill, and desire he wants, but if the phone feels like it's 3,000 pounds, he's not lifting it up. And that's the same in any industry.''      Why confidence is #1: ‘'Confidence is the number one thing that you can have to be a great employee. Nothing else even comes close. And the problem is owners don't realize and don't necessarily hire to that and they don't do anything about that.''   Why success precedes confidence: ‘'Most people think confidence is something you talk yourself into before doing it, that you get confidence and then you get good. It's just the opposite. Success precedes confidence. When you go to do something, you don't do well and you become successful at it, that's when confidence starts to pile in.''   Expectations versus agreements: ‘'I don't believe in expectations because I think when you have expectations, you are setting yourself up to be disappointed ….So instead, we do agreements. What agreement is, is okay, this is the problem we're trying to solve. I'm supporting you on getting the thing done that you want to do, that you're committed to. And now it's not about my expectations, well, they let me down again. It's about people owning the thing that they're going to do, and they react differently when they do that.''   Building relationships in healthcare: ‘'Healthcare is not my thing. I'm just looking at it as an outsider, a consumer of healthcare. And when you have somebody that takes the time to explain things to you and speaks to you and shows that they care… when you're at that place of trauma... People understanding, it makes that trauma so much easier. It makes it so much easier to walk through it. And cutting corners in so many different ways, such a big mistake.''   Why authenticity doesn't exist: ‘'And the reason I say that is we're all in the middle of changing and growing. And so when I'm authentic, I'm authentic about yesterday, not about today, because today I'm at a little bit of chaos. It's not my idea. This is from Seth Godin.'' What To Do Next: Subscribe to The Economics of Healthcare.       2.  There are three ways to work with SpendMend: Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  SpendMend can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.       3. If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or Jim Cagliostro at jcagliostro@spendmend.com. .  

Higher education plays a vital role in preparing and developing healthcare leaders. Dr Giuseppina Pagnotta explains why to Jim Cagliostro.     Episode Introduction Giuseppina shares her inspiration for going back to her doctorate during Covid, the importance of giving back to the world and how higher education can support career aspirations in nursing and healthcare. She also explains the role of connection, and why time is one of the most precious gifts leaders can offer.          Show Topics   Higher education can open doors  Paying it forward: sharing your knowledge Offering inspiration and guidance through mentoring Self-regulation and building connection  Leadership tip: Giving the gift of time      04:00 Higher education can open doors Giuseppina encouraged people to understand how further education can support your career aspirations.  ‘'And I tell people now, young people or anyone that's getting their nursing degree, whether it be from an associate or a baccalaureate program, to go on for the MSN. It's really important in today's world to get that advanced degree because you can keep it in your back pocket, and then it will allow you to have doors opened for different opportunities in your facility or in education or even as an entrepreneur. There are so many nurse entrepreneurs out now. So I attained my MSN in 2020, and our graduation was outside because of COVID, so we ended up having the graduation outside in August of 2020. And then, during that COVID spring, I realized, "What will I do with the MSN? Will it get me where I want to go?" So on that note, I evaluated, "What would I do with it? What doors will it open?" You always have to consistently evaluate, and I even tell my children, "What doors will your degree open? Where will jobs proliferate? Where can you get employment? What do you want to do with that degree, and what is the propensity of getting a job?" So then, you have to evaluate what employment opportunities does that degree align with.''   08:44 Paying it forward: sharing your knowledge Dr Pagnotta explained why sharing skills and knowledge can help others.  ‘'I think that if you have a skill, knowledge, skill, abilities, whatever you have, and I don't want to keep them for myself. I am on this earth for this many years and if I can share my knowledge and share my path with you, then you can take it forward and go take it somewhere. I realized in the past few months that it's not about me. It's about what tools I can give to you and what tools you could run with. And I don't even have to hear from you ever again as a teacher-student, but just to know that I impart with you with the skills to learn and to grow and to get excited about learning, that's enough for me. And also, with recent times and my recent role in the Monmouth County School Nurses Association, I realized that I'm giving my leadership skills to others, and I'm teaching them school nursing leadership and nursing leadership, and they're rolling with it. It makes me so happy to see others flourish with the skills that I'm giving them and the excitement and fostering that relationship and creating an excitement in them in the role in nursing leadership.   14:06 Offering inspiration and guidance through mentoring Giuseppina said it's important for leaders to examine their motivation behind mentoring.  ‘'I think it's dual fold. It takes a lot of work, but yet it's so rewarding. For myself, I started out as an American Nurses Association mentor. I think it was two years ago, and I was matched with a mentee across the U.S., and we would meet, I think, once every two months for 15 minutes and talk and then give each other... I would give strategies as to what her aspirations were or their aspirations, and we would continue the conversation there. It was interesting because I tend to want to inspire you. I want to inspire you in your path, and I want to look up possibilities for you. If you want to go back to college, I will look up colleges for you and look up different programs that you may like to attend in your area or that have the specific degree or certification program where you would like to go….And also, it's important for you to examine why you would like to be a mentor and what purpose does it serve for you. For me, it just serves the purpose of guiding. I love to guide colleagues into their path, colleagues, students, friends. I really get excited and happy about doing that. It gives me joy, lots of joy to do that, to help others and discover what their potential is because sometimes you don't know your true potential. And I have had several colleagues that have shown me my true potential.‘'   18:49 Self-regulation and building connection  Dr Pagnotta highlighted two key elements to support academic success. ‘'…. as a student and as a nurse already advancing in your degree, even if you are in an inpatient unit with a BSN, and you would like to be on a committee, shared governance committee, there are a lot of opportunities. In academia, I think initially, the administration and the chairs and your professors guide you, but then at a certain point, you kind of take over, and it's all you because you yourself, especially in a DNP program, you have to be self-regulated and to regulate your time and to really understand, "I have this much time today. What can I get through?" So it's important as a doctoral student for me to write down what I need to attain and also the deadlines. When is everything due and when am I going to revise? So definitely in that path. In addition, I think that it's really important for academia to set up paths to have the students connect, especially in an online platform. MSN programs are online. DNP programs are online. They have to have a coffee place online, its own place for students to connect to each other. So the nerd that I am, and friends, colleagues can say this that I've had in class with, I would email all of my classmates in the beginning of the semester, say, "Hi, my name is Gius. Nice to meet you all. If you want to connect and chat about the course, here's my number." And so I've met amazing people throughout my time as an MSN and DNP and actually some classmates that I can call friends today.''   22:03 Leadership tip: Giving the gift of time  Giuseppina said empathy, guidance and giving time through mentoring is highly rewarding for leaders.  ‘'I think the connection with family and friends and colleagues is very important. And also, to have that empathy and caring aspect about yourself, I think that is a big part. I tend to be very empathetic and very caring, even with students and colleagues to guide them in the right direction even if something is... You lost a lot of points on a paper, or something happened, and I will tell them how to get most of the points next time or how to prepare so that it doesn't happen again. I'm that type of person. And also, with mentorship, with my role, with inspiring others, you give yourself, and you give others your gift of time because your time is so important. And you give a gift to others, and you give them a gift of your time because your time is really precious. I think by me giving the gift of time to others, it's rewarding. And you had said nurses burn out…. It's difficult, and you're always giving, giving. But when you are a mentor, you're also getting that feedback from somebody else that's saying, "Thank you. Thank you for your time. I appreciate talking to you. You inspire me." And I think that's important.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Dr. Giuseppina Pagnotta on LinkedIn    Check out SpendMend      You'll also hear:    Gaining a doctorate during Covid: ‘'There's nowhere to go. There's nothing to do… So instead of watching Netflix and binge-watching and discovering new shows out there, I decided to go back to my doctorate. So then, I was immersed in leadership classes, mentorship, and population health, epidemiology. And so, I never looked back.''   Giving more back to the world: ‘'Do you like your current position? Do you feel like you can give more back to the world? And if you feel like you can give more back to the world in your particular profession, well then, you have to consider ways to give back, either it's with a certification or teaching CPR or teaching others or entrepreneur or patenting something.''   Why face-to-face connection matters: ‘'I think we're realizing the importance of that face-to-face connection. It's great to have the digital ability, but to meet in a coffee shop, to meet someone, go for a walk, and to really get to know someone, I think that's huge.'' What To Do Next:       Subscribe to The Economics of Healthcare.       2.        There are three ways to work with SpendMend: Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  SpendMend can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.      3.   If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or Jim Cagliostro at jcagliostro@spendmend.com. .  

Language can have a powerful impact on the patient experience and our perspectives on illness. Claudia Cometa, author, pharmacist, and founder at Peace Advocacy Group explains why to Jim Cagliostro.    Episode Introduction Claudia explains how her passion for advocacy arose following her father's illness, and how moving away from images of a cancer ‘'battle''  helps us to see our bodies as allies, rather than adversaries. She also highlights the barrier to healing created by the language of competition, how she found inspiration from the Princess of Wales, and why no patient should feel like they are a burden.                Show Topics   ‘'How is this the patient experience?'' Seeing our bodies as allies, not adversaries Moving away from an ‘'illness identity'' Overcoming the language of competition  Creating a more peaceful patient experience Leadership tip: Twofold knowing      02:44 ‘'How is this the patient experience?'' Claudia said it was her father's cancer diagnosis that prompted a heart-centered decision towards advocacy.  ‘'…my father was diagnosed with cancer in 2016, and I quickly was in crisis resolution mode. I was on the other side of the equation, jumped headfirst into that side as it just made sense. I was the only one in my family who was medically trained. And so I saw the other side of the system for the first time of any significance and was mortified like, "How is this the patient experience? How did I, number one, not know this was the patient experience and how am I just now coming to grips with what is happening on the other side of where I'm working?" And it was very discouraging. Obviously helping my father, you want the best care for your loved ones. And so to not be able to get that, to be dismissed, I ended up firing several hospital systems. It was a really, really negative experience. And that was with my oversight. That was with my deep understanding of the medical system, how to navigate it. …. And so I vowed at that point that I have to do for others what I did for him. There's just no other way around it. …. It was a feeling that I've never felt before. It was a heart-centered decision-making I had never done before…''   06:32 Seeing our bodies as allies not adversaries  Claudia said using ‘'battle'' language around cancer makes it sound like our bodies are the enemy.  ‘'… if I go back to when I was helping my dad, I hadn't really come to this realization yet. And so I was the daughter who was posting on social media, "We're going to fight this, cancer chose the wrong girl." I just fell into the trap of what sounded like what I'm supposed to say. Like, "Yeah, I'm going to win this battle." And it wasn't until years later, well beyond when he passed away that I really started to question, some of this being part of my spiritual growth too and personal development, but how are those words really helping us? If we are really talking about whether it's cancer or another illness as if we're going into battle, and ultimately, we're going into battle with our own body. So if we are going into battle, there has to be a winner and a loser. It's no different from any war that we're used to in history class or any wars that happen right now. There's going to be somebody who's going to come out victorious and somebody who's going to be a loser. Is that the approach we have to take? Is it just that that's what we have heard, that's what's been modeled for us, that's what society has taught us? And so it feels good. It feels like, "Yeah, we're going to fight this." And so we have this internal, "Yeah, maybe this will fire me up if I feel like I'm going to go into battle and I'm going to put on my boxing gloves and I'm going to win this thing." Is there a better approach? Can we start to shift that into, instead of being at war or an adversary to our bodies or our bodies being the enemy, can we actually come back to it being an ally? So is it possible that the symptoms that we're experiencing, whether it's cancer or literally anything else, anything else that is a symptom we are experiencing, can that be seen as a message from our body? Because our body obviously isn't able to speak a language.''   11:04 Moving away from an'' illness identity'' Claudia said a ‘'mind over medicine'' approach can help to change the language around cancer.  ‘'So number one is, okay, maybe a second opinion wouldn't be cancer. I don't know. But then there's the second part of this deep-seated illness identity of if I move through my life with the statement, "I have cancer," running through my mind at all times, then I am acting like what I think a cancer patient is. And so it becomes a deep-seated shift in our identity. And I saw it with my dad. I wasn't able to process it till later. But it's like, "Okay, well, now I'm that person." And this is actually mind over medicine, it's actually a thing. It's actually a book. It's a fantastic book. It's a well-researched concept. In fact, there's studies showing that women with breast cancer, if they are told they're getting chemotherapy, even if they're not, so they're told they're getting chemotherapy, they actually get placebo, they lose their hair because they're so convinced of the identity that comes with chemotherapy like, "Okay, when I get chemo, I lose my hair." So there was no pharmacologic or physiologic reason for them to lose their hair, other than the deep-seated identity that that gave them. So I really do think that our language around illness and how we process the identity around our illness is so important. It doesn't mean it's easy because you're swimming upstream. The easy societal swim on the lazy river is just do what everybody else is doing. Right? And so how do we start to shift this paradigm? And it's hard when nobody else around you is. And so it takes each of us to start making that shift.‘'   15:50 Overcoming the language of competition   Claudia said our cultural language can block out messages from our bodies.   ‘'…..there is an element in our society of competition, and there are some settings where competition makes complete sense and sports is one of them. That makes sense. I don't really believe in participation trophies. When you are playing a sport, it's competition. It just is what it is, but that has permeated... The concept of competition has permeated our society so far beyond sports and so far beyond the arenas where it needs to be, and sickness isn't immune from that. We feel like we're always fighting something, we're always competing with something. So if we're in business, we're competing with the business owner who does the same thing we do. And even in social dynamics and high school, it's like we're always competing. We want attention. We want social media. And so it's almost like in every aspect of our lives, there's this trying to win something, win attention. And it's rare that we just are okay in what's happening and able to quiet ourselves down and evaluate what's happening and learn from it. It's like we just want to keep getting louder, like, "Now we're going to be the louder one. So my body's getting loud, I can be louder." And it is not to anybody's fault. I fell into this trap with my dad. So I think that when we start to shift in... Perspective is the perfect word, is when we start to shift our perspective that what if your body really is doing everything it can possibly do to share a message with you that could change this? That it's basically saying, "Look..." The body has an innate amazing resiliency and ability to heal, but it can't do that. …… our bodies also cannot undergo the healing processes that it so divinely knows how to do if we don't give it what it needs. And so can we just get to a point where it's like, "Okay, I hear you body. What is it that is lacking here?" Maybe it's something tangible like a shift in food, movement. Maybe it's something intangible like stress. Maybe it's connecting to your intuition, maybe it's loneliness. Maybe you've been isolated. We saw this obviously a lot in COVID.''   22:14 Creating a more peaceful patient experience Claudia explained why preparing for healthcare appointments can help to reduce stress.  ‘'So you are allowed to have health goals. You are allowed to have intentions for appointments. You're allowed to voice those intentions for appointments. You're allowed to prepare, and you should prepare for appointments. If I have an intention at this appointment that I want to get this specific thing answered, let me backtrack and see what information might be helpful for that physician to help me clarify that and help me get to where I want to go. And so I'm going to start taking notes, taking journals. Maybe I just started a medication. Let me take notes on how I'm feeling after the medication. Maybe I have trackers of my blood pressure. Let me keep all that information instead of sitting in the doctor's office and the waiting room, scrolling my phone or looking through magazines. What else do I want to get from this appointment? And let me get in the right mindset of being an activated patient. So a lot of the environment and healthcare that is already chaotic and stressful, we don't necessarily have a lot of control over. So what we can do is what is in our control, and that is the things I've just laid out and many more. And the verbiage that we use and our choice of physician, right? There are some really great matches, physician to patient……what can you do within your control, language being one thing, and these things being another, that that can help your healthcare environment and your healthcare journey be way more peaceful?''   32:02 Leadership Tip: Knowing is twofold Claudia explained the importance of ‘'getting quiet.'' ‘'So I think there's elements of that, definitely elements of getting around the right people and just being a lifelong student. I don't think any of us ever just reach a level of knowing enough, and that knowing is twofold. Knowing from a knowledge standpoint, how can I learn from others and glean from the wisdom of others? But then the deeper knowing which we talked about with getting quiet, how can I also... I often take people through an exercise where on paper, we split it in half, knowing on one side, knowing on the other side. One knowing is, "What have I been taught? What did I learn from others? I would've never known this if somebody didn't tell me." And on the other side is, "What do I know that nobody could tell me otherwise? I just know it from a deep place," kind of like me starting Peace Advocacy Group. Nobody could have told me, "That's a bad idea." I wouldn't even have asked, and I wouldn't have listened. So what do you know from a deep inner knowing and how can we continue to nourish both of those sides of knowing?''     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Claudia Cometa on LinkedIn    Check out SpendMend    You'll also hear:    The purpose of Peace Advocacy Group: ‘'So I'm not an entrepreneur by childhood….the challenge of course was, "How do I build a business? I don't know what I'm doing. I don't know how to make a website." So really, the challenge was the logistics around the business. And so in 2017, I started Peace Advocacy Group…. locking arms with individuals who are in a situation of a lack of clarity, feeling dismissed by the medical team, feeling like they're not getting answers and they don't know where to go.''   Inspiration from the Princess of Wales: ‘'And for those who follow Princess Kate and her recent announcement of cancer, it was like a little bit over a two-minute video, but if you really dissect it and listen to it in its entirety, she never once said, "I'm going to win this fight. We're going to win." There was no war language. She also never interestingly said, "I have cancer," …. She said the physicians found cancer….there wasn't this ownership, this possession of the identification of cancer.''   Tapping into the power of guided meditations: ‘'There are great guided meditations that I've led and that others have led that really help you tune into, "Is there a message here? There's something that I need. Maybe I need more rest. Maybe I'm actually so stressed out in my job that what I need is a shift in career. Maybe I need X, Y, Z. I need to shift my diet. Maybe I've really gone off the wagon and the processed foods I've been eating are not serving me." But we can't hear that until we quiet the external noise. And we certainly aren't going to be able to hear it if we're in battle.''   Patients should not feel like they're a burden: ‘'You are allowed to ask questions. You should ask questions. If you just think about the fact that you are in a hospital bed, swallowing pills you don't know what they are, you're getting IVs in your arms, you don't know what it is. It doesn't feel good. That can't possibly feel good to not know those things.''     What To Do Next:       Subscribe to The Economics of Healthcare.         There are three ways to work with SpendMend: Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  SpendMend can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or Jim Cagliostro at jcagliostro@spendmend.com. .  

A competitive environment can prevent healthcare organizations from engaging online. Justin Poulin shares his insights into the untapped potential of social media with Jim Cagliostro.    Episode Introduction Justin explains why the key to a successful podcast is consistency, how the pandemic masked issues with supply chain workforce shortages, and how silos in healthcare hold people – and organizations - back. He also explains why competition makes people fearful of social media, provides key tips to getting started and explains why ‘'chasing the money'' will always leave you dissatisfied.   Show Topics   Consistency is the key to successful podcasting Bring your whole self to an organization The supply chain workforce shortage came in under the radar Healthcare supply chain needs more mentorship Tailoring content to your target audience Competition creates a fear of social media  Getting started online Leadership tip: ‘'Promote, promote, promote''     02:56 Consistency is the key to successful podcasting Justin said creating a regular schedule is the most important factor for long-term success.  ‘'….podcasting, so much of it is a soft skill. I could give you little tips and pointers, but the most important thing about podcasting, and you're doing a great job with this, it's just being consistent. Making sure that you are putting content out on a regular schedule that people know what to expect. I see a lot of startup podcasts and they come out with a lot of gusto, and they do a bunch for about two or three months. And then, all of a sudden, there's a four-month gap. And those ones never really take off. I've always told everybody who wants to get involved and do it, "Hey, nobody's trying to own this space. It's a fun, creative outlet. But one of the things you have to do to be good with it is make sure that you are constantly putting out consistent content." You could do a podcast once a quarter, as long as you deliver it once a quarter on a schedule that people can expect…..It's like the TV series that comes to this great cliffhanging end of season two, and then they don't get renewed. And you're just left going, "Why? Why did you do this to me?" And so, yeah, that's the experience. And so, if you're doing podcast, just stick with it.''   11:24 Bring your whole self to an organization Justin said healthcare can be siloed but merging skills and interests benefits every organization.  ‘'…what a convergence of my passion to do this radio show podcasting, my clinical background as a nurse, and then this entrepreneurial sales side. It's all just merged into this role and what this company is. And who would've thought all of that would've intersected, what I was doing? And I saw it as something separate. So I'd also encourage people to consider their diverse interests and experiences. And not try to partition or segment them but, actually, bring them to the table and bring their whole self to their employer, or help them create their dream job for themselves. It's really important that I think a lot of times we're taught diversify your revenue streams, you hear that, so it's all segmented. And you think about healthcare and it's very siloed. But we actually do that to ourselves. We silo our skills and interests, instead of merging them into what makes us a unique human being, which is, ultimately, how we can bring the most tremendous value to any organization that we're involved in.''   14:28 The supply chain workforce shortage came in under the radar Justin explained the impact of the pandemic on staffing shortages.  ‘'I feel like the supply chain shortage, or workforce shortage, is sneaky. It came in under the radar. I'm sure people in supply chain might've been aware that it could be become an issue, but I don't think it was as transparent as the one that everybody talked about with nursing. We could have planned better, for sure, but we knew it was coming. I think some of the things that had happened with supply chain was really the emergence of strategic sourcing and these other roles that, at one point, when you said supply chain, in a lot of ways, you meant logistics or materials. And maybe a little bit of contracting and purchasing. But what has happened since the Affordable Care Act and value-based purchasing is we've now really expanded on the skillset that's required, where you can take your career.. But then, obviously, I think the fact that we didn't have enough people with enough experience in growing into these advanced roles in supply chain really came to a head when we hit the pandemic. Because, prior to that, it was pretty easy to say, "We're doing okay." Because we're consolidating agreements, we're looking for discounts based on volume and economies of scale, really. And I think once the supply and demand and the supply chain itself got disrupted, I think it really exposed something that was inherently there that we dodged dealing with for a really long time.''   18:19 Healthcare supply chain needs more mentorship Justin explained why time constraints are affecting leadership's ability to nurture talent.  ‘'I definitely think there needs to be more mentorship, but I think there's plenty of willing mentors out there. The problem is, with the constraints that we're under, you're talking about taking somebody and their time that is incredibly valuable right now. So I feel like we're a little upside down on that. I think there's a lot of willing mentors that are in leadership positions. But it's about nurturing the talent and that takes a lot of time away. And, honestly, if you're already short on talent, then you're in a position where you're already lifting up, just with your own personal efforts. So how does the senior staff in a supply chain carve out that time right now to really mentor and nurture the individuals that are coming onto their team? So I think they can still do it, but I think they need a lot of augmented resources to help. And if you just even look at standardized training, like we've got the CMRP through ARM and there are some other programs that are out there, but, by and large, most of the training is institutional. And some of it needs to be tailored to the healthcare organization because everybody does things a little bit different. They use different ERPs. And so you can't just put a standard training package together. It requires, I think, the new blood coming in to be quite motivated, and also able to self-educate and be self-motivated to educate. And so, for that to really happen, you've got to inspire them. And you've got to give them resources that not only give them information, but that also give them encouragement.''   21:26 Tailoring content to your target audience Justin explained how social media enables people to find valuable content.  ‘'… …So I think the answer to the question that you just asked me is individualized. And I think this is one of the keys of social media. What it does enable people to do is to find the content that they find valuable. And as a matter of fact, LinkedIn, in the way that they continue to do developments in their platform, is geared around connecting people with noted experts that are talking about the things that somebody wants to be learning about. They're very focused on that. And they also throttle... They don't want big media blasts. They don't want content in a commodity sense, where you just hit everybody and hit them with a ton. They don't want the users of the LinkedIn platform to get washed out. They want them to be pulled in and find value for being on their platform because it helps them grow professionally. That is different than the approach for Facebook. However, I still believe in all forms of social media having a purpose. But you do have to tailor the content to that targeted audience, and which platform they're on, and maybe the reasons that they're on that platform. So I prefer LinkedIn for a lot of reasons. But, mostly, I believe in their philosophy about connecting people to the resources that they are looking for and/or needing.''   25:20 Competition creates a fear of social media  Justin said collaboration and transparency can help to transform healthcare. ‘'We talk a lot about transparency, collaboration. There are a lot of themes that people incorporate into their vision for how to transform healthcare, not just in the supply chain but across the board. But, yet, we say those things, but a lot of what happens is we live in a very competitive environment. And I believe that we haven't really taught our culture here in the United States how to work collaboratively and competitively with a certain amount of respect. And I think a lot of people are fearful of social media because of that reason. But if we actually learned how to do what you just said, where we could converse even with our competitors on certain topics... Because guess what? Your competitors, because you're bringing different value props to the table, it's not a one size fits all. It's different perspectives on how to solve similar problems. And those perspectives match up with different cultures in different ways. And I think we fail to recognize that it's not you're everything to everybody. You're hopefully, and every good business owner knows this, you're hopefully aligning yourself with a good customer for your company so that they have a good experience and that only builds your reputation. I think we absolutely need to do a better job, not even just in healthcare,  but in general, of how can we come to the same table with our competitors in a professional manner and both benefit?''   30:34 Getting started online Justin said getting involved is about more than being a content consumer.  ‘'… the best way to do it is to follow some hashtags, like #HealthcareSupplyChain, HealthcarePurchasing. Just look for some of those. Maybe find some companies that you've done business with, colleagues, and connect with them. But, essentially, curate the content that you want to see on LinkedIn. And when you find something that you have maybe some thoughts on, the hardest thing is creating content. It takes effort, it takes thought. But the one thing you can do to share your knowledge, you can share somebody else's post on a topic that you're either experienced or passionate about. Or that you know, "Hey, this was a great conversation that so-and-so had on this podcast." Or maybe somebody just does a general post, a couple of paragraphs on an experience they had. You could highlight that by sharing it out and saying, "Really good insights here." Something that I have always noticed that people often overlook, you don't have to tell the whole story. You don't have to be the single authority. But it definitely helps when you share somebody else's content with one or two lines that include your own insights. And especially if you think it's something that most people miss. Just get other people thinking by seeing your post. That's the best way to get involved, not just be a content consumer. ‘'   34:16 Leadership tip: ‘'Promote, promote, promote'' Justin said a servant leadership mentality is common among successful leaders.  ‘'I don't know if this is really a big aha lesson, and I might give you two, but a lot of times people are worried about elevating the people that work for them or that they're mentoring. And I just think, time and time again, it pays huge dividends to elevate those that are under you. They're never going to replace you. You're just going to become more valuable. And you never know where they're going to go in their career. So I feel like in leadership, it's just promote, promote, promote, and develop the people that are around you. You never know when you're going to need them. So, sometimes, there's just that hesitancy. I think all the great leaders are never worried about being replaced. And, sometimes, on the sales side, that can be adding staff to the team, or maybe it's you're adding a CRM, and so you know all of the functions of your role are now going to be documented. And you're like, "Oh, that could make it easier for them to bring somebody else in... You're never going to have a shortage of career opportunities if you approach it that way. You just won't. So I think that's a common amongst really excellent leaders. That servant leadership mentality I think is really important.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Justin Poulin on LinkedIn    Check out SpendMend    You'll also hear:    Justin's career history, via nursing and a podcast on Boston Celtics: ‘'This is in 2005. Podcasting, that term was coined in the same year. I didn't even know it was a term. I called it a toll-free, live, call-in webcast, specifically for Celtics fans. I had people calling in from Australia and Italy, all over the world. And wound up credentialing my way into the locker room with credentialed access to the Boston Celtics. I was the first person from new media to get in there.''   Tackling the workforce shortage in the healthcare supply chain: ‘'And then you're also competing with other industries, which is another difficult aspect, as people don't really find the healthcare supply chain as a destination career. They find supply chain as a destination career. They go to school for it. But not always for healthcare. And a lot of times, the wages are just more competitive in other industries. And so we do find that there's that new talent that's being trained isn't necessarily landing in healthcare roles, unfortunately. And it's certainly something that we need to tackle.''   Why the healthcare supply chain is limited on social media: ‘'And I think there's some fundamental reasons for it too, which is to say people don't necessarily want to share their strategies for fear of losing their negotiating leverage. So I think the healthcare supply chain leader, in general, is positioned differently than maybe a clinician in how they would have a discussion on LinkedIn.''   Don't chase the money: ‘'But chasing the money, I think, will almost always leave you somewhat dissatisfied. So align your organizational strategies with your professional goals. As long as it's not simply money, you'll win every single time.''     What To Do Next:   Subscribe to The Economics of Healthcare.   There are three ways to work with SpendMend:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  SpendMend can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or Jim Cagliostro at jcagliostro@spendmend.com. .  

Marketing effectiveness has fallen by nearly a quarter since 2020. Ian Baer, Founder & Chief Soothsayer at Sooth, offers his insights on how healthcare organizations can respond, with Jim Cagliostro.   Episode Introduction Ian shares how 90% of today's marketing decisions are emotional, and 80% are made on impulse, and the challenges of ‘'marketing by the pound.'' He also explains why a regulatory environment means healthcare often stays in the shallow end of the marketing pool, how data unlocks empathy between brands and audiences, and advises everyone to ‘'bring your soul to work every day.''   Show Topics   Making emotional connections in marketing Sooth helps brands to understand the truth Healthcare has unique marketing challenges ‘'Marketing by the pound'' The roadmap of healthcare marketing is the most complicated The power of patient stories Leadership tip: Bring your soul to work every day     08:13 Making emotional connections in marketing  Ian said 90% of the decisions people make when spending money are emotional.  ‘'AI, it's very buzzwordy, but what it does for us is it allows me to take what used to require one or two years of custom research that might cost hundreds of thousands of dollars, into a methodology that we can execute in a few weeks to give a brand a very clear understanding of the emotional journey of the individual that they're trying to reach. Now of course, the impact in healthcare is huge because look, 90% of all the decisions people make when it comes to spending their money are emotional. It's a big mistake marketers made for decades upon decades in thinking there's a balance between the rational and their emotional. No, there isn't. People make emotional decisions, and then they seek rationale to back up where their heart has already gone. And Harvard did some brilliant work that they published in 2016, an article I recommend to anybody and everybody get their hands on, called The New Science of Customer Emotion. .. And what they found was, of the thousands of different emotions we all experience, it's been estimated that people experience 34,000 different emotions. … But what they found is there are actually only 10 things that we feel as humans that have a positive correlation to the way we spend our money.''   14:54 Sooth helps brands to understand the truth  Ian explained the background to his company name, and its purpose.   ‘'So, I went looking through my LinkedIn profile, just going through all my experience and, "How can I describe what I do?" And I found a LinkedIn recommendation from a former client in which he referred to me as, "Soothsayer." And it reminded me that very often, when we were at a time of crisis for his brand, he would pick up the phone and call me and say, "Oh, soothsayer." And that would very often start our conversations. I thought, "Well, that's a really interesting word." I always thought a soothsayer was somebody who predicts the future. It's not. Soothsayer is somebody who tells the truth. The word sooth literally means truth. It just went obsolete in the English language about 400 years ago when Shakespeare got done with it, which is what enabled me to actually trademark it as the name of a business. It's pretty hard to get a vernacular word as the name of your company. So, when we decided to name the business Sooth, because in reality that is exactly what we're doing is helping brands understand the truth, then it just followed suit that I should be the soothsayer, that we actually have two practices at the company. We have the soothsaying practice, which is determining what the truths are, and then our client partnership practice, we call those people ‘'soothsolvers'' because what they do is actually take the truth and put it to work in really smart marketing recommendations, and work in partnership with senior leaders on the client side.''   17:23 Healthcare has unique marketing challenges Ian said the regulatory environment means that healthcare is averse to taking marketing risks.  ‘'Because of the regulatory environment, healthcare marketers have learned to play it extremely safe, and it's understandable. The last thing you want is a slap on the wrist, or much worse, from the FDA when you've spent countless millions of dollars, let's say, bringing a drug to market. But the result is most healthcare marketers have become conditioned to stay in the very shallow end of the swimming pool. And where that becomes unfortunate, we spoke earlier about no industry really needing empathy in their marketing more than healthcare. Well, we now have the ability through use of data, through use of technology, through one-to-one connection and interaction, through experience design, to create a really special personal experience. And yet, data privacy is a scary thing. Engaging with someone, one-on-one, whether it's through social media or other, that's a scary thing because you may wind up having to capture adverse reaction information that you then have to report to the FDA, that a lot of people would prefer not to get their hands up. So, the result is you have too many brands that don't say enough to really be helpful to people, and they're holding back way too much. And one of the biggest challenges there is the unregulated side of the healthcare space, the area that a lot of healthcare marketers might not want to acknowledge as legitimate, companies selling nutritional supplements, companies selling devices that don't really have any medical benefit, but they're claiming, "Just put this on your wrist. Just put this on your knee. Just sit up against this thing." They're not operating under the auspices of the FDA. They're making outrageous claims, and almost daring consumers and competitors to sue them. And because we live in a world now, where it's very hard for anyone to find one truth in any area of marketing or the news, consumers are somewhat in the crosshairs here. So, if healthcare marketers play it too safe and continue to stay in the shallow end, the ones who lose are the very patients and families that they're trying to help, because they'll chase false promises that really are leading healthcare marketers can fulfill in a much more meaningful way.''   21:35 ‘'Marketing by the pound'' Ian said marketing effectiveness is down by nearly a quarter since 2020 and 80% of people make decisions on impulse.  ‘'Yeah, marketing effectiveness overall is down 23% since 2020, as a global practice, across all industries. Marketing is significantly less effective than it was 20 years ago. So, we have more data than ever, more technology than ever, more access to people than ever. And we're getting so bad at this that most brands have now shifted much more to managing the economics of marketing, how much they're spending. It's become somewhat of a marketing by the pound model because if we can't get it to produce more, then we just have to spend less on it. And everyone has gotten to settle for this reduced level of performance. How did we get here? Well, impulse is a huge issue. The extent to which people make purchase decisions, and a decision to seek out a certain medication, that falls into the category of purchase decisions. The extent to which people do this on impulse has doubled in the last 10 years, and the amount of money people spend on impulse purchases like that, "I'm going to click twice on this Facebook ad and get those gummies and throw out my metformin." That's happening faster than ever. So, when 90% of decisions are emotional, when 80% of people are making decisions on impulse, which means they're not gathering the facts, they're not gathering information, they're not calling their doctor, they're not asking other people who are suffering with the same condition. They're just saying, "Yep, that's for me." That's how we got here.   26:33 The roadmap of healthcare marketing is the most complicated Ian explained why patients and professionals walk one path, with multiple points of view at every step.  ‘'Here, every step of the way, there's an advisory relationship going on. There are certain things the consumer can do without the professional. There are certain things they cannot do without the profession, and it really is a pathway that needs to be curated. We need to understand where they come together and the information they need to reach the right decisions, and where they're going to be off on their own, exposed to different information. So, I think starting with the fact that there is no differentiated journey between the patient and the professional, but actually it's one journey, it's one path, and they're both walking it. They just enter and exit at different times. I think that's the most critical truth to understand, to start to do this thing the right way and to see every one of the decision points through multiple sets of eyes: the patient, the professional, often caregivers are involved. Sometimes you have primary and specialist professionals, institutions, payers. There are multiple points of view at every stage that need to be considered. It is the most complicated roadmap of marketing that exists.''   30:32 The power of patient stories  Ian said there's no substitute for hearing people's ‘'data-rich'' real stories.  ‘'There's a lot of things a drug company can't say, that a patient can. And I think the more drug companies get comfortable giving voice to the people who are actually on the journey with that disease or that illness, it's really going to help bridge the gap between this kind of odd mix of old school branding and clinical detail. But within all of that, I have a hard time finding the humanity, and I think the more brands get comfortable, letting people tell the story of what it's really like to experience the uncertainty of disease, the hope that comes with treatments. I had a heart attack six months ago, a massive heart attack, the type that has a 96% fatality rate. It was the first cardiac event of my life. It changed my perspective on everything. I've learned a lot about my body, about my health, about what it's going to take to live a good healthy life for as long as I can. I've got a story to tell. There's millions of people like me who have stories to tell, and I would love to see more healthcare marketers be brave enough to let people tell their own stories. I think that would make a dramatic difference. Through the work we do here, we try to approximate that. We do a very good job of creating data-rich stories that represent people's beliefs and fears and tendencies. There is no substitute for hearing people's real stories. And when I see healthcare brands step up and tell real stories, I applaud them…… People retain information 30 times more when they hear it in a story.''   34:41 Leadership tip: Bring your soul to work every day  Ian shared an encounter with journalist Jimmy Breslin.  ‘'If you've never heard of Jimmy Breslin, you should find out who Jimmy Breslin was, because in New York in the 1970s and '80s, he was the most important voice in journalism. He told the stories of this city. And I got to meet him. And in a conversation in which he talked me out of a career in journalism, which is a story for another day, the advice he left me with was... the last thing he said as I walked out of the room, "Hey kid, don't be a suit. Whatever you do, don't be a suit." Now, nothing wrong with suits. I own a few. I wear them occasionally, but what it really meant to me and what I internalized and have carried as a mission is, "Don't ever give up who you are in the pursuit of business success. Don't ever give up your integrity. Don't ever give up your identity. Don't ever let a company tell you what you're really about as a human being." That has never let me down. It has defined both my good and bad career choices, but I think as much as you can stay true to yourself, that's what the world needs from you. AI is going to move in and automate a lot of the things that we don't need humans to do for themselves. So, more than ever, really bring your soul to work every day, and everyone that surrounds you will benefit from that.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Ian Baer on LinkedIn    Check out VIE Healthcare and SpendMend    You'll also hear:    Ian's mission at Sooth: ‘'There's nothing more we can do as marketers, as a noble mission, than to help people live better, longer, healthier lives, protect families against the economic crisis that healthcare represents in our country right now. And that endless money pit, and homes and savings being lost, chasing solutions….. Our mission at Sooth is really all about being able to quantify and leverage a very deep level of understanding and empathy to solve people's problems. And gosh, doesn't healthcare need that?''   Disease is the #1 cause of bankruptcy in the US: ‘'People don't talk about that enough. It is more than just selling drugs. So much more than that. When you talk to people whose lives are being impacted by these diseases, it changes everything.''   What Soothsayer offers to healthcare organizations: ‘'What we do as a practice is give brands a highly robust understanding of all of that intricate emotional decision-making that they can literally wire their brand's marketing into. There is no category where empathy matters more than healthcare because everyone's journey with an illness is unique. …we're able to see all the way through, see where those emotions collide, see where they might cause people to sort of go into their own camps and how the brands can bring them back together.''   Why brand equity is occupying the wrong place in the timeline: ‘'Most brands still are too focused on the moment of truth, whether that truth is a click, whether that truth is a purchase, whether it's making an appointment, whether it's a visit, whether it's an order, whether it's a script. And what they're not focusing on is understanding who that person is before those transactional moments take place, and solving their problems, or at least giving them a pathway to a solution before they ever reach the moment of impulse. Because once you let them get to that moment of impulse, it is Dodge City.''   Data unlocks empathy: ‘'…my whole business is about using data to unlock empathy between brands and audiences. So, there's a huge role for data to play, but data is not just about targeting and segmentation and managing the numbers side of things. We are all, really, walking data vaults. Our data includes experiences, our data includes our emotions, our impulses. These are data points too, and they're every bit as valid and important, and drive 90% of the impact of marketing effectiveness.'' What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

US health systems are slowly adopting a patient-focused approach. Shanil Ebrahim, Partner in National Life Sciences & Healthcare Consulting Leader at Deloitte Canada, explains its benefits to Jim Cagliostro.    Episode Introduction Shanil explains why healthcare needs to move away from the ‘'one-size fits all'' approach to patient care, why patients should be treated as partners, rather than recipients, and the impact of a healthcare model designed around systems. He also outlines why patient-centered care is an investment in quality and efficiency and highlights the benefits of adaptability in leadership.   Show Topics   Patient care goes beyond managing health conditions Healthcare is designed around the needs of the system  ‘'Patient feedback should shape everything we do'' Funding the cost of change A champion for patient care Improving the patient experience leads to better outcomes Leadership tip: embracing adaptability      05:12 Patient care goes beyond managing health conditions   Shanil said patient-centered care is designed around patient preferences.  ‘'Ultimately, when you think about that term, at its core, patient-centered care is about ensuring that healthcare systems and all of their processes are fundamentally designed around the patient's needs or their experiences or their preferences I should say. And this approach goes beyond just treating diseases or managing health conditions. It's about considering patients as active participants in their own healthcare, which means that any sort of treatments or healthcare plans we develop, it's not about just focusing on clinical guidelines alone, but how do we deeply integrate that with the individual's lifestyle or their cultural background or their personal preferences into how those treatments are actually planned and executed?''    10:45 Healthcare is designed around the needs of the system Shanil explained how the historical context of healthcare models affects patient care today.  ‘'…your question really gets at the heart of many challenges that we face in healthcare today, irrespective of where you are, whether you're in North America or globally, and you have to consider that historically, our healthcare models were designed more around the needs of the healthcare system than the needs of the patient. All you have to do is look at things like financial models of all of these health systems, which is focused on volume and paying for services that a doctor provides over value of the services or take healthcare organizations like hospitals where they prioritize operational efficiency, where you have a ton of metrics around that over personalized care. And even though we may make patient-centered care sound easy and obvious, transitioning to that type of care is a big paradigm shift when you consider that historical context. And it requires both a shift in mindset and operations.''   11:48 ‘'Patient feedback should shape everything we do''   Shanil explained why the starting point is to consider the patient perspective.  ‘'And to me, first and foremost, it starts with leadership commitments, whether your ministers or C-suite execs at hospitals to re-envision what healthcare should look like from a patient's perspective. And this means aligning the organizational culture with patient-centric values and training your workforce to adopt this approach in every interaction in every decision. And when you think about what are practical first steps that you can actually take, it often involves gathering extensive patient feedback to understand their experiences and needs better. Something that we talked about obviously just at a length. And this feedback that we get from these patients should shape everything we do from policy to bedside manner. And technology plays a pretty crucial role here because it can be leveraged to improve communication with patients. It can be leveraged to offer more personalized health management tools or provide healthcare professionals with real-time data that is much more patient-specific, so that they can continue iterating in terms of what they need to do on a daily basis.''   16:19 Funding the cost of change  Shanil said the initial cost of transitioning to patient-centered care should be viewed as an investment in quality and efficiency.  ‘'Now in the US, where the healthcare system is more privatized, funding might come through insurance reimbursements or through investments by private health systems where they're looking to improve patient satisfaction and reduce long-term cost. You can't think about this as a short-term game, and you have to be able to measure what the value of the investment is now on something that hits long-term as well. And this is where whether your insurer or providers like hospitals, they could also tap into incentives offered by government programs or payers for meeting certain patient care standards and patient outcomes as well. So that's kind of giving you a contrast between those public health systems and the private healthcare systems, right? But regardless of the country, the initial cost of transitioning to patient-centered care needs to be viewed as investments. And these investments, by the way, Jim, are not just financial. They're investments in quality and efficiency, that over time lead to cost savings, right? Because you are reducing interventions over time, you're reducing hospital readmissions over time, and you're also improving the management of chronic conditions. So right now, if we're aligning with those value-based care models, which by the way is gaining a lot of traction worldwide, it provides that financial incentive to improve those patient outcomes and that naturally supports a care approach or a patient-centered care model.''   19:15 A champion of patient care Shanil said the role of patient experience officer is increasing but change starts with the CEO.  ‘'The question is how do we enable patient experience to be at the heart of the organization, because that's what ultimately it is, right? And usually it is a step-wise approach. So the first thing that we end up trying to see is who's going to be the champion? And largely, we want it to be the CEO of the organization. If it really comes from the top and they have their strategic priorities and strategic comparatives centered around the patient, it sends a message to not only the C-suite, but across the organization as well. So that's where we usually like to see it's starting right from the top. Now as we start to see this penetrate or proliferate throughout the organization, it's an interim solution, which is where you would want someone who owns this as a mandate going forward once the CEO has actually set its goals and the role of the patient experience officer is increasing quite a bit, and especially in larger, more modern type of healthcare settings because it bridges a gap between clinical care and patient satisfaction and someone has a mandate to continuously challenge that. Like isn't it great if we end up seeing the type of conversations that is happening between the patient experience officer and the CFO, which may end up having different imperatives where the CFO is not only thinking about the long-term cost, but of course thinking about the short-term cost as well and focused on operational efficiency indicators, whereas the patient experience officer is thinking about the long-term value that we're providing as a healthcare system.''   22:55 Improving the patient experience leads to better outcomes  Shanil said capturing and measuring the outcome data is the key focus.  ‘'In a value-based healthcare model, the focus is squarely on patient experience and outcomes. Because the fundamental principle behind this is that these factors directly correlate with the effectiveness of care. And in terms of reducing costs or the burden on the healthcare system, and a better patient experience often leads to higher levels of patient engagement, which is critical for the success or uptake or adoption of treatment plans and ultimately improves overall health outcomes, which is the end goal of whatever we're trying to do, right? So even in simpler words, when a person or a patient feels supported and valued, they're just much more likely to actually follow medical advice and maintain their health regimens. This kind of connecting on the diabetes example that I actually provided earlier as well. And when it comes to the measurement, you can measure these patient outcomes over time to see how effective it is, whether it's measuring recovery rates or complications or taking holistic approach and measuring quality of life, which there's a significant amount of instruments or questionnaires around it, and they all serve as indicators on how we're effectively doing this and how effectively this value-based system is actually operating. But to be able to do that, and this is also turning out to be a fundamental problem or enabler that we need to fix, is we need to be able to capture all of this, this outcome data and these experiences that patients are having, and then we need to measure that data and have some analytics to offer us insights into how we're doing.''   26:32 Leadership tip: Embracing adaptability  Shanil explained why adaptability has helped him to stay ahead.  ‘'…this is not just from a personal standpoint, but I also think about it from my team and the entire ecosystem because we're moving from traditional models of healthcare and healthcare delivery to highly tech enabled healthcare, and that shift is going to continuously increase as well, right? And ultimately, when you think about that tech enabled world, it's not about new software or fancy tools, it's just about a whole different way of thinking about patient care, thinking about patient data differently, thinking about how we improve effectiveness differently. And adaptability, ultimately thinking about all of these types of changes and in these type of contexts, for me as a leader, it means leading my team through this transition, ensuring that they are not only trained in new technologies, but they're also mentally prepared to embrace these type of changes, which is different because now it involves shifting our mindset from this is how we've done it previously, to what's the best way to do this now. And one thing I love about adaptability is that there's a lot of these sub-characteristics that are inherent to it to enable you to think differently. Because adaptability means you have to keep an open mind. Adaptability means that you have to be willing to learn continuously. It means you have to be resilient; you have to show that you're not afraid to pivot when the situation calls for it. And this approach, or this principle or this guiding principle, we'll call it, has not only helped me personally stay ahead, but it has also ensured that I can help lead my teams to continue to deliver high quality solutions to our clients no matter what changes come our way. So that would be the number one thing that I would share with your audience.   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Shanil Ebrahim on LinkedIn    Check out VIE Healthcare and SpendMend    You'll also hear:    Healthcare is about people; Shanil's passion for improving patient care: ‘'….the reason I do this personally is because one, I'm really passionate about it and it really stems from personal and professional commitment to making healthcare better and more accessible, especially for underserved and vulnerable populations, which has been a common thread throughout my career in terms of serving those populations.''    Moving away from the one-size-fits-all approach to patient care: ‘'… we need to involve patients more directly, ensuring that they have easy access to their health information. We have to support them through various channels that respect their time, that respect their preferences, respect their individual life circumstances. And it's all about moving from your classic one-size-fits-all approach to something that is more tailored, more holistic, and responds to the needs of the patient.''   Creating a healthcare experience where patients are partners not just recipients: ‘'…if we truly want to do this right, we have to measure the true value from it because all the things that I'm saying are also hypotheses that are based off of research…..And the ROI should be that if we provide tailored approaches to patients, they'll be better managed. They will get to positive outcomes faster, which means incurring less costs in the long run and everyone should benefit.''   Why patient-centered care means a focus on the patient journey: ‘'And any sort of position, whether you call it a patient experience officer or someone wearing the hat of a C-suite executive that champions a patient experience, they would be focused on the patient journey through the healthcare system and ensuring that we're empowering the patient's experience. And one of the main reasons for creating such a role is let's have someone who systematically addresses and improves all aspects of patient experience.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

Strategic planning is vital to successful healthcare management. President & Co-Founder of The American Healthcare Journal, Cole Lyons, explains his goal of fostering a community of education to Jim Cagliostro.    Episode Introduction Cole explains why transfer of knowledge is a key goal of the Journal, why healthcare strategy can be described as moving from checkers to chess and emphasizes the importance of thinking before you speak. He also explains the importance of competition in healthcare and identifies humility as an essential leadership trait.   Show Topics   Redefining healthcare strategy A strategic alternative for nonprofits  Breaking down silos in healthcare Join Cole's community on LinkedIn Applying economic theories to healthcare strategy Leadership tip: why humility matters     05:36 Redefining healthcare strategy  Cole explained why thinking about the impact of your actions matters.  ‘'For me, it's kind of thinking before I speak. I think that's the best way that I've come up with how to explain it. In operations, day-to-day, things are quite hectic, especially at high volume clinics. And you have to make very quickly, fairly educated decisions based on standard operating procedures. But sometimes that doesn't always lead us down the best path. So part of that is creating standard operating procedures that allow you time to think about how it impacts things long-term. So, thinking before you speak for me means instead of just saying what I need to say in the moment, I think about what I say, how it will impact the person hearing it, how it'll impact my image. And if you apply that kind of thinking before acting approach to your actions in the operations space, it means taking a step back and looking at the competitive landscape in your industry, looking at the competitive landscape in your institution, different departments competing for funding, different departments competing for exposure, and looking at how even small actions in the operations world will impact that.''   08:12 A strategic alternative for nonprofits Cole said the Journal aims to foster improvement and education in strategic thinking for nonprofit institutions.  ‘'… the problem right now is VC-backed healthcare firms, those that are backed by venture capital. They have a high concentration of MBAs who have really good strategic insights. So don't get me wrong, and we can always go into this anytime, but there's a problem with a lot of the strategy theories out there in general that are taught to MBA graduates because it's based on economic theories that don't always play out in the real world. But still when they make decisions, it is much more strategic than in nonprofit healthcare. And so, one of the issues is that I'm not a fan of government-run healthcare, which is a little contrarian. I'm just not particularly a fan of it. I think that free market healthcare is good, nonprofit institutions are my favorite. I love nonprofit institutions. I think that that's the best form of delivering healthcare. But they don't act very strategically, especially compared to VC-backed or for-profit healthcare, which employ all these MBAs, they recruit MBAs from the top schools, they can pay them. …I'm not saying that they're any less educated, they're just educated differently. They have MHAs, they have MPAs, a lot of them have MDs, and they are educated in a very different way. So the journal's purpose is how can we foster this community of improvement and education in strategic thinking for these people who are educated in a much more practical way? An MHA isn't sitting in their office thinking and going into philosophy a lot of times. A lot of times they're figuring out, how can we solve this problem? How can we deal with this emergency situation?''   13:36 Breaking down silos in healthcare  Cole said administrative fellowships can help to develop a well-rounded approach. ‘'One of the ways that this is going to work out really well, and a lot of programs are doing this, is through administrative fellowships. I actually have a lot of different things that we're involved with with that, trying to get fellowship certified, trying to get fellowships publicized a lot because administrative fellowships have to rotate through every department in the organization usually. They know all the leaders. And so when they go and work in operations, they are very well-rounded. They have a much better strategic vision of the organization. They know clinicians, they know the house staff, they know the janitors, they know everybody. A lot of times they know the people who are on construction teams building the building. And so that gives them a huge, well-rounded approach that's also going to massively improve strategy. So yeah, the majority of organizations are still struggling. They're siloed or they don't even have really a strategy team, but there is a good trend for improvement I think on the way.''   16:32 Join Cole's community on LinkedIn Cole said anyone who wishes to get involved with the Journal can connect on LinkedIn and YouTube.  ‘'LinkedIn is one of the best knowledge communities. There's a bunch of knowledgeable people. All my mentors have come from LinkedIn. The past two jobs I've gotten, including the journal, so I guess my past three jobs, have all come from people I've met on LinkedIn. So I would say go to LinkedIn, the American Journal of Healthcare Strategy is on there. I am on there. Happy to network and connect with anyone. Also, just happy to be kind of a funnel connecting you to other people. If you want to meet someone in the Philadelphia region, I know most of the senior leaders here at least casually, so I can always connect you to somebody if there's somebody you want to meet. So yeah, LinkedIn is definitely the best way until we get that website and mobile app up and running…. I know sales teams have told me that they've benefited a lot, our YouTube channel and our LinkedIn, a lot of time our LinkedIn will link to the YouTube channel.''   19:08 Applying economic theories to healthcare strategy Cole said education is important to help hospitals adapt to strategy. ‘'I think the first reason that it's important is because if you're an MHA grad and you're interfacing with an MBA graduate or somebody who's a consultant, I guess classically trained in business, you need to understand the economic theories that they're going to be using and you also need to understand why they seem flawed. So when you go through a strategic plan and you utilize one of these theories, it could be like Blue Ocean or you utilize Porter's Five Forces, I like them, I think they're excellent, but they are flawed in some situations. And coming from operations, you'll identify, "Oh, there's something wrong with this," but you might not exactly know how to explain it. And it'll give you the language, it'll give you the techniques. You'll be able to construct these Five Forces plans, the Blue Ocean Plan. There's another one I can't remember off the top of my mind. But then it'll take you and say, "Okay, here's the problems with some of them. Here's how you can identify what the issues are, and here's how you can fix them as well." So, when a consultant comes in and gives you this awesome plan, it'll not have you throw plan in the trash. It'll have you say, "Oh, here's how I can adapt it to fit my organization."    21:55 Leadership tip: why humility matters Cole said humility enables leaders to make connections.  ‘'Humility is really, really important. I've been so privileged to sit with most of the CEOs of hospitals in the Philadelphia region. I think that the humility of some of them is really astounding and it leaves a lasting impact on me. I also think that those are usually the ones who are most respected, being down to earth and being humble, speaking with all the members of staff because you actually need to and want to and not just because it makes you look good…Also, the other lesson Six Sigma, the Gemba walk, the... Before you can become a manager in Japan, you have to go through all the departments…When these people rotate through these departments, I was talking to one the other day that she was in the parking lot looking at the road signs in the parking garage and working with the builders in the state to make sure that these parking lot road signs were constructed correctly. A few years later, she's going to be a hospital administrator, but that experience in the parking lot looking at the road signs, invaluable, because now she has a connection to the whole organization. And you can only make that connection if you're humble.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Cole Lyons on LinkedIn    Check out VIE Healthcare and SpendMend    You'll also hear:    Transfer of knowledge, the goal of the American Journal of Healthcare Strategy: ‘'It's really essential that we think of things differently. …. what we're trying to figure out is how to transfer knowledge around in a better way, whether that is through consulting one-on-one, whether that's through one-on-one coaching, or whether that's through podcast or video. How can we get a community that is knowledgeable and is empowered by that knowledge? That's what our real goal is at the end of the day.‘'     From checkers to chess; another way of looking at healthcare strategy: ‘'So with checkers, you're kind of looking at the very next move. With chess, the best players are looking many moves ahead. And how one move in one side of the board will affect the move in the other side of the board. It's a pattern of thinking that's very hard to develop even. In the first way I mentioned with thinking before I speak, it's very challenging.''   The role of competition in American healthcare: ‘'Even though we have problems with our population care, our actual procedures that we perform, there are lots of medical tourists coming from other countries to receive care in the United States because our healthcare is really excellent in terms of a lot of the quality. We want want these nonprofit firms to be able to compete really well against VC-backed. And so that's what motivates us.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

Tech startups are predicted to disrupt US healthcare in 2024. Scott Nelson, co-founder, and CEO of venture backed FastWave Medical, offers his strategies for success in innovation with Jim Cagliostro.    Episode Introduction  Scott reveals the two signs that an idea has potential, why market trumps everything in innovation, and why leaders should focus on eliminating pain points for their end users. He also advises innovators to connect with potential strategic acquirers at an early stage and explains why leaders of startups shouldn't put all their eggs in the venture capital basket.   Show Topics   Two signs of a good idea  Market ultimately trumps everything in innovation Engage with potential strategic acquirers at an early stage Finding investment in your community  Flipping the script: eliminating pain points Effective ways to raise capital Leaders of startups don't have to be the CEO  05:49 Two signs of a good idea  Scott said there are two things for leaders to consider in innovation.  ‘'I guess to answer your question in a little bit more long-winded way, I would say if you've got an idea that you can't seem to shake a little bit… It's sticky and you find yourself maybe waking up at night thinking about it or you thought about it and then two weeks ago you're still thinking about it, maybe a month goes on, you're still thinking about it, that's usually a good signal. Maybe there's something there, but the most important point from my perspective is before you go too far, before you get too latched onto this idea, you really need to think about two things primarily. One, does it solve a real glaring problem? Is it a painkiller? I remember interviewing Dan Hawkins way back in the day. He was actually the founder of Shockwave, the company I mentioned previously, was very early at Intuitive Surgical, was the founder of Avail Medsystems, et cetera, serial entrepreneur. And he phrased, this was back in, I think 2016 or 17, but he mentioned finding a painkiller, not aspirin, not Tylenol, but a real painkiller, something that really causes a lot of pain, whether that's from a cost perspective, whether that's from a workflow perspective, but something that's like, there's a lot of friction there. That's what your idea hopefully solves for, a real painkiller. And then secondarily, if you think you're onto something that solves that real pain point, secondarily, you need to think about this as early in the process as possible. Who's going to pay for it?''   09:03 Market ultimately trumps everything in innovation  Scott explained why market is the #1 factor for potential entrepreneurs.  ‘'I sort of fundamentally believe that market ultimately trumps everything else, right? Now, don't get me wrong, you could have a great product and a great team, but if it doesn't serve a huge market, you're going to have to think about other ways to fund that, right? Maybe it's a product that you can invest your own money in. Maybe it's a product that you can get to market quite quickly and use revenue and profits to support the company's growth, etc. But the reality is you need a big market to serve in order to give you optionality to capitalize and fund your idea or fund the company moving forward. So I do kind of think market trumps everything, because again, you could be working on a great product, have an awesome team, but if the market just doesn't support it, it's likely not going to have a lot of substance there. On the flip side, you could have an awesome market and maybe a decent product and a decent team, but it's probably going to do fairly well because the market supports that need. So, long story short, there's a couple of different ways to think about it. They're all important. ‘'   12:38 Engage with potential strategic acquirers at an early stage ‘'Obviously you need to be careful and cognizant about not disclosing too much, but the imperative is really to start engaging early on with those, what you perceive as potential strategic acquirers, really under the guise of just an introduction. You're not trying to sell them anything. It's a dating process. You're trying to get to know them, inform them of what you're building, what you're working on, so at least have a high-level idea. And as you continue to make progress against your idea and against your milestones, keep them informed. Not just them, but hopefully potential investors, people that... stakeholders within your community. You want to be communicating the progress that you're making against the idea or the product that you're building. So I can come full circle on your question. I just think it's really sometimes underappreciated, and it's actually a tip that I picked up on from Duke Rohlen, he's the founder of Ajax Health, serial entrepreneurs, had multiple exits under his belt, but he mentioned this, in an interview maybe close to 10 years ago now that I had with him. That was one of the things that he really focused on with some of his early wins is really an evaluation of all of the players in a certain market and what are they missing? What are the gaps in their existing portfolios? And he put together a matrix, and that helped think about how his product could potentially fit into the portfolios and where it fits with the broader space, if you will. And so that I think is sometimes maybe a little bit underappreciated from most founders and CEOs that are highly focused on their idea.''   14:38 Finding investment in your community.  Scott said your community could be the source of potential investment.  ‘'Generally speaking… you want to engage with your community as early as possible. In your community could be your end users of your product. Your community could be the payers. Your community could be investors. Your community could be those likely potential strategic acquirers. You need to be engaging with them early, having a lot of conversations early under the guise that you want to let them know who you are, what you're building, what you're working on, and you want to keep them informed on your progress, right? Because if you can demonstrate over the course of six, 12, 18, 24 months that you delivered on what you said you were going to do, that's probably the most impressive thing that you do. You could present a fancy pitch deck, you could have an awesome advisory board. Your product could actually be quite cool, but the thing that's going to stand out is your ability to execute against the things that you say you're going to execute against. That's the most impressive thing. That's always going to stand out to strategic acquirers, investors, even your end user stakeholders. So I really, really think it's important.''   18:41 Flipping the script: eliminating pain points Scott said the key question to ask yourself is how your idea makes life easier for your end users.  ‘'I think oftentimes we might want to flip the script a little bit and not necessarily think about our idea, our technology, offering so many more benefits and so many more improvements. Actually, what does it eliminate from the workflow? What pain points, what friction does it take away from my end users to make their life more simple, more easy to use? And hopefully through that process, we're delivering on those cost savings, right? Because so many times, especially in MedTech, and rightfully so in some scenarios, we think about how to get a pricing bump, or a pricing increase. In reality, your business model might be just delivering a slightly better product, but at a very attractive price. A Costco model. So that's not a bad play. And if your wheelhouse is really more around maybe cogs optimization or supply chain management, and that's what you really know well, there could be some great ideas in there where you can just simply deliver a good enough product, maybe slightly better, but just at a very attractive price. And that could be a phenomenal idea. And so I think those are a couple of things that I would think about under the guise of how do I differentiate myself versus competition? Don't think about your product doing so many great things. Think about how it can remove friction in a process and make your end users' lives more simple, more easy, less stressful. And then maybe just as important, how can it remove costs from the equation?''   22:30 Effective ways to raise capital Scott said innovators need to be thinking in terms of major milestones about fundraising.  ‘' I'll probably say fairly high level, but I really would encourage everyone to think about how they're raising capital. Think about it in cycles, if you will. You want to raise enough capital, ideally, not too much per se, but not too little either. But raise enough capital where you can achieve the next major milestone in say, 12 months. And you need to make that very, very clear to all your potential investors, this is what we're raising our money for. This is the next major milestone that we're targeting. So being very, very clear about that and kind of thinking about your fundraising and tranches, if you will, like that. And again, it is really very important. Yes, you want to be in a position where you don't run out of cash for sure, but you also don't want to take so much money upfront that you get so diluted that will impact future fundraisers. So yes, think about these near-term milestones. Those are crucial, but also think about how those may impact the next fundraise as well. So I definitely want to, I'd like to start out there because I think it's a point worth emphasizing for anyone that's working on early stage technology.''   26:03 Leaders of startups don't have to be the CEO  ‘'I think as leaders of startups, you don't necessarily have to be the CEO. If you're in some sort of leadership capacity within an early stage company, I would just keep in mind that when you're trying to direct your team and push the ball forward, but you're pushing in essence a boulder uphill with a lot of friction, momentum is crucial. So as a leader, you need to keep that in mind, is do everything within your power to keep the momentum going forward. There's always going to be trade-offs as your company evolves, but ensuring and optimizing for momentum, that's so, so crucial. So that's probably one of the things that probably stands out most as part of this broader startup idea.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Scott Nelson on LinkedIn    Check out VIE Healthcare and SpendMend    You'll also hear:    Three things for every innovator to consider: ‘'As your idea begins to evolve and begins to take shape, you need to be thinking about…what product am I building? What market does it serve? And who's the best team to effectively build this?'' One key piece of advice for startups: ‘'As a startup, if you're working on an idea, the most likely scenario for a potential liquidity event is an exit to a strategic acquirer.'' The blurred line between payers and providers: ‘'Once my technology is approved or cleared by the regulatory body and I'm ready to sell, then I need to think about who's going to pay for it. Well, the reality is … the lines between payers and providers, is really, quite blurred… They ought to know who you are and what you've been building for hopefully months, if not maybe a couple of years.'' Don't put your eggs all in the traditional VC basket: ‘'If you're so highly dependent upon traditional VCs, likely they're going to get squeezed…. So the onus on founders, CEOs, in terms of fundraising is to keep a lot of options on the table, go far and wide. It's a lot of work.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

Purchased services is often the most overlooked expense in healthcare yet offers opportunities for cost savings. Brian Bartel shares his best practices for effective contract management, with Jim Cagliostro.    Episode Introduction  Brian explains the unique challenges of purchased services, why a centralized contract repository is the first step to successful purchased services management, and why hospitals should never allow contracts to auto-renew. He also explains why ‘'red flags'' aren't always necessarily malicious and why it's vital to question the line-item details of your purchased services invoices.    Show Topics   Purchased services present a unique challenge in healthcare #1 tip: Create a centralized contract repository Review your contracts on a minimum annual basis Don't assume all red flags are malicious The hidden cost savings in your line-item details Be inquisitive, be patient, be strategic – and build relationships 06:35 Purchased services present a unique challenge in healthcare Brian explained the difference between supplies and purchased services.  ‘'…When you're talking about supplies, it's pretty easy. You've got a specific item number, you've got your power set, your requisitions, everything is very orderly. So things are coming in, you can track it, you've got the data behind it, there's a contract with that line item pricing. And then when you get confirmations back, usually people are using some form of EDI, which makes it relatively easy, and you can track that. Item A is item A, item B is item B. Purchased services is different because it typically is not on a PO. Again, I've worked places where it is, but that comes with its own challenges. It's very department specific, so you've got usually a department manager or leader that's kind of running that point with it. We don't have as much interaction on the supply chain side of this either. Communication is usually kind of sparse between supply chain and a purchased service provider as compared to a typical supply vendor. And again, the data is just, it's more difficult. When you start looking at how things are being invoiced because there's no PO line, it gets very challenging to try to figure out, "Okay, what's actually happening with this spend?" Typically, an invoice will come in, the department manager signs off on it, it gets paid, and that's it. So a lot of opportunity there.''   08:30 #1 tip: Create a centralized contract repository  Brian said a centralized contract repository was the essential first step to successful purchased services management.  ‘'I think that at square one, I think the biggest thing you can do is if your organization or your hospital, your ASC, your clinic, whatever it is, if you don't have a centralized contract repository, that's step one. Again, stepping into certain roles in my past, you've got contracts that might be down in admin. You've got department managers that have signature execution authority and they've got them in their files, and then you realize three years later that there's been this contract that nobody's really paying attention to because it's just a paper copy. Really I think that that's the biggest thing for me is getting your hands around it. Number one, you've just got to have that centralized repository. Again, that doesn't mean that you need to use software. Software obviously makes things easier. I'm a big proponent of that. But again, even just saying, "All right, nobody can sign contracts except for," whether it be your CEO, your CFO. "Send all these down and we're going to put them in a file cabinet." At least then you can go and try to find where those contractual documents are.''   10:07 Review your contracts on a minimum annual basis Brian said it's important not to let contracts auto-renew.  ‘'It's always good to have that check-in annually, even if it's just pulling the contract, making sure when does this contract terminate? That's the other thing about automated systems through contract software is that you can set those flags. “Hey, something's coming up 180 days later.” Again, with things that are just auto-renewing, that's an issue too. If you miss that window to terminate something that you do want to go out to bid for, or maybe it's a contract that you don't need anymore. And I've seen, you've probably seen it too, 180 day out clause, some of these things. So if you miss that, that's going to be a problem. As far as reviewing, it depends too on the type of service. Some of them are much more important, and so having a quarterly business review or a semiannual business review is important, and that gives the vendor time to come and showcase what it is that they're doing too, because at the end of the day, sometimes these people are coming in, they're doing great work, but nobody really knows except for that department or specific area that they're there too. So giving that face time opportunity for the vendor, especially on those critical contracts, is important as well.''   12:21 Don't assume all red flags are malicious Brian said reaching out to the vendor is important if you notice an invoice discrepancy.  ‘'I think that that's where you've got to have a little finesse, again, realizing that some of these contracts, there's a lot of relationships built in. Again, if you've got somebody that's on site providing this, odds are they built those relationships. So I always take the approach when I notice that something's not going well on my side, if I notice an invoice discrepancy or something, it's an automatic red flag, but don't assume that it's malicious, right? So the first thing that I recommend is definitely reaching out to the vendor, the supplier, the individual, whoever it is that's your point of contact and just have that conversation. Say, "Hey, we noticed that there's a deficiency here," or, "We have a question about this invoice," and give them a chance. Because again, remember, on their side, I think it's probably maybe not quite as complex as it is on ours, but I know that just the conversations that I've had with suppliers in the past is that there are mistakes made when they're sending out invoices on a monthly basis or whatever it is. Again, give them that opportunity to rectify, at least bring it to their attention, and don't assume a malicious intent, even though that's probably from a supply chain standpoint, something that we might tend to do a little bit too much, right?''   14:22 The hidden cost savings in your line-item details Brian said a detailed review of purchased services invoices can uncover significant cost savings opportunities.  ‘'At the end of the day, we're paying for whatever it is that we've signed up contractually for. And so having that actual invoice in front of you will tell you a lot of different things. Number one, you get the contract. Number two, you get the invoice. And then you start going through, does this make sense? Are things lining up? And I found some just very easy wins, things that they've been charging for, like an EVS vendor that was charging for restroom service, thousands of dollars a year, nobody knew what it was, and all they were doing is just bringing in little scent pads and not even going into the restrooms. But that was a line item that nobody had really questioned before. And so by seeing that actual invoice, again, now you're not just seeing it as X amount, now you can actually go in and see what it is that they're invoicing for. Again, correlating back to the supply chain side, we know that. We know each individual widget, case, box, each, but until you see that invoice a lot of times, if you're looking at it from a GL perspective or an expense, you don't see that line item necessarily all the way down to that detail. So it just tells you a lot. And again, maybe I'm just a nerd, but I like doing that. I like pulling those occasionally and just making sure, do the sniff test. Does this seem like everything that it should be? And then ask those questions. And again, you learn through that too. Some of the services that we have, it's like, "Oh, I didn't know that that was included." So again, that goes back to the communication with the vendor or supplier, give them opportunity to explain what it is that they're invoicing as well.''   19:05 Be inquisitive, be patient, be strategic - and build relationships  Brian said building relationships is vital in leadership.  ‘'I think the biggest thing is just like I mentioned before, be inquisitive, have patience, and be strategic. A lot of the things that we would like to get done, whether it's supply chain or in our personal lives, it takes a while. So build those relationships, know what you want to do and know that it will take time. Rome wasn't built in a day. And so when you have those opportunities come up, if you're strategic about it, that door opens a little bit, you've got all your ducks in a row, then you can walk through and say, "Hey, I've got a solution to try to fix this, because I've been working on it in the background." So I wish that there was more that I could say than that, but I know personally that's what it is. Be inquisitive, be patient, be strategic, and build those relationships. Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Brian Bartel on LinkedIn    Check out VIE Healthcare and SpendMend    You'll also hear:    From critical care to materials management, Brian's journey in healthcare: ‘'No day is the same. Hopefully we can bring efficiencies and streamline processes to avoid some of these chaotic fires that pop up, but again, every day brings this new challenge.''   A straightforward definition of purchased services: ‘'I just keep it simple. Is it a service that we're purchasing and that's usually typically some sort of a purchase or a contract or an outsource of some service that we're taking advantage of.''   The benefits of a mentor in effective contract management: ‘'If you would've just stuck me in purchased services when I left the critical care access hospital, I would've had no idea, but I had a mentor, I had somebody that was teaching me that. So rely on those people and ask those questions. Ask the department managers, your GPO. Again, I know that there are pros and cons of GPOs, but that's a great place to look too.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

Flourishing supplier relationships can transform healthcare organizations. Samer Haddad, shares his experience of building and navigating successful partnerships with Jim Cagliostro.    Episode Introduction  Samer explains why trust is the foundation of all successful supplier relationships, the importance of human-to-human connection and why a partnership sometimes means giving your partner the benefit of the doubt. He also outlines the key to a successful exit strategy (plan, plan, and plan) and why solid leadership means treating others as you want to be treated, and leaving your ego at the door.   Show Topics   Supplier relationship management isn't just a keyword  Trust is the foundation of successful relationships  Managing multiple suppliers is about more than spend ‘'Partnership is a partnership'' Managing a successful exit strategy  Leadership tip: keeping your ego out of the way 04:33 Supplier relationship management isn't just a keyword  Samer explained how the impact of Covid revealed the importance of strong supplier relationships.  ‘'When the world went into COVID and all the crises that came after that, in terms of shortages and everything, I can make a pretty easy judgment that there was a big differentiator between companies who made it and who maybe struggled mainly was supplier relationship management. Because when the real challenge came to the world, companies that invested in relations, companies that had deepened their relationships, especially with the significant suppliers to their production or to their delivery, whatever that is, made a difference. Those were the ones who were able to actually leverage that challenge to their benefit in the market. So they gained market share. The ones who had superficial relations, maybe more towards purely commercial kind of dealings, I think they struggled because, at such a moment, that kind of... I can't call it a human-to-human relation, or personal relation is where things are tested, and when companies need to make decisions, that's always an element. The trust between those organizations is essentially trust between humans that are doing business for years together. So if you just... we learn from the past two to three years it is I think many of my peers in procurement supply chain will vouch to the importance of supplier relationship management in general and not just like a keyword that you use and throw around…''   07:09 Trust is the foundation of successful relationships Samer said KPIs can help to measure progress and build trust.  ‘'It takes time to build up that trust. So it is very important when we start a relationship that we create the proper agreement because this is why contracts are there. Contracts manage the relationship between parties. And you're establishing basically a baby kind of relation that has no trust yet, and you need to monitor it and start putting in the building blocks of that relation. Usually, in my opinion, that is established by having mutual mechanisms to judging how companies are engaging with each other. That could be the KPIs that you set. And it's not fair only to set a KPI for the supplier that you're establishing a relationship with, especially if you're looking long-term. Some KPIs should be set, maybe not in the contract, not necessarily, but self-imposed as you manage that important relationship that you know about. So you can even monitor internally how you're engaging with that supplier. Now, if you do that kind of fundamental layer of developing that relationship and you start building upon it, with time, trust starts getting improved and starts growing. It's like a baby, and it grows. It becomes an entity.''   10:24 Managing multiple suppliers is about more than spend Samer said organizations need to understand how suppliers can impact their business.  ‘'…... But let's say what are the top 10 suppliers that basically can make or break your business? Because each business needs to know these kinds of suppliers. What are the suppliers that, if they don't deliver, you're going to have challenges actually delivering to your customer, or it'll affect your quality, or it might basically put you in a different pricing position in the market, which could basically hurt your business? So you need to understand those really well. And what I see as a common mistake is people treat category management as just a function, just an area. Like supplier relationship management. "Oh, you're a procurement person, so you do the procurement, invoicing, all of that. And by the way, you need to just take care of categories. Also, take care of the supplier relationship." It doesn't work. So especially when it's big business, when there's lots of money being moved around, you need people to focus on those suppliers and those categories. So I would recommend that you really understand the suppliers that drive the goals of your business and, at the same time, the suppliers that probably could hurt you if you don't nurture them. And that has nothing to do with spend, by the way.''   14:41 ‘'Partnership is a partnership'' Samer said treating suppliers as partners can help to navigate challenges during the contract period.  ‘'You can't go purely by contract. If I have a relationship with a significant supplier and they're misperforming, I can't just jump in and I basically come in with the request that, "You're not meeting the contractual agreement, and we need to go to remedies." That will destroy the whole thing. Partnership is a partnership. When you have a partner, you need to work with the partner. So yes, at some points, you might have to make hard decisions for the business, and yes, your top priority should be your business goals and your business targets. Nevertheless, I would say, depending on the situation, there's no one answer I can say here, but depending on the situation, you need always to give the benefit of the doubt for the partner. If they need help or support, you need to pitch in and help if you can. You need to offer that. You need to understand what's happening because it's easy always to blame the other party for the issues and challenges. You might be either contributing. If not, at some times, you get surprised, and you're causing some of that kind of challenge. So you need to deal with it as a partnership. So you look at the people, so the people you know, call them up or you meet them, you have a conversation around the challenge, you try to understand it, analyze it, break it down, go down a route where you're looking at a structured, logical approach to that problem. You're not there to blame. You're not there still to go for a contract. You're there to solve a problem with them as a partner.''   17:26 Managing a successful exit strategy.  Samer said it's essential to have a Plan B before exiting a contract. ‘'…. I assume someone who reached a point where they want to break up a relationship with a supplier, probably, we're talking about here, hypothetically, someone with a deep relations, one of those significant suppliers that affect your business, you need to have your own plan B. And this takes us to the first point I covered. I assume also that you did your job in creating contract that has a clear pathway to exit that relationship. If you have that, okay, so at least you have your map to exit that relationship, but also, you need to get things sorted before you go there. And the point comes where if you ask me, why would you do that? What's the tipping point that could take my company or me personally managing that department or procurement, in general, to go from point A, we have relationship, I need to break it. Well, it's a plethora of things. So it could be simply the attitude of the team on the supplier side that I'm dealing with. Once I see that there's zero care to the business I'm bringing, because sometimes they could grow as a company, my business is not growing at that rate. So I might become a much smaller piece of the pie for them. So things change, but the attitude towards my company is very important… there are red flags and red lines I think you should keep always, even with the best relationship, where you need to say, "I need to stop here, and I need to make a decision."    21:56 Leadership tip: Keeping your ego out of the way  Samer said knowing that your organization will succeed in your absence is the sign of an effective leader.   ‘'At the end of the day, a solid leader is the one who can have confidence saying, "If I leave today, work will not be affected." I think our ego gets in the way in many cases. I try not to let it affect me. It's a human thing. Everyone has it. I try always to make my decisions separate from fear. So I want my team to be able to generate leaders that could replace me at any moment. It's a hard mental thing to wire, but from my experience, it only pushes you towards growth in your career actually. It doesn't hurt you. It helps you a lot, and it gives you your life back because, today, when I go on leave, I do not look back because I know I have a solid organization, solid leaders in my team that if things go wrong while I'm away, they can take care of things. So treat people like you want to be treated and grow the next generation leaders in your organization.'' Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Samer Haddad on LinkedIn    Check out VIE Healthcare and SpendMend      You'll also hear:    Samer's role within Emerson Automation Solutions and the push for sustainability: ‘'…now we're pushing more, especially in this region around sustainability, which again, gives you more reasons to enjoy what you do, and you feel that you are a little bit maybe contributing to that big change that's happening in the region and hopefully for future generations when it comes to the environment here.''   Human-to-human connection is vital to successful partnerships: ‘'If you do the perfect KPIs and you always hit them, and you do the perfect contract, but you don't meet them, and you don't really engage with the supplier, members, and peers at that company, it'll never happen. So people, in my opinion, will establish you as a partner when you meet them, especially face-to-face.''   Effective supplier management needs constant monitoring: ‘'Are we getting the best service? Are they satisfied? Do they have issues from our side? If there are issues from our side, are we addressing them on time? … And I think with that, you address 90% of the challenges and the problems.''   The end of a relationship; deciding early and moving on: ‘'And do not hesitate .. because if you see really good reasons to exit a strategy, it's like maybe, I don't know if it's the right thing to do it, but it's like a divorce, right? Sometimes, if you spend too much time, it might hurt you and hurt your customers more. So, sometimes, it's just better to make a hard decision early and move things on, even if there are challenges. But make sure your business and your customers, first and foremost, are getting the service that they expect from your business.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

An estimated 40% of expenditure in the supply chain goes to waste. CEO Luka Yancopoulos explains to Jim Cagliostro how Grapevine Technology aims to put the power back into the hands of hospitals.   Episode Introduction  Luka explains how Grapevine can help hospitals save up to 80% on a single line item, how even small healthcare businesses spend six figure sums on the supply chain each year, and how to frame the reality of years of overspending to his clients. He also reveals three key ways that hospitals can lower the expense of their vendor management.      Show Topics   The power of building networks Supplies are a huge expense in healthcare Up to 80% of spend may be waste Connecting the source of supply to the end user Framing harsh truths on expenditure Seeing value every step of the way Leadership tip: deliver solutions to real problems 03:12 The power of building networks Luka said Grapevine can help its clients to save 70-80% on a single line item.  ‘'So Grapevine is working to make it very easy to basically manage your existing network. We've got healthcare businesses. They usually come to us, and they've worked with a handful of suppliers over the years. They think of each of these suppliers as their supplier for blank, fill in the blank, and Grapevine rewrites that. We think they're all your suppliers, they're all your network. Every time you add an item to cart from one of them, let's make sure it's the best price and that your other suppliers that you already trust and know don't have the same exact product at a cheaper price. Oftentimes, they do. We've basically redirected spend from one major distributor to another major distributor, saving the customer or the healthcare business 70%-80% on a single line item. The thing like a Becton Dickinson or a BD catheter or infusion pump or something they buy, and they have a bad habit of buying it from the wrong guy. So we basically let them link all their suppliers with the click of a button to a single screen, read in their current offerings, and tell them where to redirect their spend, acting as a traffic cop if needed.''   05:14 Supplies are a huge expense in healthcare Luka explained that even small healthcare businesses are spending six figure sums on supplies every year.  ‘'Certain medical specialties get hit harder than others. If you're performing surgery, obviously, you're burning through a lot of supplies, you're using anesthesia, you're using all sorts of things that maybe your average urgent care clinic won't need. So we focus on specific specialties that have a high consumption rate of important and expensive technologies, things like oncology, dermatology, surgery, these sorts of things. Even a small healthcare business is spending six, seven figures on medical supplies and pharmaceuticals, like, a customer that comes to mind, a family-owned dermatology practice in upstate New York, and Rochester, New York is spending $200,000 a year pre-Grapevine on medical supplies. So like the instruments and whatnot, they're using sutures and implants and this and that, and then they're spending another million a year on injectables. Things like lidocaine, fillers, and different sorts of things of that realm.''   08:38 Up to 80% of spend may be waste  Luka explained why a single supplier can't offer hospitals the lowest price for every item.  ‘'I think that, in some cases, it's as much as 80% of the spend on supply is fruitless and extraneous. As far as what makes up those inefficiencies, there's a number of things. There's a classic idea that I am a strong believer of, that no one person or entity can be the best at everything. So even if you're comparing suppliers of the same business model, these large distributors, we could talk like McKesson, Henry Schein, Medline, the list goes on and on. Every one of those has built supply chains like warehouse fulfillment, shipping teams, customer service, et cetera, tailored around a specific core competency or level of products. So not one of those suppliers is going to be able to offer you the 5,000 SKUs or different item numbers that you need, all of the lowest price. That's naive. The way this world works is helping specialists, people that have specific skill sets, work together to serve a singular end goal.''   10:24 Connecting the source of supply to the end user Luka said simplifying the supply chain is key to reducing costs.  ‘'I understand that when I'm buying it from a reseller, it needed to get in the hands of the reseller. That means it needed to get shipped there. That is a cost. Costs get built on the customer service, the labor. It all gets built into the price that hospitals are paying. By working with these downstream distribution companies that are, in some cases, 200 years old, you're just taking on additional costs. So if we can disintermediate supply chains when possible, connect source to end user as much as possible. You make things overall much more efficient. Then the third and really important major point, just to exemplify the inefficiencies and the lack of belief I have in these major distributors, is, you've got these distributors that people still buy everything they need from. These are the same companies that were selling cocaine pills to pregnant women in the late 1800s and arsenic pills for patient treatment and temperature up until the mid-1900s.''   13:33 Framing harsh truths on expenditure Luka said understanding the extent of potential cost savings can be a shock to hospital executives.  ‘'People are definitely surprised, and honestly, I need to figure out a better way to frame sometimes exposing harsh truths to our customers because we've had people... When you find out that something bad's been going on for a long time and you're the victim of that bad thing, it does not feel good. We've got customers that are hurt by that. They don't blame us, but I wish we could deliver that more as an opportunity to win as opposed to an exposé of historic losses. I think you could do that with the right framing, with the right user interfaces, but it's something that we're not doing the best job of now, just packaging that and making it a digestible change for them. But yeah, people are shocked when they're working with, let's just say, even two distributors. They're working with... We've talked about the names already, so I won't name them here, but one 200-year-old company and they have another 100-year-old company that they've worked with, and when they add to cart for the first time on Grapevine that same IV catheter that they've purchased thousands of times, that they've spent literally millions of dollars on over the last couple of years, that one item number, and they add it to cart and it says, "But wait, you could buy the same exact item from the other supplier that you already trust and know for 70% cheaper." That happens. They feel a level of frustration, and rightfully so.''    22:47 Seeing value every step of the way  Luka said that hospitals need to be able to see the win and the reason when they're stepping out of their comfort zone.  ‘'So work with your existing suppliers, and you're going to save a lot of money by having them on one screen and us alerting you, and there's a cheaper alternative. Once you've done that, then, "Hey, why don't we introduce you to this broad network of new suppliers that we know, that we've vetted, that we trust?" And you can connect them and start subbing in not exact matches from your trusted network, but new suppliers or specialists that can add way more value, exponential value, and achieve even more savings. That's why we could deliver this all in month one as a 60%, 70% savings, but it's not palatable. People would rather get month one of halfway there, big win, see their wins and their hard work paying off, and see the value of what they're doing every step of the way. Every time we make them do something outside of their comfort zone, they need to be able to see the win and the reason. If it ties back to financial savings, that's part of it. For the people that actually shop, we're putting things into one screen, and that's a part of it. They don't need to flip between tabs and windows anymore. So showing what we do and showing why it's helpful to them every step along the way to mitigate the pain of adopting a new solution is a big part of our philosophy here.''   25:19 Leadership tip: deliver real solutions for real problems  Luka said solving the biggest problems for your target customers is the way to unlock real value as a business.  ‘‘…So I think if you are following the white rabbit of real problems for real people, real struggles, and you constantly and iteratively try to come up with smarter and better solutions to solve those pain points, and once you do look for new problems, the next biggest problem they're facing, and continuously deliver real solutions based on those problems, I think that's the key to financial success as a business, is make yourself important, make yourself valuable, make yourself the solver of the biggest problems for your target customers, and that's the way that you unlock real value as a business and the money, the revenue, the whatever it comes all from that. If you're not important to solving someone's real problem, mending someone's real problems, then you shouldn't play the game of business in the world that we live in.'' Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Luka Yancopoulos on LinkedIn    Check out VIE Healthcare and SpendMend    You'll also hear:    How Grapevine is putting the power back in the hands of healthcare providers: ‘'We do that by showing doctors what they should be paying for the supplies that they use on a regular basis. We make it incredibly easy to achieve savings of more than 50% on their healthcare, medical supply, and even drug, pharmaceutical spend.''   Helping healthcare organizations to shop smarter: The hospital that saved 40% in one month: ‘'We've got a public company that uses Grapevine. They have 80 locations. They're in the oncology space. They went from spending $400,000 a month on supplies down to $250,000 in their first month, which was January 2024. So they are down 40% in the first month. There's a lot more work for us to do there. I think we can get them down to close to 80%.'' Recognizing that every hospital has unique needs: ‘'So yes, we need to have standardization. We need to have the best practice, best ways of doing things, but this hospital, this large health system in New York has different needs than a rural hospital out in Kansas or wherever it may be. So meeting those needs is going to look different. So we need to find ways to do that in order to minimize those inefficiencies.'' Putting all of your data into one screen is the first step to reducing waste: ‘'If you're managing 100 different suppliers, and that means you have a person or maybe dozens of people or hundreds of people that log into one screen and then they are pulling up listings that look totally different, and then putting another window up and looking at it on the other screen and then trying to do that across 12, you're hopeless at that point. You need to have all of your options in one place. ‘'   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

The US healthcare sector has struggled to put innovations like AI into practice. Mara Cairo explains the advantages of applying machine learning and AI for hospitals to Jim Cagliostro.   Episode Introduction  Mara explains why the first step towards successfully embracing AI is literacy, the challenges hospitals face in system integration and why AI isn't intended to replace humanity in patient care. She also illustrates the benefits of AI for healthcare, including predicting patient no-shows, effectively managing inventory, and reducing costs, and explains why successful leadership means getting out of the way.    Show Topics   Taking the first step towards AI literacy The challenges of AI in healthcare Applying AI across industry sectors Anticipating patient no-shows The impact of AI on cost reduction initiatives Leadership tip: Hire the right people and get out of their way  03:48 Taking the first step towards AI literacy  Mara said AI literacy helps to overcome resistance to AI. ‘'Really the most important thing is AI literacy. It's just like learning what AI is, what it isn't, the types of problems it's really great at, the types of problems you shouldn't use it for. On the earlier side of the spectrum, we have lots of training and education really meant to get industry partners, but also the general public. We're working even with K-12 teachers and students now ... to make sure that everyone has that literacy because it's just becoming more and more important to kind of arm yourself with the information because we're being inundated with information and news articles and scary stories. So it starts with literacy, that's the first part, and then kind of evolves from there hopefully.''   05:46 The challenges of AI in healthcare Mara said the complex needs of healthcare mean hospitals struggle with system integration.  ‘'There are different disciplines. Each maybe has their own labor agreements, regulation and whatnot. So when we think of human resources as a piece of inventory, that gets quite complicated quickly. Another thing, supply level. Inventory levels are complex. We kind of all saw it in COVID. The demand can spike really, really quickly. And you don't necessarily know when that's going to happen, right? So these surges can catch everyone off guard. And maybe traditionally it's been harder to anticipate when these surges might appear. Luckily, maybe machine learning is a tool that can help us with that. Also, just I think the shelf life of different supplies is unique to healthcare. You have to be really, really careful about storage and transportation requirements. And all of that is compounded by distance and transportation costs. Especially in Canada, in the far north, those care locations, they're really dependent on certain supplies, but if there's a road closure or a snowstorm or something, it's further complicated. The inventory supplies and healthcare are potentially life changing, right? So it's just so much more important that that is managed properly. And that complicates things. I think overall, in general, we've just seen that healthcare systems can struggle with system integration.''   08:30 Applying AI across industry sectors Mara gave examples of how AI helps with demand forecasting and warehouse management.  ‘'Some of the really cool projects we've worked on with our industry partners in the supply chain space, but more in the kind of consumer goods area are things like demand forecasting. So helping them better predict what items they're going to need and when. What's really great again about working with our supply chain partners is they have a ton of data, historical data. And that's really, really important. When we start looking to build machine learning solutions, we often rely heavily on that historical data to be able to make those predictions about the future. So the demand forecasting problem is really ripe for innovation and for machine learning because usually there is a large amount of data and we can start making predictions based off of what's happened in the past about what supplies will be needed and when. Another cool thing we worked on with one of our warehousing companies was pick route optimization. So when you're picking items from an order, what's the most efficient way to pick the items to start fulfilling orders? And then to that even more so is how do you build your warehouse up from nothing? How do you make sure that the space is optimized the best way that it can be so that you're optimizing your pick route, but also so that maybe commonly used supplies aren't blocked in. So we're able to, again, use some really cool machine learning techniques and historical data to help just those ground level initial planning things to make sure that we're setting up these warehouses to be really, really efficient.''   10:41 Anticipating patient ‘'no-shows''  Mara said machine learning can help hospitals to predict individual patient no-shows.  ‘'And then maybe speaking more specifically about healthcare, one project we worked on was really cool. It was about managing staff inventory and patient load. So healthcare patient no-shows are a bit of a problem sometimes. My dad is a retired dentist, and that would just pain him every time there was a no-show. I know firsthand how frustrating that can be. And that can also lead to an oversupply of clinicians, right? It throws the whole system off. So we worked with one of our partners to develop a model that actually predicts the likelihood of the patient being a no-show. And if the model is saying, "This patient is likely to not show up," maybe we send them an additional notification. Maybe there's a bit of an overload of bookings in that anticipation that no shows are coming. So that is a really cool application of machine learning to hopefully alleviate a little bit of the load and the stress of the healthcare system.''   14:27 The impact of AI on cost reduction initiatives Mara said AI can help to improve the flow of inventory from the outset and help with HR resource planning.  ‘'…machine learning can be really great with helping inventory management get closer to more accurate just in time delivery. So again, that sort of demand forecasting. I think currently the mitigation strategy for that is just to stockpile more supplies than you need, but then that leads to spoilage, especially if there's a shelf life and we're sort of back to square one. But machine learning is a really great tool for that demand forecasting, right? Also, these models can help us locate supplies where they're most likely required. So instead of last minute shuffling around supplies to an area that really needs them, which is increasing our costs, you're making sure that they're getting to the right care sites from the beginning so that it's just a more efficient flow of inventory from the very beginning. And then again, on the human resources side, even forecasting the future need for skilled professionals….if we just had a better line of sight into the future, which again, machine learning is a great tool to make those predictions, I see that as decreasing costs across the board and just making it easier to make decisions ahead of time, again, through data, but vetted by an expert that can also bring that domain expertise and that perspective to the solution too.''   22:07 Leadership tip: Hire the right people and get out of their way  Mara also added that soft skills can be harder to teach in a technical environment.  ‘'I lead a team of very technical machine learning scientists. I don't necessarily have the exact same background that they do, but what I've found when I'm building my team, I'm really focused on hiring the right people, making sure from the beginning that you're investing the time and finding the right person and then sort of getting out of their way, but being there to support them if and when they need you. So I really want to make my team's jobs as easy as they can be and not have to worry about things that they shouldn't be worrying about. I think that's what I've learned through my leadership experience. And because I'm hiring often highly technical people, those roles can be hard to hire for. And I think, of course, technical skills are really, really important and valuable, but there's also a lot of room for growth. And when you're hiring early career professionals, they should be given the benefit of the doubt in some cases that they can continue to learn and grow in the role. So I am usually looking for those softer skills that are maybe a little bit harder to coach or teach someone. And because we're putting our young scientists right in front of a client like their first day basically, it's the softer skills that are much, much more important. I think when you're hiring technical people, it's really important to be aware of their understanding of the business side of things and if they're able to translate their fundamental technical knowledge into something that non-technical people can understand.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Mara Cairo on LinkedIn    Check out VIE Healthcare and SpendMend      You'll also hear:    AI is a journey:  ‘'It's not necessarily something that happens overnight, and we often refer to our AI adoption spectrum in a way to assess where our partners are at and where they want to go. …my team works with companies who are really ready to get some hands-on support to start building out these predictive models.''   Overcoming the challenges of system integration in healthcare: ‘'…. Just… managing all of the information that's spread across different platforms, that can be really difficult to pull together and start understanding the bigger picture in real time. .. that understanding is really important and it leads us to solutions, but bringing all of that information together, …we've seen it being a bit of a challenging project to take on.''   Maintaining the humanity in healthcare: ‘'We don't want a machine to be telling you that you have cancer, right? So whatever the solution is, we also want to make sure that there's a human in the loop maybe validating these decisions…..It's a tool for clinicians or anyone to use. And it's not meant to replace anyone. It's really meant to just kind of enhance our decision-making abilities with some ….data-driven insights.''   How Aimii meets organizations where they are: ‘'…we have services where we work with our industry partners just to help them start brainstorming ideas. "So let's learn about your business. What are all of your problems? What data have you historically been collecting, and where can we maybe tie that data into the solution of some of these problems that we've kind of helped you brainstorm?" So that's just a way to help them start feeling comfortable that they know how to identify a machine learning solution to a problem.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

2024 has been described as a financial ‘'make or break'' year in healthcare. SpendMend Research Supervisor Zachary Markham explains to Jim Cagliostro why time and data are money for hospitals.     Episode Introduction  Zach explains why the lack of timely, accurate data can delay recovery of credits, and why most hospitals only have 50% visibility into their spend and accounts payable processes. He also shares why duplicate payments and credit on spend are the top two methods for recovery of costs, and highlights how uncovering dark data saved SpendMend clients $413 million in 2023.   Show Topics   Data analysis identifies duplicate payments Timely data is vital to maximize cost savings The significant cost savings potential hidden in dark data 3 challenges to gathering hospital data Positivity and communication skills are essential in leadership     02:18 Data analysis identifies duplicate payments  Zach provided a ‘'birds eye view'' of data analysis. ‘'So, when we initially get a client's data in, a hospital's data, we jump right on that data and we go ahead, we search account numbers and vendor contact information for each. So, if it's a larger healthcare system, we'll search for each entity within that healthcare system. We'll search for account numbers for all those, as well as the contact information for vendors. And then, for duplicate payments, that's a large revenue stream for us. So, that starts in the data scrub team. They scrub down the data and identify some good potential duplicate payments. And a duplicate payment is just an invoice that was paid twice for one reason or another. And once the data scrub team is done with that, they'll pass it off to us and we'll go into our client's imaging systems, where they store their invoices and we will pull those invoices and pass it back over to the data scrub team for validation. And I guess the third one here would be just various invoice pull requests for other departments, including the tax team, purchased services, as well as med device, just to name a few. And then, the last one I'll cover here just for the bird's eye view, PHIQ, which is protected health information. So, we've talked about data and it's extremely important to obviously protect our client's data, but it's equally, if not more important, to protect the patient's data as well.''   05:24: Timely data is vital to maximize cost savings Zach said hospitals sometimes don't obtain credits for years if price discrepancies aren't found quickly.   ‘'I'll give you an example from my time as a pricing analyst. So, as a pricing analyst, we would review data price discrepancies that were about one to two years old from present from what they were currently paying, the hospitals were paying. So, we'd go through identify, "You're paying this vendor $20 for this item, when you should be paying $10 for that item," just as an example. And we would get that and working one to two years behind them. I guess the quicker that we would finish our review and then turn that back into the client, they'd be able to mend the price that they're paying, get it back to the contracted or agreed upon price. And also, collect the credits that were outstanding for the time that they were overpaying. So, I guess the sooner you can identify that you're paying at a higher rate than the contracted price for items, the sooner that you can correct it and get credits from the vendors.''   07:44: The significant cost savings potential hidden in dark data Zach said hospitals only have 50% visibility into their spend and accounts payable processes.  ‘'Dark data is information that is hidden or not visible to a hospital for a variety of reasons. But it comes down to them not having the time, resources, or insights to uncover their own data blind spots. And I like to think of this kind of as a puzzle. So, when a hospital or healthcare system hands over their data to us, they're giving us basically a half put-together puzzle, and it's our job to put together the missing pieces or the other 50%. They only have approximately 50% visibility into their spend and accounts payables processes, and this dark data is essential to uncover, so our clients have a full set of data to make and implement decisions. And then what I always like to say is time and data are money. And then, as far as what hospitals can do about it... So, like I mentioned previously, hospitals are rarely equipped on their own to uncover their own dark data. Again, due to lack of time and resources. And that's where we step in as SpendMend to provide unique services that we do. All of our time and resources are used to uncover hospital's dark data through various tools and good old-fashioned investigating, I guess you could say. And in the past year alone, we've actually delivered $413 million back to our clients. ‘'   14:23 3 challenges to gathering hospital data  Zach said access to imaging systems, inadequate software, and losing data can all be obstacles to accurate data analysis.  ‘'Typically, when we get a new client, and again, this will be a rough number, we get probably 80% or so of those clients, we get imaging system access, which is vital to what we do. Then we're able to pull the documents that we need to support our claims. And not only that, but going back to the data, validate the data. That's imaging systems. And I'll break this down into three main categories. So, some healthcare systems or hospitals haven't invested in proper software to store their invoices or any. So, some hospitals don't have electronic imaging systems, so they're old school, storing their invoices on site within file cabinets. And that's tough for us to get to, unless we go on site. So, it's a lot less efficient that way…..And I guess number two there would be kind of the same category here. Some hospitals haven't invested in proper software to store their invoices. So, kind of like the first one, they use electronic folders within their system to store invoices, which in my experience with these sorts of clients, it's very difficult to locate invoices. And a lot of times it's not well-organized. It's timely to search for invoices, and a lot of them just straight up aren't uploaded, aren't imaged in these folders….And then, an issue that I've seen more recently regarding imaging systems, are hospitals upgrading their imaging systems and financial systems and leaving the old one behind. So, in essence, we're losing and they're losing the data that they've collected previously, and just starting fresh. ‘'   21:26 Positivity and communication skills are essential in leadership Zach said skillful listening is also vital to successful communication in leadership.    ‘'Well, I'm very blessed to be where I am within the company as the research supervisor. Anything that I accomplish or get praised for is not mine. It's God who gets the glory. He has blessed me tremendously through my life, but especially here at SpendMend in the past almost seven years. And then, I guess going over to the leadership advice, positivity is essential as well as communication, and then a subcategory of communication would be skillful listening.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Zachary Markham on LinkedIn    Check out VIE Healthcare and SpendMend    You'll also hear:    Zach's career journey to Research Supervisor at SpendMend: ‘'I started with the company about seven years ago and I moved through a few different departments…. One being pricing analyst, another being a data scrub technician….. And learning the ins and outs of other departments within the company really set me up or at least paired with my education.'' How SpendMend helps to identify and maximize cost savings using healthcare analytics: ‘'…. our healthcare systems are just …trying to stay basically afloat at this point.... They don't have the time, the money, the resources to really dig in like, all right, what did we do last week? What did we do a month ago? So, that's where we step in and help the clients along.'' SpendMend cost savings directly impact the quality of patient care: ‘''….. that's money directly pumped back into the American health system, which can be reinvested by or reutilized by the hospitals for nursing, if you want to bring on more nurses, staffing specialists, or robotics for surgeries, or whatnot. So, really, we're indirectly, directly affecting patient care and the quality of that patient care, which is what all this work really boils back down to.'' The top two recovery methods for SpendMend clients: ‘'From my perspective, it would have to be duplicate payments and credits open on statements.‘' What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

US healthcare is facing a severe shortage of workers at every level. 6.5 million are expected to leave their jobs by 2026. Geoffrey Roche addresses the challenges in building a new workforce with Jim Cagliostro.    Episode Introduction  Geoffrey highlights the impact of the current staffing crisis in healthcare, and why leadership needs to evolve from a transactional to a heart-centered approach. He also explains why delays to access in care can cost hospitals up to $1 million every month, how one community college turned away over 13,600 qualified students from a program, and why every healthcare leader should become a mentor.   Show Topics   The impact of an ongoing workforce crisis A changing approach to healthcare leadership Industry and academia must connect to support the workforce Access to care delays may cost hospitals $1 million every month Delayed care leads to poorer patient outcomes and higher costs Qualified students can't access vital healthcare programs All healthcare leaders should mentor     02:33 The impact of an ongoing workforce crisis   Geoffrey said the staffing shortage, combined with retention challenges, are impacting access to care.  ‘'… we sit at a huge inflection point. Probably without question the most challenging time in our nation's healthcare workforce is, as we speak today, certainly not that dissimilar from 2023. And when we look at it, we've got a significant supply and demand challenge. We know that there are not enough individuals graduating from college in pretty much every aspect of a healthcare program. We also know that retention still remains a very significant challenge, whether it's a clinical role or a nonclinical role. I think we have to be honest though about the impact that we are all seeing and will continue to face, particularly in the licensed areas of our healthcare system. It doesn't go a day where I talk to somebody and they share an access to care delay, whether it's in imaging, whether it's in lab, whether it's in outpatient or inpatient services. We're certainly at a very, very difficult time.''   06:00 A changing approach to healthcare leadership Geoffrey said leaders in a multi-generational workforce need to demonstrate empathy and not judge.  ‘'I think leadership as a whole is taught very differently, right? And different points in time, different generations, the way that they have been taught leadership in some ways was command and control, which some would argue is more like transactional. And as we further see, we've got how many different generations, some people say five, some people say six. Whatever the number is, we've got more generations in the workforce than ever. And what we know is that our younger and our future generations have a much different view of leadership than previous ones. And we know that connection, respect, empathy, really this desire to understand that it's not going to just be the status quo, is not going to be the future of leadership when we look at all the different generations. And so it's really incredibly important that we have leaders in healthcare that can relate and understand and demonstrate empathy and not judge. I always say nobody should be judging on generations. I am the first to say I'm a millennial, but that doesn't mean right away go in and talk about, "Well, millennials leave jobs." That has no business in this conversation. What does have is how do we work together to achieve outcomes and results? And ultimately, I think if a leader can find connection with a person and help drive them, mentor them to achieve results, everyone's going to be rowing the oar in the right direction.''   08:08 Industry and academia must connect to support the workforce Geoffrey explained why collaboration is vital to improve access to care delays.  ‘'….we have significant access to care delays in the healthcare system today where whether you're going for an imaging study, whether you're waiting to get an appointment for whatever it may be, cardiac related, oncology related, we have a really challenging situation where you have a situation where literally I talk to people across the country and they're like, "Well, I was supposed to get this study done, but the person who was going to do the study called out sick and they didn't have somebody else to do it." That's the reality that we sit in today, and we have to really address that. And that's really where that industry and academic connection comes in, where we've got to get strong connections where we're working together to make sure that not only do we have all the right programs to support the workforce, but that industry and academia are also coming together to talk to accrediting bodies, to talk to licensing boards because sometimes what's in place from a licensure end and from an accreditation end is not necessarily helping address these issues. We sit in a time of 2024 where some licensing standards and accreditation standards have been there for 40 or more years. Well, this is a very different world and a very different healthcare workforce today. And so I can't stress enough that importance that we really are fully integrated working as one towards the exact same outcome that we all want.''   09:52 Access to care delays may cost hospitals $1m dollars every month  Geoffrey said high workforce costs need to be considered against the high cost in delayed access to care.  ‘'The other point I would just highlight is, look, access to care and access to education go hand in hand. But what we also know is that these access to care delays have a significant impact on the bottom line of the healthcare system. If you study it over time, whether it's an imaging study, whether it's other diagnostic related things, anytime you don't have the workforce to operate a specific piece of medical equipment, just on reimbursement alone, you could be looking at a million dollars a month. I mean, just think about that. When you think about that in the healthcare system, how much workforce costs. But then if you don't have the workforce to help operate the equipment that allows care to happen, they're not able to reimburse for it. And so there's a significant implication there as well. And so that's why these things are so important. First, people. But second, process and the impact and the financial is really critical.''   11:42 Delayed care leads to poor patient outcomes and higher costs Geoffrey explained why costs will spiral if challenges in access to care are not resolved.  ‘'…... So access to care is delayed, ultimately they're probably going to end up in the emergency room. And then when you look at that situation, that care is going to be so much more costly than it could have been if that care wasn't necessarily delayed on the front end. While at the same time, we know workforce, people, still remain one of the top costs in our healthcare system for every single employer. And so most healthcare systems have tried to do their best to not have as many travel staffing occurring in all facets of the organization. And as part of that, obviously some have none today, many still do, but those costs are exorbitant. But the ultimate element is when patients can't get the access to care when they need it, that condition can get worse, diagnoses can be delayed, and it just can further add up and add up to a very expensive healthcare system as we know that ultimately is not going to be good for the entire holistic sense.''   14:19 Qualified students can't access vital healthcare programs Geoffrey said in 2023, over 13,600 students qualified for a community college program were turned away.  ‘'Today, we sit in a very different time where we have far less individuals expressing interest in healthcare careers as a whole. And we also sit at a time where we have a challenge where so many healthcare programs, particularly at the community college level, which have historically been our biggest supplier of our clinical healthcare roles are capped or they don't have any additional seats currently available. We get into accreditation issues there. We get into faculty student ratios there, but it's a very real issue. So I'll give you an example. In imaging, which is so important to all facets of our healthcare system from a diagnoses standpoint to helping the whole care delivery system to rural, suburban, urban communities across this country, you have, in 2023, the professional association, ASRT, surveyed community colleges. And what that survey said was that roughly just over 13,600 students qualified for a community college program in imaging were turned away…..Just over 13,600 qualified students turned away from community colleges across the country. Now, we know nursing has even worse numbers when it comes to community colleges. And here's the fact these community colleges are not turning them away because they want to. They're turning them away because of accreditation. They're turning away because they don't have enough room, seats, faculty to student ratio, a whole host of things.''   17:52 All healthcare leaders should mentor  Geoffrey said it's important to give back and help others to achieve their dreams. ‘'…I think particularly if you are a leader, make sure you're mentoring and that you are giving back to help others achieve their dreams. And if you're seeking a mentor, certainly people that have not necessarily been a mentor, think about mentoring others too. Everybody we know, based on data, particularly in healthcare today, needs a mentor. This is not an easy industry, but it is the most fulfilling industry to ever serve in. But we know that with a mentor, it's not going to be easy, but it certainly can be a bit easier along the journey. And so that's what I would certainly leave you with.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Geoffrey Roche on LinkedIn    Check out VIE Healthcare and SpendMend    You'll also hear:    The meaning of ‘'Healthineers'': ‘'Healthineers is the healthcare side of Siemens….Healthineers was a name given that really reflects that our workforce at Siemens…are pioneers in breakthroughs in medicine.‘' Challenges in staff turnover and hospital leadership: ‘'We have seen larger numbers of individuals at middle management all the way up to senior executive management leaving our healthcare systems. Some of that in all honesty is not a bad thing…. In my opinion, we have had far too much transactional leadership in healthcare as compared to true heart-centered transformational leadership.'' Burnout remains a very real issue for healthcare workers: ‘'….we're also seeing (burnout) among other professionals and other leaders in healthcare. It's a very, very real issue…, we don't always take care of ourselves because we're so externally people-focused. And so it's impacted across the board.'' Time is of the essence for staffing and patient care: ‘'…if we as industry don't work to … find innovative and creative ways to join together to talk to the accrediting bodies, to work with the licensing boards, we're going to only further perpetuate that reality becoming far worse. This has a significant impact to patients. This has also a significant impact to the workforce, the existing workforce, because think about burnout, think about moral injury, think about stress. We don't have enough people to help you, everything's on you.'' What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

Tom Pierce, the President of Integrated Information Systems Incorporated provides valuable insights based on his diverse background in problem-solving, logistics modeling, and consulting.    Introduction Our guest, Tom Pierce, the President of Integrated Information Systems Incorporated provides valuable insights based on his diverse background in problem-solving, logistics modeling, and consulting. The episode explores the impact of technology and human behavior on the supply chain, challenges in decision-making related to expenses and stock management, and the importance of honesty, transparency, and human connections in supply chain management.   Topics Covered The mindset required for effective decision-making in healthcare expenses The social and psychological dimensions of business decisions Transparency and human connections in supply chain management Data quality challenges and human intervention with digital technologies Overseas supply procurement and its implications The importance of truthfulness in buyer-supplier communication The bullwhip effect and technology's role in accelerating it Cost-risk versus schedule-risk: organizational motivations The impact of just-in-time vs. just-in-case inventory strategies   2:45 The Impact of Technology on Problem Solving "Once computers made their appearance, and yes, I am so old that I learned how to use a slide rule and the calculator was in advance, so I'm that old, but as computers came on the scene, the only reason I was interested in them was because they could help me do things to solve problems quicker, more efficiently, all of that. So I've grown up with the introduction of technology into previously very human, very brute force, mental math, pencil and paper, problem solving, but it's very hard to condense 40 years of what technology has done to the ways we solve problems and the ways we create new ones. Everything we did humanly good and bad has been accelerated and amplified by technology.:   6:17 The Impact of Technology on Human Behavior "It's rather amazing how much our computers have been created in our own image and exemplify, manifest the same flaws that we as people exhibit when relating to each other, but it's less inhibited."   10:34 The Impact of Financial Incentives in Organizations "I don't think that's a bad thing. I think people should be rewarded financially and get fairly compensated for their investment in in technology, you know, and people that do well should be rewarded for doing well. I got no problem with that."   13:26 "Just in Time Inventory Practices" Well, if it's not broke, don't fix it. Well, that doesn't mean don't have spare batteries. When my flashlight goes out in the middle of the night, I want to be able to go into my pantry or my workshop and get more batteries, but that's not lean unless you can predict exactly how many batteries you're going to need and then the ideal becomes, "Well, we'll just have an Amazon ready to deliver to batteries same day," and just reduce and reduce and reduce the carrying cost of your inventory, and I blame the Walmarts and the Targets of the world for doing just that. They leaned out their own cost by offloading those costs to their suppliers, so the just-in-case part, right? In case of disaster, well, that's your vendor's problem, because your big and powerful and you can insist, if you want to do business with us, then you've got to maintain stockage objectives and you've got to reply 24/7 replenishing my shelves, because I don't want to maintain a big warehouse. I just want to move parts through.   15:07 Just in time versus just in case "If your only motivation is profit, that's a really good business model for a finance person. Mhmm. It's not a great business model if what you're really trying to do is continuously improve your product and your service and the delivery times and, you know, customer lead times, all that."   19:30 The Deception Game in Business “I need to know when my parts are going to arrive and I need you, as my supplier, to meet that date, because I'm counting on it, but I'm not going to tell you that I'm fudging the date a little bit, because I want to build myself a little cushion, because I'm telling my boss it's going to be here by February, so I'm telling you I need it by January, and you've got sub-tiers and if it goes seven levers down, now you've got people running around like mad people trying to do things six months earlier than they're really needed. And if you're good and successful, it goes through the chain and it ends up on somebody's shelf six months earlier than it was really needed” 22:42  The Bullwhip Effect “The more you fudge, the more you hedge, the less honest you are, you end up with what a lot of people in supply chain refer to as the bullwhip effect, right? You make a slight quick motion with your wrist on the handle and on a really long whip, the tip of it is going to break the sound barrier. You can have that dramatic effect on a really long supply chain as the amplification, and again, technology amplifies and accelerates that.”     25: 19 Predictability in Supply Chains: "Level is more predictable when your forecastability, your coefficient of variance, Ratio of standard deviation to mean is, well, one expert that I trust highly says, when it's greater than 20%, You're entering an area, a quadrant, that they would call unforecastable."   32: 10 The Importance of Trust in Leadership: "I will trust you until you give me not just one, maybe two or three reasons not to trust you. Maybe the answer should be seven or 70 times seven, but my default position is going to be in trust until I have a reason not to trust you. I believe well-informed leaders make better decisions, so there's way too many people that are afraid to tell the boss the truth, to tell the shareholders the truth, to tell the clients the truth, to tell  well-informed people throughout your living experience perform better.”   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Tom Pierce on LinkedIn  Check out VIE Healthcare and SpendMend        You'll Also Hear: 1. The Impact of Technology on Human Behavior: We discussed the interplay between technology and human decision-making in supply chain management, emphasizing the psychological and social aspects involved. Understanding the mindset needed for decision-making related to expenses, shelf life considerations, stock management, and tolerance for excess stock is crucial in today's rapidly evolving healthcare landscape. 2. Transparency, Trust, and Communication: Honesty, transparency, and human connections are essential for effective supply chain management. We explored the challenges of data quality, the need for human intervention in digital technologies, and the implications of deception and lack of transparency in communication between buyers and sellers. Establishing trust and honest communication is vital for well-informed decision-making and effective leadership. 3. Balancing Cost and Risk: The episode delved into the concept of cost risk versus schedule risk in business and the implications of the healthcare industry's focus on cost and slim operating margins. We explored the balance between maintaining emergency inventories of life-saving equipment and outsourcing supply chain overseas to manage costs, highlighting the impact on organizations' motivations and incentives.   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.      

After 25 years and $1 billion of hospital cost savings, Lisa Miller is joined by Rich Dormer, Bryan Covert, and Pandu Mitre to celebrate this landmark episode of THLE.     Episode Introduction  Together, the team discuss the cost savings surprises of 2023 and look forward to 2024. Insights include the two-tiered approach to cost savings goals that all hospital leaders might want to consider, and why difficult vendor negotiations will continue in 2024. The team also review the potential impact of AI on cost reduction, why finding hidden costs always comes back to line-item data, and why every hospital needs a spend data strategy in 2024.    Show Topics   Building strong teams in a post-Covid era Vendor negotiations became more difficult in 2023 ‘'It always goes back to the line-item analytics'' A two-tiered approach to cost savings goals The hidden cost savings in AI  Vendors will continue to say ‘'no'' in 2024 Two keys to an efficient supply chain More buying power doesn't always equate to ‘'best pricing''      02:26 Building strong teams in a post-Covid era  Rich said healthcare systems are hiring people with a broader skillset that need an accelerated learning curve.  ‘'…one of the biggest things that we saw this year, or I saw specifically was a lot of organizations were building those sourcing and supply chain teams. Where in the past they've been really lean and relying on GPO or other types of resources. But with COVID and the need to really do a lot of contracting, a lot of complicated agreements, most organizations recognize that they really needed to build their teams. But the issue that a lot of them have is that there's really only a limited pool of seasoned players on the market essentially. Therefore, when they look to hire, they're hiring a lot of people that are either early in their careers or they come from a different industry which when we look at healthcare it's really unique and complex. So bringing someone from the manufacturer industry coming in and looking to do a sourcing or some sort of negotiation in healthcare, it's very different. So with these large obviously needed cost savings goals for organizations, these newer teams that are being put together need to really accelerate their learning curve. So we've seen a lot of conversations around the support that they need. Right? And probably the biggest one that we keep hearing is that access to data, really that line-item invoice level data is critical to be able to do these large initiatives that a lot of them are working on now and they struggle to get that information. Because the biggest piece is to really do analytics around it and they're doing it off of projected data or vendor supplied information which is not always accurate. So those are the biggest pieces for a lot of these teams coming in and really trying to meet these aggressive goals that are needed for these organizations to maintain their profitability and not only with analytics and data but also negotiations.''   12:06 Vendor negotiations became more difficult in 2023 Bryan said utilization and market data are just two elements hospitals can us to combat vendor refusal to reduce costs.  ‘'I think the most surprising thing for me was just how difficult negotiations with vendors became in 2023. To your point and Rich's, point earlier we saw on the hospital side more investment in supply chain teams, probably some of the largest cost savings goals we've seen at our clients throughout the years. Just because costs were going up and they're trying to come up with ways to combat them, the vendors had a really solid narrative. We had 8% inflation; their costs were up. They're also coming out of a time with COVID where a lot of the vendors had to really step up in supply services and crunch time, so they really developed stronger relationships with the stakeholders at the hospital. And then we're seeing in 2023 the vendor is more willing to tell supply chain no to cost reduction, costs are going up and then lean on those relationships with the stakeholders. In some cases have stronger relationships with the stakeholders than supply chain and finance, it was really a difficult time to just negotiate for cost savings because you're really up against a lot of external factors. So for us I know achieving cost savings for our clients more than ever we really leaned into a lot of contract compliance and also a lot of the utilization, implementation, ways that you could improve service, improve scheduling, lower costs that way. But more than ever heading into negotiations you really needed a solid strategy, good market data to combat that. But also more than ever you really need involvement with the stakeholders at the hospital. …. also what we see is our clients who are successful were the ones that were more willing to engage the stakeholders, maybe take a little more risk and look at change and look at consolidation and kind of think outside the box.''   18:14 It always goes back to the line-item analytics Rich explained why invoice details are vital to understand cost drivers and strengthen negotiations with vendors.  ‘'So it always goes back to the line-item analytics, right? So the invoice details are super important to be able to build the baseline and understand where the cost drivers are and then to be able to negotiate and Bryan, mentioned utilization. Obviously, there's a lot of opportunity in utilization now and it's not just pricing. In some cases we're saving our clients 60, 70% of the total spend for a vendor because they're not using them properly. There wasn't things that were set up that weren't even being utilized and that wouldn't be identified on just a contract review on just a 12-month spend report from the vendor. These are the things that you would get from the invoices and working with the stakeholders and understanding and diving into each one of those applications you'll figure out okay, well we don't need these. Why are we even paying for these? And that's where a lot of the cost savings came over the last year outside of those line-item analytics negotiations.''   23:59 A two-tiered approach to cost savings goals Lisa explained why a ‘'stretch-goal'' can help hospital leaders to identify more cost savings.  ‘'….Everyone gets a cost savings goal and they're driving to that, and I think the thing that surprised me this year and we've all talked about it and it's probably a little sensitive. So I will approach it from a sensitive perspective, is that once hospitals have hit those savings goals in the department everything kind of seems to stop. Right? In terms of savings. And so let's say the hospitals hit their savings goals in September, we do see... And we've seen it every year for years and years and years it slows up, unless the initiatives are driven let's say by say a CFO or someone there. Right? They're like, "Keep on going, keep on going." And I think that surprised me this year and I would've thought that everybody with all the losses and all the issues would've just continued to put their focus and would've just continued to drive, drive, drive right until the end of the year. Let's get as much as possible and I know that whether it's goals or incentives, they do drive behavior and outcomes and so maybe hospitals and leaders need to think of two tiered on this like a goal and a stretch goal. I think for me I was surprised to see the let up considering all the losses in hospitals in the…. I was surprised to not see like listen we got to forget my goal, I got to surpass my goal. So for me that was a big surprise.''   33:55 The hidden cost savings in AI Rich said transparency is need from vendors if they expect to make future cost savings from AI.  ‘'Obviously, AI is being talked about a lot and we're really starting to see some of the first steps and some of our clients recently worked for an IT call center and the AI functionality is going to really take the initial call desks. So this way it eliminates a lot of the costs that would be going to this third party that they were outsourcing. Then what happens is then the remaining calls are more complicated and take longer. So it's actually going to cost the vendor more to support the call centers because all the quick calls that could be taken with them that they're doing now are going to be eliminated by AI. So there's a lot of these disruptions that are going to happen within healthcare, it's coming it's just a matter of when and how quickly but we're definitely going to see them. I mean it's going to be patient financial services, transcription language services. There's a lot of these different that you could see it's going to impact and then there's going to be a lot that we don't know it's coming. But it's one of those where from an organization standpoint, negotiating contracts now, like if there is some pending or soon to be released AI functionality in certain areas, they really should know about it. Because if they're putting a five-year contract in place and there's a replacement lesser cost AI functionality, they would really need to know that beforehand going in because the vendors would probably know that.''   38:48 Vendors will continue to say ‘'no'' in 2024  Bryan said hospital cost savings teams need to be prepared for inflexible vendors.  ‘'I think that cost savings teams at the hospitals have to just anticipate hearing no from the vendors more than ever. I think we heard it last year…..I think it's kind of a paradigm shift where supply chain used to come into these initiatives with either some level of benchmarking or cost savings goal and sort of bluff a little bit. "Give us this price or else." And now the vendors are just saying, "Okay. Well no, what's the “or else?" And then it became a question of are we going to look into the “or else” then? Are we going to go talk to stakeholders? Can we really move it? Can we impact this or impact change? But I think now more than ever moving into the new year, you really have to be prepared from the start. You have to get that engagement and think critically about how serious you are taking on a category, get with those stakeholders and really get that engagement and come up with a plan. Because you need to anticipate that they're going to say no and then you have to know what “or else” is and you have to have some teeth behind it or it's just not going to work.''   42:49 If you're not in the business of data you're not in business Lisa explained why a spend data strategy is vital for cost savings in 2024.  ‘'….. My prediction for this year as it relates to 2024 because it talks about data. So I read this quote, and I really loved it, "If you're not in the business of data you're not in business." And I actually think it's data, data, data for 2024. Right? Using data with brave new strategies versus being reactive in your decision-making. So I think that while we've had some advances in hospitals being your supply chain or spend data, I think there's been some movement on how we look at data. I think there's still a big quantum leap in the discipline of data. Anything, in department sourcing, how do we look at spend data from a real monthly approach? Line-item approach? It is going to require either an investment or resources, but I actually think that's the easiest part. I think the hardest part is the change, it's actually putting in that data discipline and metrics and all those things in place. I think that's the harder component, but I just think there's so much money available to hospitals if they just really had a spend data strategy. What's your spend data strategy? So that for me is the prediction for 2024 is it's all about data. ‘'   46:17 Two keys to an efficient supply chain in 2024   Pandu said better communication between internal stakeholders and more effective contract organization will help to improve renewal processes.  ‘'The biggest thing is just communication between internal stakeholders, we see a lot of times where you're working on an initiative it's a large vendor and there's just multiple services coming through. We talked about it a little bit, and you have two different people working on essentially the same initiative but they're looking at two different aspects of the initiative. So they're not aligned, they're not communicating and they're kind of just looking after their own goals and I think that needs to change. I think a formal process that then needs to be put in place is going to help make that change. So having a written checklist with things that you need to evaluate, a list of questions that you're constantly asking, and you have to ask on every initiative and then the timeline to completion. So that everyone's aware of when things need to be done so that they have time to collaborate with each other. And then in addition just organization. Having a repository of all of the contracts that you've worked on in the past, all of the data, all of the utilization reports that you should be requesting as a part of that checklist and then commitments or notes that you're making now when you're negotiating a contract. So you can look back on it a year or two years or five years down the road, which will make your renewal process a little bit easier. So I think there's so much more, but I just wanted to keep that high level.''   48:04 More buying power doesn't equate to ‘'best pricing'' Rich said that most of the time larger health systems are not getting the best value from contracts.   ‘'It really comes down to a lot of the health systems, they're pooling that money together, the buying power. So you would think they're getting the best pricing and a lot of times we've seen our clients and some of the larger health systems, they're not getting the best pricing, they're not even getting even average pricing. And a lot of the times it's because the contracts are so complicated, the services are so different and unique by location that to kind of put everything together it doesn't mesh. Right? So they're trying to fit everything together as quickly as possible when a lot of times these things are not aligned. Right? So like food nutrition services or EVS or medical gases. It's just how are they winding up and how quickly they can line up these different services from even sometimes the same vendor but competing vendors as well. Without that, we've come to it again the line-item analytics and really that contract mapping. Right? So it's a combination of both the line-item analytics, the contract mapping by location. The quicker they can do that, the more money they save. Even if they line up these contracts, most of the time they're not getting the best value. So it's really how quickly they can do that, even though they're so big and they have this buying power a lot of times like I said they're not getting the best rates.''     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Rich Dormer on LinkedIn  Connect with Bryan Covert on LinkedIn Connect with Pandu Mitre on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:    Hospitals need to put in layers: ‘'Vendors and vendor partners dedicate an enormous amount of resources, time, training….they're putting in layers and jobs in their organizations for pricing committees….But how much so should hospitals be putting in those layers that thinking, that discipline that they are doing?'' The hospital paying half a million dollars for ‘'software on a shelf'': ‘'There's such a high level of disagreement between hospitals and vendors coming out of COVID where vendors seemed like they're really stepping up and being good partners and they kind of transitioned into “well, we helped you out. Now we need to raise costs because inflation's really high.'' Focusing solely on contract reviews means missed opportunities for cost savings: ‘'… if you were just to look at a chemo dialysis agreement you would for the most part look at one-on-one, two-on-ones. But if you didn't look at the invoice details and you look at utilization, you wouldn't see delayed start times. You wouldn't see all those inefficiencies …..just reviewing contracts you lose so much opportunity.'' Changing behavior to incentivizing cost savings: ‘'On the (hospital) side you're limited to just reducing budgeted expenses, that's it …I've hit my goal. If I close a project now, it doesn't do anything for me but if I close it next month it helps me meet my goal next quarter. So then you're actually incentivizing behavior to push off projects, to delay cost savings because people are going to look for their own job safety before anything else.'' Reducing time for legal reviews. Could AI accelerate contract renewals? ‘'The biggest delay a lot of times is on the legal review, so you have to imagine that if there's an AI component there which would be a lot less expensive than a lawyer reviewing the contracts that could accelerate a lot of the different negotiations.'' Having a back-up vendor rather than sole source: ‘'... We like sole source, we think there's aggregate discounts, there's reasons why. I just think that having a backup and a backup strategy, …. having a number two in some way, shape or form makes a whole lot of sense too. …I think hospitals have to take control.'' What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

After labor, the supply chain is healthcare's biggest expense. Randy Subramany, Director of Supply Chain at New York Presbyterian Hospital, shares insights into 2024 trends and innovations with Jim Cagliostro.    Episode Introduction  Randy explains why there's more to his role than ‘'bandages and gauzes'', why people are the most important element of the ‘'three-legged supply chain barstool,'' and highlights why patient care, decision-making and retaining talent are the top supply chain challenges. He also explains why it takes an eco-system to keep people healthy and how tapping into the power of technology can improve slim hospital margins.    Show Topics   A day in the life of a Hospital Supply Chain Director Caring for patients with complex health needs Challenges in retaining and growing talent  The impact of digital transformation on healthcare Utilizing technology to promote a sustainable economy Supply chain management: improving margins Leadership tip: Going to the Gemba     02:26 A day in the life of a Hospital Supply Chain Director Randy explained the far-reaching impact of the role and his team.    ‘'People think about supplies in a hospital, I'm sure the basics, whether it's through a TV show or just walking through a hospital, you'll see the fundamentals, you'll see gloves, you'll see gowns, you'll see all the different forms of PPE, people think bandages and gauzes, but let's move beyond that now because that's some of the basic things. As a supply chain director, my team is also responsible for pacemakers, for skin tissue that we purchase for a patient that has a severe burn and needs to have emergency surgery, for all of the accessories used in robotic surgeries as well, for grafts and stents and meshes that are used throughout all different sorts of vascular cases. And to give everyone those numbers, to give a number, my team, on a daily basis, is managing 15 to 20,000 case-dependent, unique supplies. To take you through my day, fundamentally, I have 135 wonderful human beings who are responsible for all elements of supply reordering, replenishment, distribution, logistics, triaging, back orders, and really, anything disposable, and some reusable, but mostly disposable that's used on a patient is touching a member of our team. So as I'm sure you can imagine, as I'm sure anyone who's familiar with the hospital can imagine, as I'm sure anyone who's not familiar with the hospital can imagine, the role itself, it's quite impactful.''   08:52 Caring for patients with complex healthcare needs Randy said that caring for patients with complicated illnesses was the primary challenge.  ‘'But I think the primary challenge that we have, that we will have as an academic institution, is we're seeing patients with the most complicated illnesses and diseases that require, although state-of-the-art and groundbreaking, the most complicated treatments and the most complicated processes and procedures to care successfully for these patients. Of course, fundamentally, in a hospital setting, you're never going to be 100% ever. You're never going to cure anyone 100%. Sometimes care is more important than the cure itself. But putting that aside, I think we're what they call a tertiary coronary academic medical center, which means that we encounter the sickest patients in the world that come to us. So I think the first challenge is we are caring for humans who have very complicated illnesses and diseases.''   11:43 Challenges in retaining and growing talent  Randy said he expects to lose up to 40% of his experienced team members in the next five years.  ‘'From my direct lens internally, I think the main challenge is retaining talent and growing the talent. I say that from two lenses, I'll say that from the lens of 30 to 40% of my team members are within five years of retirement, 30 to 40% are within the first five years of their career. I think there's a gap. And we're noticing, universally, putting aside the supply chain industry, that talent is leaving the work environment or leaving the market because it's time for people to live on to their golden years and pursue other adventures. But for me, it's like how do I bridge the gap with that talent in X number of years from now where the majority of our workforce or my team will be relatively, it's wrong to say inexperienced, but will not have the same levels of experience as those who just have that anecdotal information of they know that this unit uses this supply. It's not something you directly can teach, it's just something that people learn.''   17:08 The impact of digital transformation on healthcare  Randy said moving to cloud-based systems will be vital for effective supply chain management. ‘'Why is that? I think it's because we think of, historically, ERP systems as transactional systems, systems that you use to order, sometimes to manage inventory, but as we move to the cloud, there is going to be this recognition. Cloud-based systems are built as well to be more of analytical tools that can offer forecasting services, that can truly offer inventory management visibility that get into a lot of those key metrics and KPIs that supply chain leaders such as myself look for. In the current ERP systems, at least the primary ones used in healthcare, like Infor, Oracle, and Workday, the non-cloud based systems I can tell you from firsthand experience, aren't there yet. And I'm not by any means saying anything negative about the products, they serve a key function of getting supply orders to our vendor partners and getting supplies in our doors. But moving towards cloud-based systems, which I think will be the centerpiece of this digital transformation for hospitals, is of the utmost of importance for supply chain leaders.''   24:17 Utilizing technology to promote a sustainable economy  Randy explained how a sustainable approach can also help to create a healthier society.  ‘'The last trend I'll say it's really around what we term the circular economy or the sustainable economy. I think when we think of... In the world of disposable supply, it's hard to kind of connect that to being sustainable because disposable, you associate with using once and then throwing away…. but the trend of using technology to accomplish the key tenets of forecasting more accurately to ensuring that what we have on the shelf is exactly what we need….creates a more sustainable environment because we're not over-ordering and we're not producing waste. One of the key things in healthcare we're focused on from a patient safety perspective, of course, is ensuring that an expired supply is not used on a patient for care. Having technology as an enabler helps us to track expiration dates as an example, and by doing so, we'd be better able to make better decisions about what we order, about what our warehouses, whether it's our own, whether it's our distributor, what's being stored in the right quantities, which in the end creates a more sustainable environment for everyone. Of course, we have a lot of great vendor partners who are working on state-of-the-art packaging techniques that utilize recyclable materials. But just to bring in full circle, these trends of utilizing your talent and creating an environment, digital supply chain, one that incorporates elements of artificial intelligence and big data can not only just drive us towards being more sustainable, but in the end, it makes people healthier….. having a healthier world just creates a better place for everyone. … it takes an ecosystem, and it takes a lot of external parties as well to help us get there, but these trends are essential to keeping people healthy.''   31:50 Supply chain management: improving margins  Randy explained the importance of what hospitals buy and why they buy it  ‘'….when you look at the expense bucket, you have staffing, which is the primary expense, you have the best talent. Hard bucket to touch. The second-biggest bucket though is the supplies and all the efforts that a supply chain management team is involved in. And what I would say is how... Of course, by no means am I advocating for buying the cheapest stuff to reduce the margins, that's not the investment way to think about it. But I think one thing I will say is thinking of a supply chain team as an investment is the right approach to help build bigger margins. Now I say that from the lens of, coming back to my example of spine surgery, sure, we may buy a spine implant at a greater cost, could it yield a better outcome for our patient that reduces their chance of readmissions, which... And I'm not trying to get into the insurance world, which hospitals then get reimbursed less at a basic level if a patient's readmitted. So there are factors that tie to that strategic thought process that requires so many different parties from the revenue cycle, from finance, from clinical care, to be involved and from the billing and coding, all of that ties into the supply chain. So I think thinking about supply chain from that operational lens as an investment, it's like, "What do we actually buy. And why are we buying it?" And of course, economies of scale come into play. If you can standardize, and you know this, Jim, if you can have your physician and clinical teams on board with utilizing as much stuff from one supplier or one vendor over another, it naturally will just yield the economies of scale and reduced rates. ‘'   35:47: Leadership tip: Going to the Gemba  Randy said going to the source and engaging with people is a pillar of success.  ‘'So what I would say is a lesson I try to embody and carry every day, it's centered around this theme of going to the source. So when I say that, and I mean, like literally or geographically, if there's an issue on a unit and a hospital, going to the unit, engaging with my team who's there to maybe help resolve supply chain need, engaging with the clinical team, again, as human beings, are there to help care for a human. But also, when in critical emergencies, as humans, we can't help but feel you have a variety of different emotions that go into the care of caring for others. So I would say as leadership lessons is going to the source and engaging with people. I think fundamentally it's working with people, that is the pillar of my success, or I dare to say, my success is being able to work with others. And when there's a moment to praise someone, when an opportunity arises to improve something, going to that source. My source just so happens to be a clinical unit in a hospital. And you know what? Going to the source, it's more often than not gratifying because then you really get to see, hey, my team orders this product, here's how it's used to help make life better for this person who's receiving care. So I think Toyota coined it as going to the Gemba, so I'll leave our listeners with go to the Gemba.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Randy Subramany on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    A focus on the ‘'three-legged bar stool'' of people, processes, and tools: ‘'People is the most important bucket of what the supply chain does here.''   Why decision-making in patient care can be a challenge: ‘'….we need to have the right people per se at the metaphorical table or the virtual table to make those decisions. But getting everyone to one direction is not always easy.''   Supply chain is at a tipping point: ‘'But I think we're approaching this tipping point in supply chain, specifically in the healthcare and even in the hospital sector where innovation and technology as an enabler is going to come to the forefront.''   The impact of AI on payment systems and profit margins: ‘'Many operate at less than 3% (margin). So when you think of being able to pay your partners, your suppliers or vendors quicker, but to get a greater discount, it just directly connects to the bottom line.''   Successful change management incorporates listening to feedback: ‘'….allowing the team to be heard with their feedback, even if their feedback upfront is resistance, finding some layers of compromise. … team members are rational and they will understand why the new process, one that uses technology more, will make things more efficient. And they realized that the process became 30% shorter per se, approximately 30% shorter, minutes-wise, which gave them time back to assist with other responsibilities that were directed to patient care.'' What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

A focus on frontline innovation has kept VIE Healthcare at the forefront of hospital cost savings for 25 years. Lisa Miller shares her formula for success with Jim Cagliostro.    Episode Introduction  Lisa outlines how getting to the line-item details in purchased services was the key to early success, the ‘what-if' questions that led to patents, and why hospitals should never settle for 10% in savings when digging deeper might lead to 25%. She also explains why letting the data speak takes the emotion out of vendor meetings, and why hospitals need to work with companies that will ‘'run after every dollar'' of cost savings.   Show Topics   25 years of adapting to change in healthcare Paying attention to detail and a focus on data Cost savings innovation comes from ‘'what-if''? Hospitals have one shot at cost savings Allowing the data to speak at contract renewal A comprehensive cost-savings solution with SpendMend     03:50 25 years of adapting to change in healthcare  Lisa said VIE had focused on finding cost savings in purchased services from the beginning.   ‘'25 years ago, I knew I wanted to be different. So the difference was, for me, that we would go into an AP department and we would copy invoices. So we literally would say, we don't need anything from your team. We're not going to be disruptive. We're going to go in, we're going to copy invoices, and then from those copying invoices and copying the contracts, we're going to find cost savings. So you won't even see us. We're going to, in the back room, get the data and we're going to come back to you. And that works great. I felt like that was a big differentiator because working with the CFOs and the COOs are like, "Really?" And I'm like, "Yeah, just give me a day, give me two days, we'll bring a couple of people in, and then within less than two, three weeks, we're going to already have opportunities." So that was, in my mind, the least amount of friction that we could get to working with the C-suite, and that, for them, too, they can get buy-in. Obviously, they have to task their team with this. So the most they would have to do is tell somebody in accounting, they're going to be onsite and they're going to copy invoices and contracts. That was the worst case scenario. …. So what happened is, accidentally, because we copied all the invoices, we were 24 or five years ago already started to look at purchase services because others in this space, other consulting firms would ask for a PO detail report and they would focus on that PO detail report for their cost savings. So the purchase services would come up as just the header data and a total spend… they would never even look at it.'    07:08 Paying attention to detail and a focus on data  Lisa said a desire to do the work and getting down to line-item details are two differentiators for VIE.  ‘'…we are so detailed-focused, and so when you asked your initial question how we see change or how I view that, it started with how do we support hospitals for success? And so my lens on it was always to make things easy to... be easy to work with, get the data. And then over time, as people saw, like what you said, just our desire, our roll up your sleeves, we get to the details approach. We're not looking at ratios. In the past, we've achieved 7%, so we are going to give you 7% savings. It was always about their data, their line-items, their detail. When we show an opportunity report, it is down to the details. And so that's a great point. That's our differentiation. So fast-forward, we would get the invoices. We had a team of people on the backend just entering line on details. And so our work was always so different, when our hospitals saw that work, like, this is work that we've never seen before. And it's because everything matters, those details matter.''   08:22 Cost-savings innovation comes from ‘'what-if''? Lisa explained how ‘'what-if'' questions resulted in innovation (and patents) in cost savings.  ‘'It's this, I love what if questions, and that what if question really got me down the road of finding a different solution. The different solution was take an off-the-shelf OCR tool and I had to search literally globally for the right OCR solution and reverse engineer it and have to... We code invoices. We had to learn a system, we had to code invoices, we had to bring people in and take a totally different view on it, but it was difficult. And I had people telling me, "You'll never be able to do this. You'll never get a patent." We got several patents. And it was such a great lesson to go through the process and to have people like Anthony who came on board and, of course, Pondu and Rich and Brian, who've kind of been part of this process. But now to have patented technology, to just have a different vision for our work, and to keep pushing forward. To stay ahead, for us, so we can deliver a differentiated result. So one of the things I've been really thinking about a lot is why choose us, right? And there's other people, other companies, and they're doing everything manually. We're automating it. Now we can get to savings in a much quicker, expedited, rapid way, so hospitals can get results.''   10:55 Hospitals have one shot at cost savings Lisa said health systems have to get it right at contract renewal, and that means getting to the line-item details.  ‘'But I've been thinking about why this matters. And so, the one area where I think it matters the most is that hospitals do have so many things that are going on, so many more competing priorities. So they've got one shot at this contract renewal. They've one shot at looking at this cost savings. What do you want? If you've got this one shot, do you want to just grab 10%? Or do you want to have the company that's going to roll up their sleeves, get to the details and get them 22%? Just because you get 10% of savings, sometimes everyone's high fiving, but what if that should have been 22 or 25? So the big thought that I've been coming to is you got one shot at this agreement, don't you want to... Let's do it right. And again, I go back to this differentiation of for us is that every single project is not trying to get through it. We want to do it right. And that, to me, is a big differentiator and how we look at the market. Let's do this right? You may not be doing this contract again for a few years. Let's get it right. With our backend technology and automation and our systems, we can get to everything we need to do quickly so that we can have the conversations.''   13:22 Allowing the data to speak at contract renewal Lisa said taking the emotion out of vendor meetings can help to expedite cost savings.  ‘'And look, sometimes those conversations maybe with the vendors are difficult, but sometimes, I often say, "Let's take the emotion out of it and just have the data." I'm really not trying to have any kind of difficult negotiations. They are trained negotiators, and hospitals need to understand that. But if we can let the data speak, take the emotion out, and really compress the timeline. Remember the vendors are trying to expand the timeline, we're trying to compress it. But if you let the data speak, hopefully the data gets to internal collaboration with clinicians and administrators and physicians. And then it gets to, with those negotiations, the utilization, the benchmarking, the thinking around why this contract needs to look a certain way, is done through the data and not done through emotion. And that's what I think is most important.''   16:23 Offering a comprehensive cost savings solution with SpendMend Lisa explained how VIE's services have expanded since being acquired by SpendMend.    ‘'…with SpendMend we're able to add profit recovery, which is the core offering that SpendMend has started, which is really key because this is the number one provider of an AP audit, recovery audit is SpendMend so we're able to add that offering. And a lot of the data already comes from what that work is and that core service line. So, we can get that data from those profit recovery audits, which makes onboarding us for purchase services, PPIs, or med-surg just that much more faster because we have the data. And then, finally we have pharmacy. And pharmacy at SpendMend is truly on the cutting-edge, right? So we've got pharmacists, pharm-Ds that support hospitals in their 340B analysis, support them in their cost savings, cost optimization, and we have Trulla that really is a very forward-thinking technology and service that allows them to protect and order in a way that optimizes those costs on the front-end. And then, we have Rebate Insight of course, and that's really making sure our hospitals are getting those rebates, which is really key. So, you put everything together, one solution, one offering, and under our one company, so we're not subbing out, we're not looking to pull other services into under one company: we can come in and deliver a complete cost savings initiative from end-to-end, and a hospital can know that every single dollar is being looked at, right? …From pharmacy, to PPIs, to purchase services, profit recovery, we can do it all and not need anybody else outside. We've got the experts, the team, the technology, the templates, the strategies, all under one house. So for me, that's tremendous.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    The VIE Healthcare difference:  ‘'When people say, oh, "Well, what's the difference between you and all the other companies?" I often say, "…my team's been looking at invoice data for 25 years." And it just happened accidentally.''   Innovation in cost savings isn't always black and white: ‘'There are going to be new things. But there are principles, and models, and strategies that are very successful. …Sometimes I have to ask people to live in the gray.''   Applying critical thinking in new areas leads to cost savings: ‘'….we apply some critical thinking to the data, or there's no utilization, … or we have some templates and some models that are very, very successful. And that can be applied across the board as we look at... new IT agreements or new technologies…''   Getting the most out of every single agreement: ‘'….if your hospital had this one opportunity with this one agreement and with time so short and the competing priorities, what level of results do you want if you've got this one shot? And if you're going to open up these agreements, pick the company that's going to run after every dollar for you.'' What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

Healthcare is in a time of radical and rapid change. Alan Weiss explains to Lisa Miller why coaching is a sign of strength and how all healthcare leaders can benefit from it in an ‘'age of great transition.''   Episode Introduction  Alan explains why the best time to start something is always now, and how the most successful people in every field of life engage a coach to help them achieve their goals. He also explains why there are only ‘'new realities'', rather than a ‘'new normal'', why innovation has to come from the frontline, and shares his predictions for the healthcare sector in 2024.    Show Topics   ‘'If you want to start something, do it'' There are only ‘'new realities,'' not a ‘'new normal'' Coaching is a sign of strength Private sector versus healthcare: one key difference Innovation has to come from the front line The top three skills for successful leadership  Healthcare predictions for 2024      02:58 ‘'If you want to start something, do it'' Alan said the key to success is resilience and agility, not waiting for all the information you need.  ‘'Well, if you want to start something, do it. Because nobody has all the information they need before they begin. I've been consulting for 35 years with Fortune 500 companies, and then, as you said, with consultants and entrepreneurs around the world. And I've never started with all the information I'd like to have. And even the information you start with that seemed perfectly helpful, turns out to be either untrue or it shifts or some new development occurs. So the first thing is if you want to start, just start, and have the confidence in yourself that you can be light on your feet and adjust to the times. The second thing is that even if you think you have a long-term project, you still have to start today. And so I've written 60 some odd books and they're in 15 languages. But I've never said to myself, "Well, I'm going to create a book next year. I have a publishing contract and I have a deadline." If I get a publishing contract and the deadline, I start writing the book now. And so there's no time like now. And there's no time like the present, is the old hackney phrase, but the fact is it's true. And the fact is the key isn't having everything you need to start, the key is resilience and agility as you move forward.''   05:46 There are only ‘'new realities,'' not a ‘'new normal'' Alan said today's leaders need coaching to make clear discriminations in an age of great transition.  ‘'….. There's no return to normal. There's no new normal. What you have are new realities. And the new realities are going to change every day. We're in an age now of great transition. We invent things more rapidly than we can intelligently use them. Nobody really knows about ChatGPT. There are some people lined up out there behind Chicken Little waiting for the sky to fall. We're all going to be eliminated by AI. And of course that's ludicrous. But we do have to understand what's effective for us or what isn't, so what leaders have to do is decide. And this requires discrimination. It requires a clarity of purpose. What is appropriate for their organizations and what is not? For example, I'm on a computer right now with you. And I probably use 20% of this max capability, 20%, but to 100% effectiveness. The other 80%, I don't care. My iPhone here can edit movies, for God's sake. I'm not ever going to edit a movie. But I am going to take pictures. So we have to decide as leaders, what is best for our organization? What's best for us? And that's no easy job. And that's why people need coaching. And they don't need technical coaching. They're not going to delve into the innards of a computer or code. What they need is coaching about their profession and about their own capacities so that they can make these clear discriminations about what is best for them personally and what's not.''   08:42 Coaching is a sign of strength  Alan said people who reject coaching are generally fearful of appearing vulnerable or in need of help.  ‘'The best people in the world, the best athletes, the best entertainers, the best business people, the best academicians, you name it, all have had coaches or multiple coaches. Marshall Goldsmith and I wrote a book together called Life Storming, and he very graciously said he is the best executive coach in the world and I'm the best entrepreneurial coach in the world. So I readily agreed to that. That's fine. But the fact is, between us, we've observed a hell of a lot. And the fact is that people who reject coaching are generally fearful. They don't want to be vulnerable. They don't want to be seen as needing help, and so they get worse and worse because they don't get help. They breathe their own exhaust. That's the volition part. But people who do see coaching as making them stronger and stronger, get better and better. And so I think while the medical community has come a long way from the time when doctors were Gods and nurses for example couldn't talk to them, while they've come a long way, I still wouldn't nominate them as being on the leading edge of innovation and accepting coaching and being light on their feet.''   14:03 Private sector versus healthcare: a key difference Alan explained why the medical sector can learn a lot from the private sector about customer service.  ‘'This is the difference between medical and the private sector, last night we flew home from LA. Well, it was one 30 in the afternoon, but we got in here at night in Boston. And we fly JetBlue. JetBlue has superb service. They have these nice little pods in first class. We love it. In the waiting area, about 30 minutes before boarding, a JetBlue employee says, "Look, folks. I'm sorry to say..." And I'm thinking, oh my God, a delay. "I'm sorry to say we've learned that this plane's internet is working properly. It landed and they told us that. So why don't you download anything you need now while you're here, because we have free wifi, so you'll have it on the plane."  Now, normally you get in the plane, the wifi doesn't work. You say, oh God. What'd they do to it? But that's how you handle people. You tell them, we know we have a problem. Let us try at least to ameliorate some of the effects of it. Nobody comes out in a doctor's office, any kind of specialist's office and says, "Listen, your wait time is 42 minutes." They don't do that. If you're on the phone, if you're on a damn phone line waiting for talk to somebody at AT&T, they'll at least tell you you're number six in line, or whatever it is. But this is still the godlike thing with doctors. So they've got to overcome that.''   17:57 Innovation has to come from the frontline Alan said the only way for leaders to understand what's happening in their business is to find out for themselves.  ‘'Well, recently the new head of Uber decided he would take a car out and be an Uber driver for a couple of nights. And he was in San Francisco and he got a fare to go over to Oakley. He crossed the Bay Bridge. And the Bay Bridge is a disaster, and it took him an hour and a half to get back. And he realized that his drivers, who were not allowed to pick up in Oakland, just deliver people there, couldn't make much money that way. They wouldn't take fairs to Oakland. So he changed the rates for them. But he had to find that out by doing this himself. I was on a Delta flight once in first class, and the guy across the aisle from me had three flight attendants helping him out. Now, normally there were two flight attendants in all of first class. So I call went over and I said, "This guy's an executive on Delta, right?" So he's the CEO. I said, "Really?" I said, "So what's going on?" He said, "Well, he's wonderful. He flies Delta to see how the service is." I said, "Give me a break. If he wants to see other service is, you're got to be sitting in the back, and you got to be incognito. Do you know his schedule?" They said, "Oh, yeah, they tell us what he's coming on board." So that's worthless. Absolutely worthless. He was treated like a king. He doesn't know anything about Delta service. ….And I think that innovation comes from the front line. You have to have people interfacing people.''   21:01 The top three skills for successful leadership Alan explained why making hard decisions, a sense of humor, and exceptional communication skills are vital for leaders.  ‘'Well, you can read forever about leadership skills and traits and needs. And if you go on LinkedIn, you find all these bizarre charts. I mean, if a leader consulted the chart, the leader wouldn't be able to lead. The leader would be spending all day looking at the chart. So here's what I've found. I have found that you have to be willing to make hard decisions. You need to fire people. You need to say, "We're not doing this." You need to say, "This isn't working, and so despite our investment, we're going to end it." You need to make the hard decisions, because nobody else is. The second thing is you need a very pronounced sense of humor. Because humor relieves stress, and it helps keep things in perspective. And with rare, rare conditions only, nothing that's going on is going to mean the failure or success of the business. And so you need to keep things in perspective and don't panic. You can't become Chicken Little and say the sky has fallen. And the third thing is you need superb communication skills in writing and orally, and therefore, you need a very, very excellent vocabulary. You need to be well-read. Too many people can confine themselves to their fields. The world is too integrated right now. The world is too reliant on a variety of factors. And so you cannot just sink yourself, drill down into your specialty. You have to know what else is going on.''   25:05 Alan's healthcare predictions for 2024 Alan shared his top three predictions for the sector in the next 12 months.  ‘'I'd say that you're going to find more and more reliance on different kinds of people and different kinds of interventions. People going to storefront clinics, people going to nurse practitioners, people talking to their pharmacists, people going on telehealth, and so forth. That's going to spread and spread because it's easier, it's somewhat less expensive, and so forth. So we're going to see a lot more of that. I mean, that's a great opportunity. But the problem with that is you have more and more variety and chance for bad results. I mean, not every pharmacist, for example, has been schooled in how to deal with somebody on a patient kind of a basis. They can give recommendations about things. That's one. I think the second thing is that there is a lot of skepticism about healthcare right now because of Covid and because of the combination of medical disagreement and political disagreement that went into Covid, people are not as faithful. They don't have the same faith in the medical establishment that they used to. They think that some of that was guesswork, and they think that some of it was unnecessary. Some of the advised restrictions were too great, both by physicians and by politicians…,And so I think the medical community has lost some respect that might take a while to regain.  And I think finally, we're going to have to see changes in the bureaucracy of the system. In other words, I have seldom talked to any doctor, either one of my doctors or a doctor I was dealing with for other reasons, who has not complained about the reimbursement system. Who has not complained about the paperwork system. Who has not complained about spending more time on filling out forms than meeting with patients. We're smart enough to change that.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Alan Weiss on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    How healthcare is changing radically, and for the better. ‘'And so you have this wide variety of options today, as opposed to quote-unquote the old days when I was young, either a doctor came to your house for about $6 and with his black bag. There were no hers then. It was his black bag.'' Why the medical community needs to accept coaching. ‘'I think that the medical community hasn't accepted coaching as it should. I think that's changing. But I think it needs to change a lot faster because the medical profession is changing a lot faster.'' The place of doctors may be usurped: ‘'Doctors better watch it. Because of what we talked about a few minutes ago, there are others who are going to use their practices, and they're going to find themselves in tough straits.'' Innovation has to be looked at in terms of risk and reward. ‘'There's no decision that we make that's an important decision that doesn't have risks that we have to take care of and manage. But William Penn said once, "No cross, no crown." So if you're willing to take prudent risk, you're likely to get a good return.'' Why healthcare has to deliver the care that patients are paying for: ‘'I'm not a doctor, but I will tell you that I think we have to be careful that the system is providing the kind of healthcare that we deserve and that we're paying for, and not frustrating people who are in the system from providing it.'' What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

The pandemic changed the face of healthcare as we knew it. Expert marketing strategist Lisa Larter explains why every hospital leader needs to rethink their view of thought leadership to Lisa Miller.    Episode Introduction  Lisa explains why thought leadership is essential in the era of Doctor Google, why different is better than better, and the importance of an online presence for healthcare leaders. She also highlights the 3 R's of reviews, referrals and reputation, the importance of truth telling, and why every thought leadership strategy should begin with the end in mind.     Show Topics   Reimagining healthcare thought leadership  All of us have the same Doctor – Doctor Google Every healthcare leader needs their own brand Focus on your patients, not your peers Reputation is the driver behind success Effectively responding to patient reviews  Managing patient expectations is key to thought leadership Begin with the end in mind     03:25 Reimagining healthcare thought leadership  Lisa said thought leadership is a vital part of patient care ‘'So when a hospital commits to thought leadership, not only is it a great tool for people to find when they're searching for information, but it's also a great tool to use as part of their patient care strategy. So if I'm someone who is recently diagnosed with let's say cancer, or diabetes, or a heart condition, it doesn't matter what it is, if a hospital has done a great job at creating thought leadership, they should have an area that they can direct me to that educates me on what to expect, that reassures me, that informs me, that really answers my most common questions and prepares me for the journey that I'm about to go on. Too often, I think people go to a doctor and they get some type of a diagnosis, and then they go home and they try to figure things out on their own. And I think that hospitals that are really, really committed to thought leadership are doing it so that one, people can find the information. But two, they can prescribe the information as part of their patient care strategy.''   12:03 All of us have the same Doctor – Doctor Google Lisa explained why an online presence is essential to prevent misinformation.  ‘'The first line of defense for all of us is Google. And before we've even seen a doctor, we're asking Dr. Google to tell us what's going on. And so if you understand anything about SEO, you understand that when somebody types a query into Google, you need to match the query in order to show up on the first, second, third page of Google. And if you're not creating thought leadership, then there's no way for your expertise, your thought leadership as a doctor to show up there. What might be happening is a mommy blogger who is passionate about a particular ailment because she had it or her mom had it, has been blogging about this thing. And she shows up there, because she's written more about it than an actual expert who is highly skilled and trained on the same topic. And so what happens is we go down these rabbit holes of reading information, and we don't know what is misinformation and what is legitimate information. ….so you can find whatever it is you're looking for, but that doesn't mean what you're reading is scientifically backed and/or was put together by a professional that really knows what they're talking about. And so I think Dr. Google is a scary thing, but it's the default.'' Today's healthcare systems and hospitals, especially in rural communities, are slower than ever to service patients in need. And so when you're sitting at home and you're not feeling well, and you have to wait weeks or months to get in to see a specialist, what do you do? You talk to Dr. Google.''    15:24 Every healthcare leader needs their own brand  Lisa said healthcare leaders need to make it easy for prospective patients to find them.  ‘'…. when Covid hit, a bunch of doctors, national, local, rural were thrown into the spotlight, because people were looking for information. They wanted to understand what was happening in the world. And that is not something that we've seen as much of before in our lifetime. And so I think what happened during that time is there was a bit of a shift, where we now look to doctors, clinicians to be their own subject matter experts. And we look at their personal brands as a consumer. And so a doctor may work for a healthcare system or a hospital, the same one for their entire life, or they may change, but what doesn't change is their body of work and their knowledge. And so I look at doctors and clinicians like experts of their own standing. And if they don't put their own platform out there, and show you who they are, and what they're about, and what their areas of expertise are, then it makes it hard for you to choose them…….And so if you want to control the impression that people have of you, you need to make it easy for them to find the information and find the story that you want them to know. And I think too many people are behaving like they used to behave before the internet, and they're assuming that the patients are just going to come.''   23:58 Focus on your patients not your peers  Lisa said building a brand should be focused on patients.  ‘'It's hard to get started. And you know why it's scary for so many of them? It's because they're concerned with what their peers are going to think instead of what their patients are going to think. They want it to be all academic, and scientifically backed, and perfect, and that's not what the patient is looking for. And so when you are building this body of work, you're not building it for peer review journals, you're building it for patients. So you want to talk in layman's terms, you want to talk in language that makes it easy for your patients to understand who you are and what you do. That's not to say that you can't write academic pieces that are a bit more scientific and fancier in nature. But I think you have to think about who the audience is that you are creating this thought leadership for. And you're not necessarily creating it for your peers. You're creating it for your patients.''    29:09 Reputation is the driver behind success Lisa explained why referrals, reviews and reputation are essential to building a brand.  ‘'….your reputation is really the driver of whether people want... I mean, why do some doctors have month long, multi-month long wait lists for people to get in to see them, and other doctors you can get in tomorrow? It's because some doctors have such stellar reputations for doing what they do, that people will wait forever to see them. And  so how do you build a stellar reputation? First of all, you need to do good work. Second of all, you create a body of work. Third, you want to ensure that when people are referring you, that you have the recommendations that support the work that you do.''   30:44 Effectively responding to patient reviews Lisa said responding to positive and negative reviews builds trust and credibility.  ‘'…. if somebody writes a nice review, get in there and respond, and thank them for the review. And if somebody writes not so nice a review, get in there and acknowledge that you would like to have a conversation with them. If it's positive, get in there and have the dialogue. Thank them, acknowledge it. Go all out. If it's not, try to take them offline. Try to get them to call the office, try to get them to call you. Try to leave a comment that says, "This is not the experience that we want you to have. Could you please call our office so that we can try to fix this for you?" You want to do whatever you can to protect your reputation. We all know there are people out there that are going to write really, really bad reviews. It's going to happen. And sometimes, you're deserving of the review, and a lot of times you're not deserving of the review. And so the best that you can do when you don't have a good review is at least acknowledge it and offer to have a conversation with the person. But if you show up regularly and you respond to reviews, and people see you showing up regularly and responding to reviews, it creates more of a sense of trust and credibility that you really are who people say you are, because you just keep showing up. You show up in the review space, you show up in your thought leadership, you show up online on your website, you show up on social media. It makes you a real person, and that makes you way more attractive.''   34:36 Managing patient expectations is key to thought leadership Lisa explained why honesty can help to build patient relationships and trust.  ‘'Sometimes, a patient's experience is not going to be positive because that's the protocol. There are some treatments, there are some X-rays, there are some things that you have to do when you're sick that are nasty, they're not nice, they're not fun. And if somebody is writing about that because they had a terrible experience, but it didn't matter what they did, that experience wasn't going to be positive, then you have an opportunity to get in front of that and manage expectations upfront, because now you know what some of the trigger points are. And you can actually say to somebody, "This is going to suck. This is going to be uncomfortable. This is going to be painful. You are not going to like us when this is done. Here are some techniques or tactics or things that you can do to make this easier. And I think sometimes, we're afraid to tell the truth. We're afraid to tell somebody this is not going to be a pleasant experience. And then because they didn't know it wasn't going to be a pleasant experience, you end up on the other side of it writing a review, and you're upset about the unpleasant experience, where if somebody had told you upfront, "I hate to tell you, but a colonoscopy isn't fun," if somebody actually let upfront what to expect, then maybe you wouldn't be so upset with the procedure or upset with what you experienced.''   37:35 Begin with the end in mind Lisa said getting clear on your personal brand provides a starting point for thought leadership.  ‘'I think if I could steal from Stephen Covey, begin with the end in mind. Think about who you're trying to be and what you want to be known for from a thought leadership perspective, when you begin with the end in mind and you get clear on how you want your personal brand to be and what you want your thought leadership to look like, you have a starting point. But most healthcare practitioners are not marketing experts, and so I would recommend that you work with somebody like myself who is good at developing a marketing strategy. One of the things that we do with a lot of our clients is we help them to create a strategic marketing roadmap, and we help them to actually get the ideas out of their head and create a plan that is both strategic and tactical so that they know what to do next. It's never going to happen on its own. And I would say that one of the things that is the most challenging about creating your own thought leadership is you are so close to what you know, that you often don't know what it is that other people don't know. And so you're like a fish in water. You don't actually realize some of the simple things that you know that are highly valuable to other people, because you think everyone already knows it. So I would encourage anyone who is listening who wants to really think about thought leadership, to have some type of an advisor to help them on the journey. And then if you're listening and you're an executive in healthcare and you're thinking about, "How do I do this for the hospital?" You really need an overarching strategy. And I would start with one department, one aspect, and build it out as a pilot. And then I would look at how you can build that out throughout the whole organization.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Lisa Larter on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    Leverage the thought leadership of your team: ‘'If you're proud of your doctors and clinicians, and you believe they do good work, then bring that to the forefront. It's a powerful way for you to improve your patient experience, to build confidence, to make your practitioners all feel like their thought leadership matters.''    Physicians need to take their reputation into their own hands, but how can they achieve that? ‘'Some clinicians and physicians are going to be really comfortable public speaking. They're going to get on TV, they're going to show up on Twitter spaces and have debates about this, that, and the other thing. But other doctors, maybe they're going to be better at just recording short videos, or maybe recording podcasts, or maybe writing content.''   Why different is better than better: ‘'…if you're just doing the same old and you're not thinking differently about your thought leadership in the healthcare industry, you are going to fall behind.''   Putting a piece of paper on a pile: Why publishing online is essential to promote your personal brand. ‘'Every time you publish something online, it doesn't matter what it is. Think of it as you're putting a piece of paper on a pile. And every single time you add something to the internet, you're adding another piece of paper to that pile. Your personal brand stands on top of that pile. So the bigger the pile you have, the more visible and easily sought out you become. The person who's got 1,000 pages in the pile, it's a lot easier to find them than the person that's got two.'' What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

As hospitals continue to face rising costs in 2024, David Hewitt, Snr VP of Sales at SpendMend, highlights the importance of recovery audits, and the SpendMend difference, with Managing Director Lisa Miller.   Episode Introduction  David explains why SpendMend carries out audits every 90 days, and how the company's deep expertise delivers results within three weeks. He also outlines the importance of recognizing patterns and trends in data, how a snow accumulator saved tens of thousands of dollars for one hospital, and why every CFO should care about recovery audits.    Show Topics   Why recovery audits are vital for hospitals Insight and visibility: the SpendMend advantage SpendMend: Deep expertise and results within three weeks A recovery audit case study: snow accumulators Why every hospital CFO should care about recovery audits Understanding the patterns in your data      02:17 Why recovery audits are vital for hospitals David said SpendMend offers insight and visibility, carrying out audits every 90 days, versus every other year.  ‘'Time is our biggest thief, right. And it doesn't matter what industry you're in, what sector you're in, you're always going to have financial leakage. And the best way I can describe it is, you take a cookie, and you break that cookie in half, you have two very large profits, but if you take that cookie year over year and break it over the same broken process and clean those up at the end of the year, those crumbs, that's a significant amount of money. …We audit process, not people. Okay, we're talking one 1/10th of 1%, so 99.99% of the time, the process is done. But anytime you have human interaction and technology or a handshake in your procure-to-pay process, there's always a likelihood for financial leakage, right. And in healthcare…it's very unique. It's niche. SpendMend offers insight and visibility. In healthcare, they've done kind of recovery audits every other year or every third year, where at SpendMend, we do it every 90 days. We kind of stay on a continuous basis. I used to play sports, and when I was a freshman I wasn't very good with my left hand. So I used to watch film or I used to work on getting my left hand strong. Well, I can assure you, as I progressed my senior year, I didn't have to watch that same film. There are other things I needed to work on or other things that I saw, and that's the real value of doing a recovery audit, of having that third party or that best practice and that safety net's more real time so then we can kind of fix it concurrently than retrospectively.''   07:23 Insight and visibility: the SpendMend advantage   David said it's not what you find in a recovery audit, it's why.  ‘'The biggest advantage that I like to call at SpendMend is our insight and visibility. And what I mean by that, anyone can tell you what they found and how they found it's the why they found it should matter most. Educating upstream or downstream because 9 times out of 10, everything falls on APs lap, but they're not the single source of truth. You have to go back to what was harboring that control gap to actually implement process improvement. And we provide you with that education. We're not just giving you the dollars and cents, we understand cash is king and we're really good at that, but it's more so understanding what was harboring that control gap. To give you that go forward business intelligence, 'cause you have to understand what happened in the past to give you that education going forward, and that's the real difference at SpendMend. We're going to provide you value, not just substance, and we actually back that up. So when we come into engagement, there is no bait and switch. Our team is there from start to finish, starting with our audit manager and audit supervisor, but more importantly, we provide a vice president of strategic accounts. And why that's important to you is their job to be your eyes and ears outside your four walls 'cause I can assure you the same pain points that you're having other institutions are having. Right now, everyone's going to the cloud, whether it's Lawson or Workday. We understand the nuances in the patterns and trends and the blind spots and that conversion. So having that voice or single source of truth internally to help you navigate that, that's the real value of SpendMend. The dollars are nice, but there's so much more that comes out of it and it's the insight and visibility and understanding how we put data together, because we are matching payments to contracts and that's the value.''   12:08 SpendMend: Deep expertise and results within three weeks  David said SpendMend's expertise means audit plans are built from the outset, with rapid results.   ‘'There are only so many suppliers in the healthcare, right. So when we show up, we're going to have a relationship with probably 98% of your supplier base. We understand what suppliers suppress credits, apply credits, offer credits, write off credits, we understand their invoice cadence, their sequences. One of the things that's unique about Lawson is, if an invoice number can only be 14 characters and a lot of people read left to right, so if they're going to truncate, truncate from right to left, not left to because the computer's reading right to left other than we read left to right. So there's this unique nuances difference of these ERPs, but we understand what those tendencies are, what those blind spots are, and that's why when we show up, a lot of our competitors need clients' data to build your audit plan. Our audit plan's already built when we show up, we're backing it into it. We're just using your data to validate our assumptions because I can assure you, we understand where to look and where to find some of those blind spots. And it's because our ability to provide more than just the dollars and cents, we're not looking at your data mechanically, we're looking at it strategically, putting all the pieces together, connecting the right dots between different departments to give you a different view. Once we've received the data in less than three weeks, we're going to start to see results. We can churn data very, very quickly, but again, we don't need your data to get started. We need your data to validate where we already have your audit plan already set. So that's what makes us different is why we can kind of onboard very quickly and we don't need any on the job training.''   17:16 A recovery audit case study: snow accumulators David explained how digging into details resulted in significant savings for a New York based client.  ‘'When you get into, what sets us apart too is since we take data down to its rawest format, as I said before, many times you see new opportunities. So this one was a client in New York. They had a unique request. They asked us to look at their maintenance agreement and they wanted to really dig into their snow removal and their salt. So as we were going through, again, we have all of the data right, so we had to get the contracts. Some of it was PO, some of it was non-PO, so we had to normalize it and get on it. And there was a clause in there that they would pay a snow accumulator based off of the amount of snow within their county, right. So we saw that, we went through it and we started to do it, it was like, we understand last year, because I lived in kind of the area, so I kind of had a leg up on knowing that it didn't snow that much, but over the past three years, what they were doing to calculate their accumulator, they were taking the entire state of New York, not just the county, and using that as a multiplier, okay. And they couldn't believe the significance. And it wasn't just about the trucks plowing the snow, it was also the salt, okay? Which the salt was very, very expensive. It was a huge savings because there was just a small clause and it wasn't for the entire state, it was just for that county right. And while we were doing that, they had all these facilities and they started to acquire other physical locations outside of the state of New York. They had a facility in Charleston, South Carolina that they were charging snow removal and it hadn't snowed there in three years.''   23:59 Why every hospital CFO should care about recovery audits  David explained why working with SpendMend isn't only about the recovery audit.   ‘'So again, going back to the misperception of recovery audit, there are so many more departments that actually touches this is the ecosystem that runs the hospital, your entire procure to pay process, right. There's so many other things that can come out it. Again, when you start talking about utilization of variation, that's when the CFO quirks up. But that is a byproduct of recovery audit. That's what I always tell you, at the end of the day, we're all looking at the same subset of data, we're just looking at it through a different lens. I'm looking at it retrospectively. You're looking at it prospectively. There's real value of getting both sides of the coin of looking at that contract, and that's why the CFO should care, because the best way I can put it's right now we're coming into January. What does that mean? Everyone's wanting to go to the gym, everyone's going to want to lose weight, everyone want to get in shape. So you do your research and you go to a fitness coach, okay. "Fitness coach, I want to get in shape." Okay. He's going to give you an entire program how to get in shape. He's not just going to give you an arm workout. The analogy is we're not just here to give you a recovery audit. We're here to give you the entire, because the data's coming for pharmacy, it's coming for purchase services, it's coming for recovery audit, it's coming for our medical device. It all comes together. It's all the same data, but we've just viewed it very siloed. Now that spend has branched out and acquired these companies, we can give you the entire program. ..That's why CFOs should care because this isn't procuring one-time credits. This is putting a plan in place and ensuring your entire house is cleaned up and we have the data to do it. That's why I'm so excited about our trajectory at SpendMend, because we're not recovery audit anymore. We are that fitness coach to give you that program for financial fitness.''   27:02 Understanding the patterns in your data David explained how the patterns and trends in data, empower SpendMend's strategic approach.  ‘'This is actually something I'm very passionate about because at the end of the day, knowledge is key, but knowledge without insight isn't much of an advantage. And what I mean by that is when we show up, we're not going to show up with hypotheticals, right. We're going to show up with your data, and that's why there's so much value of putting both sides of the coin together. We're going to use the pattern and trends in your data to make those recommendations going forward. It's not just benchmarking, right. There's so much more strategic that comes out of that, but you have to get down to that line out of detail, and there's value in that. But putting those together, that's the real value of doing the entire program, of not just looking at it, of showing up, "Hey, this is hypothetical based off of a hospital in your area, you should be paying this," or... It's none of that. There's so much more to that. So now we can use real life examples to arm you with that education. And the best way I can put it, we're not just going to empower you with this information, we're actually going to guide you along the way. ….It's connecting not only the dots, it's the right dots between departments because you have different behaviors, different initiatives, different goals going into 2024, but how we can put that to bring it back to the CFO, that's the real power to impact multiple different departments other than just AP.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with David Hewitt on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    Ripping off the bandaid: Carrying out recovery audits every 90 days: ‘'…if you're paying a recovery audit firm to find the same stuff over and over, what's the real value? Again, we're just providing substance, not value…..Once we rip off the bandaid, give you that clean bill of health every 90 days, we should see your financial leakages curve go down.'' The importance of analytics at SpendMend: ‘'Since we take data down to its rawest format for our clients, we can look at it through a different lens and many times you see new opportunities. That's what brings us into the purchased services. We're all looking at the same subset of data, we're just looking at it through a different lens. But that's the real value of SpendMend, having that person that can take that data and drive incremental revenue or different revenue streams by not having to go back to the well on multiple different times.'' Getting to the details, the SpendMend difference: ‘'In the beginning, cash is king. We understand that the hospitals need it, so do suppliers. So they've gotten very creative of how they're suppressing these credits or offering these rebates or putting these fuel charges or all of these miscellaneous charges onto an invoice. Until you actually go through that line of detail.'' Providing value over substance for CFOs: ‘'There are lots of unique things that we do at SpendMend, because again, we need to continually provide value other than just substance. It's not about the overpayments and the duplicate payments, it's about the things that they don't have visibility into. It's matching, is the price negotiated the price that you paid?''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

Workplaces are only as safe as the experience of the least safe person. CEO and Founder of Iterum Tom Geraghty, discusses the need for psychological safety in every organization with Jim Cagliostro.   Episode Introduction    Tom outlines the evolution of psychological safety, why diversity will remain ‘'on paper'' without inclusion, and why high-performing teams possess high degrees of psychological safety. He also explains the principle of the Andon Cord and how behaviors, practices and leadership are the three keys to creating psychologically safe working environments.    Show Topics   Why psychological safety matters The role of the aviation sector and Google's Project Aristotle Psychologically safe workplaces are more inclusive The unique challenges of psychological safety in healthcare Three keys to creating psychologically safe organizations The Andon Cord principle     05:38 Why psychological safety matters Tom explained why psychological safety is a belief that one will not be punished for speaking out.  ‘'So psychological safety has been recognized across multiple studies, a vast array of studies as the foundation, the core necessary but not sufficient element for high performing teams. And it has got a long history. It first emerged in the literature maybe in the 1950s or so, but it wasn't really until the 90s where Amy Edmondson was studying clinical teams, and she was looking at the mistakes that these teams made, and she was separating high performing and low performing clinical teams and looking at the dynamics between them. And she defined and codified psychological safety at that point in her research. That is to say psychological safety is a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes. It's essentially a belief that the team is safe for interpersonal risk taking. That means being able to ask questions, to be able to admit your mistakes and ask for help and all that other stuff. But it also means being able to do it in a way that is safe and works for you. So for example, if you have a stutter or a stammer, or if you have a tick, or if you communicate by a sign language or by a written format, that it's safe and okay to do so in the way that resonates and fits you.''   08:02 The role of the aviation sector and Google's Project Aristotle Tom outlined the evolution and impact of psychological safety.  ‘'I think if you look back at domains like aviation, back in the 70s and 80s, aviation was probably one of the first industries to really recognize that as a result of analyzing disasters, they recognized that either poor communication or lack of communication or miscommunication was a primary, if not the primary causal factor in loads of disasters, including things like the Tenerife air disaster and things like that. So aviation has got on board, if you like. Then with cockpit resource management turned into crew resource management, and then we skip forward to the nineties with Amy Edmonton's work. And then in 2013, Google Project Aristotle came up. Julia Rosovsky's team did a bunch of research on teams inside Google and were able to show that psychological safety was the foundation for all high-performing teams in Google. That is to say that all high-performing teams possess high degrees of psychological safety and low-performing teams possessed low levels of psychological safety. There's a clear correlation.''   12:34 Psychologically safe workplaces are more inclusive Tom said if we don't practice inclusion, we will only have diversity on paper, not in reality.  ‘'…we talk a lot about diversity on teams, diversity in organizations, but fundamentally, if we're not practicing, and psychological safety is about the practice of inclusion, if we're not practicing inclusion, then we might have diversity on paper, but we won't in reality. We might have a very diverse group of people who don't feel safe to suggest their ideas or ask for help or ask questions, and that's not true diversity. So I guess that's what I really mean by inclusion, and that's where we're coming from. …..And I should say as well, because that also leans directly into high-performing teams, right? Because a high-performing team is one where we surface all the best ideas or we surface all the ideas, and the best ones come to the surface and get made into reality. And it's also the ones where people are safe to challenge some ideas or some ways of working if we think there's a problem with it or there's a risk to it. And of course, it's through those multitudes of diverse backgrounds and diverse experiences that we can surface that range of ideas and that range of challenges.''   15:01 The unique challenges of psychological safety in healthcare Tom said the potential for serious consequences makes healthcare unique.  ‘' It is certainly unique. In healthcare, we're dealing with grave consequences of failure, patient safety, patient outcomes, life and death situations where, as we were saying earlier, where if an anesthetist or a nurse in an operating theater it doesn't feel safe to point out, "You've left something in the patient or that's the wrong leg", or there's some other concern, then that's going to result in a very bad outcome, which is not necessarily the case in other industries. There are also aspects of sheer demand on people's time, the cognitive load and the physical load and the time burden on people working in healthcare is great, is incredibly high. And what may be even more challenging is that it can be unpredictably high and low. So we go through periods where it's incredibly busy and then maybe less busy later on. We don't necessarily have the luxury as other industries do. We don't necessarily have the luxury of managing how much work we're doing at any one time. And that can result in, as we often see, the patient outcomes are worse when those peaks of workload are at the highest because people are more likely to miss an important step in a process or misread a signal or misread an alarm.''   18:23 Three keys to creating psychologically safe organizations Tom explained why behaviors, practices and leadership involvement are vital to create safe organizations.  ‘' This is the big question, isn't it? So I'm not even sure where to start because there's a few things we'd like to suggest, and we work with organizations to do. First of all is that for the people at the sharp end, for the people at the sharp end of work, we need to talk about behaviors and practices. And we like to separate behaviors and practices. So practices might be things like after-action reviews, debriefs, Schwartz Rounds and things like that. Things that you can name and begin doing and get better at creating feedback loops and things like that to continuously improve. And those practices and those rituals and those ceremonies, and whether creating team charters and social contracts, they can help foster and build psychological safety within our teams, within our organizations. There's also behaviors, and behaviors are the way we do things, those little interactions and the way we communicate, the way we work with each other. And that might mean improving the way we listen. So active listening. It might be non-violent communication. It might mean framing work in different ways. It might mean checking your body language and the way we communicate. All those sorts of micro dynamics and the way we interact with other people. So we can work on behaviors, we can work on practices, and we can do that at the sharp end of work. What we also need to do is speak to leadership and convince leadership that this is something worth doing. This is something worth putting effort into. And that means speaking the language of leadership. That means speaking to their desires, their goals, their objectives, and their fears as well. And in healthcare, the fears are patient deaths and poor patient outcomes and whatever that means for the organization.''   22:49 The Andon Cord principle Tom said thanking people for pulling the Andon cord is the most important part of the process.  ‘'The Andon cord is a principle, a part of the Toyota production system that... is a mechanism for someone who's working on the production line to pull a cord or pull a metaphorical cord nowadays and request help. Stop the line, stop work, request help, because either there's a problem to address, which indicates some upstream fault or some process issue or something else going wrong, or there's simply an opportunity for improvement that they need help with implementing and it's important to address right now. And there are a number of amazing things about the Andon cord. One is that whenever it gets pulled, people are thanked for doing so. And that's probably the most important part of the whole thing, because ….this takes away that interpersonal risk. Well, it doesn't take it away completely, but it mitigates it. So it means that it's a praiseworthy thing to do, and it gets embedded within the culture. And so every time you pull the cord, something gets improved, even if actually it was a false alarm. Because even if there was a false alarm, you're learning about the signals that created that false alarm. What do we need to do to make sure that it's not going to happen again? And it's fantastic. The Andon cord is such a powerful idea that almost every organization we work with adopts the Andon cord in some way, whether it's language or an actual tool or a real physical thing.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Tom Geraghty on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    Tom's personal experience of dyspraxia and his career history: ‘'….at some point during that process, maybe about a decade ago, I came across the term psychological safety. And for me, that was the light bulb moment.'' How psychological safety has finally come of age: ‘'You've got this conflux of factors coming together with a topic, a field, a phenomenon that is of its time and the need for the growing recognition for psychological safety in … healthcare, in technology, in manufacturing, in aviation, and everywhere else.'' A team or group is only as safe as the least safe person in the group: ‘'In a group of 10 people, you might have… eight people who feel really psychologically safe …. but two people in the group who don't for whatever reason…that group is not what we would call a psychologically safe group.'' Everything is an experiment and a learning opportunity: ‘'The outcome of work should be learning how to do it better next time. And if we reframe work like that, we're almost taking failure off the table because the only experiment that fails is the one we didn't learn from.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

American healthcare outcomes are falling. Can a collective response bring much-needed change? Authors of Ripple of Change, Todd Otten, MD, and patient Joshua Judy explain why it's possible to Jim Cagliostro.   Episode Introduction  In a wide-ranging conversation, Todd and Joshua share their transformative patient-doctor journey, the most important component of the quadruple aim, and why healthcare providers need to ‘'put the keyboard down.'' They also emphasize that telehealth isn't a ‘'one size fits all'' solution, explain that it's OK to be vulnerable, and encourage doctors to offer hope, even when they don't have the answer.    Show Topics   We sorely need to talk about American healthcare Four components of the quadruple aim Three stories about patient-provider relationships The need for leadership at the highest level How to rebuild patient trust The positive impact of telemedicine     01:59 We sorely need to talk about American healthcare  Josh outlined the motivation behind Ripple of Change.  ‘'For us, I would say it was really born out of a mutual frustration with our experiences. First, as individuals, me as a patient and Todd as, my family physician. And over time, you know, as this project got off the ground, we realized, there's really a collective frustration. And we realized our feeling was that not only did we deserve better, but everyone that's a participant in the health care space, whether it's a nurse, a staff, or all the other patients out there. And there's just too many not getting quality care that they deserve in a way that they can afford. People are feeling powerless, so we wanted to give that a voice, as well as tell our story and help others. It takes months to see your family doctor, and that shouldn't be the case.''    04:21 Four components of the quadruple aim Todd explained why the fourth component of the quadruple aim matters.  ‘'I was an early adopter of that vernacular probably, I guess, 7 or 8 years ago, almost right when it came out from Dr Sinski and Dr Bodenheimer. But it just seemed brilliant to me. You want the best for the patient experience. You want quality care. You want lower or reasonable costs. But that 4th component is so important, that's provider well-being. Over the years, Joshua saw me at my best, And he saw me at my worst. And, you know, that's brought out in the book, and we don't want patients getting the worst from their doctors or their providers or their clinicians. But we also felt like that it needed to be not just my idea or Joshua's idea, but anybody can take these simple principles and run with them and make them their own. Change the verbiage a little bit. Right? Like, some people don't like the word provider. Fine. So be it. Change the word. Use clinician. Use health care associate. Use human being.''   07:11 3 stories about patient-provider relationships Josh said patients appreciate uninterrupted listening from their healthcare provider.  ‘'Story number 1 handles my hormone treatments. It's through telemedicine. But, he approaches each visit the same way. He goes over the blood results, and then he turns to me and he says, the floor is yours. And he never cuts me off or tries to subordinate. And even if the treatment plan doesn't end up changing during the visit, I already feel better. So it's interesting because it's a cash practice without the obstacle of insurance. Right? So that that gives a totally different dynamic. And so the time is there. And it's not a competition to win a debate. It's really a competition to heal. And that's story number 2. I recall times my wife would come home after a hard day at work, and, she'd start telling me of her challenges from the day and only for me to immediately pounce and try to problem solve her issues. But that's not what she was looking for. She just wanted me not to sideline her and prove how smart I was at fixing these things. Purely listening proved enough for her. And number 3 is about an endocrinologist I saw before the doctor I described in story number 1, and he practiced with taking insurance. Each visit started the same way there. Most of the 20 minute visits were his retelling of the anatomy of the pituitary gland and how it sits in the head, so it was a competition for time. Each story shows the same thing. People simply appreciate that uninterrupted listening.''   10:46 The need for leadership at the highest level Todd said change is possible with a culture shift.  ‘'And it I think the good thing, though, is I think it's possible. There are a lot of examples out there of good things happening, but the culture has to shift that way. People have to buy in. There needs to be the right type of leadership at the highest levels. Unfortunately, Joshua got to experience some of this in the most recent office I worked in where we called it the office utopia. There were all those pressures there and there were the time tranches too. But it wasn't the same, and we didn't treat it that way. And we didn't treat it like people were widgets going through an assembly line.''   11:55 How to rebuild patient trust Todd reinforced the need for healthcare providers to listen to their patients.  ‘'I would echo what Joshua said in terms of listening. Frankly put your keyboard down, look the person in the eye, shut up, and listen. Don't have preconceived notions about what the diagnosis is because you might be wrong if you've already made it in 15 to 20 seconds. There might be some nugget of detail in there that is invaluable. I learned quickly on in my career that if you asked a couple questions and just sat there and listened to the person in front of you, they would usually tell you what the diagnosis this was. That would be my number one piece of advice. Joshua's case was very complicated…. near the end of our time together as physician and patient, the majority of what I did was listening, counseling and alternative methods. We wrote a book together, and that was one of the treatment protocols, and we're both better off for it.''   19:11 The positive impact of telemedicine Josh said telemedicine isn't ‘'one size fits all'' but a helpful tool in patient care.  ‘'My wife who has epilepsy, she's actually never met her current neurologist, she sees her through telemedicine, and it works really well. They've been able to establish a great rapport and they end up talking about the book sometimes. It's just been a really great thing. You can't really approach it with one size fits all. It's another tool on the tool bag. People should embrace it if they feel comfortable. I think things are moving in that direction. You know, so much of Ripple Change is not about leaving people behind. It's kind of about meeting them where they're at. Some folks are tech savvy, some aren't. But I see it as an overall positive thing.''     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Dr Todd R Otten on LinkedIn Connect with Joshua J Judy on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    Why driving change in healthcare needs a collective voice to succeed. ‘'It has to be a large number of individuals to break down those silos. Ultimately, we're probably talking about pretty significant policy change.'' How capitalism has failed the American healthcare consumer: ‘'The mantra of profits over people has condensed the visits and put the priorities in all the wrong places. How do you get a good experience when you're afforded literally 7 or 8 minutes to go in and talk to somebody? … It has to change.'' It's OK for healthcare providers to say ‘'I don't know'': ‘'If you don't have the answer… you can offer some hope, or at least try and get somebody to the right direction.'' The benefits of a strong doctor-patient relationship: ‘'If you do it right first time you might avoid those repeat visits and all those referrals that increase cost…. and with that good relationship you share in the treatment plan.'' Why it's OK to be vulnerable as a patient: ‘'It's okay to fall down and be vulnerable, but it's what you do to get back up that matters.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

End of life care is a topic rarely discussed in healthcare. In a sensitive and candid conversation, critical care nurse Seung Eli Oh, RN, MSN, CCRN, explores what it means to die well, with Jim Cagliostro.    Episode Introduction  Seung explores the need for more medical training on end of life care, and why quality of life should be considered in patient treatment decisions. He also encourages all families and patients to have timely conversations about their wishes, discusses the importance of dignity in death, and welcomes the return of spiritual care for terminally ill patients.  Show Topics   The current state of end of life care in America A gap in understanding between doctors and patients Enabling meaningful conversations around quality of life Dignity in death and dying well Spiritual care and the end of life journey Serving as a model of leadership      4:04 The current state of end of life care in America Seung said doctors require more training on end of life care conversations.  ‘'….there are some interesting books out there that really talk about how health care in the modern age has become more and more secular. So it's gone away from kind of the clergymen who used to have this conversation of end of life. Sure. You know, your primary doctor was probably the only doctor in your village who came and came to your home. So these conversations we're having in your house. But now it's all happening in the hospital. And it's happening away from faith communities. So it's much more secular now. And it's all done by doctors, which there really isn't that much training, to be honest. Most doctors that I talk to tell me pretty honestly that there really is no training in med school, if at all. You might get 1 class, you know, at most about palliative care, goals of care conversation. And I see that pretty realistically on the floor when we do have the situation when patients are dying and there are goals of care conversations about changing code status. A lot of these residents have no idea how to handle these conversations, and they kind of freeze up, and they're not giving the patients really enough data. I've seen, like, the shifts towards palliative care. I think that's really good. I think there's more of that happening. But I don't think it's happening fast enough, and those conversations are still way behind. And I think the doctors are still very undertrained in terms of having goals of care conversation because it really is an art more than the science.''   06:38 A gap in understanding between doctors and patients Seung said doctors must have honest conversations with families around patient survival.  ‘'But I think we also have a cultural issue here in America….. American medicine is reluctant to be paternalistic. They really don't want to tell patients and their family how things should be done. They try to just give them data, and then the family gets to decide. But sometimes that doesn't always work. We live in the age of Google, and every patient and their families think they can Google everything and find out the information. But I find that even with patients who are highly educated, that when it comes to medical decisions, it's very difficult. And when it comes to their family, it's even more difficult. There are many more emotions that come into play. And I think a typical example might be a family member who's an engineer. If the doctor were to tell them you have 10% chance of survival, he sees the 10% much differently than the medical personnel who sees 10% as well. That's basically an impossibility. But as someone who works with computers, he might actually think 10% is not so bad, so we should keep trying.''    08:00 Enabling meaningful conversations around quality of life  Seung explained the difficulty of discussing quality of life with families and patients.  ‘'… I think a lot of conversations are happening in less than probably 5 minutes, and there's not enough time. And sometimes there's a really good family meeting, and we do have good conversations, and there is a full discussion. But a lot of times in emergency, sometimes it's a 5 minute conversation, and patients just want everything done. The family just wants everything done because they feel guilty. They want everything for their family. Without a full understanding of what does this mean for quality of life? What does it mean how this patient will die? And I think I've had one really good conversation where I try to tell the patient, you know, if you were to be intubated and go to ICU, this might mean that you never wake up. This might be a final time with your family. Versus if you were to go comfort care, you might have the last few hours with your family. You might be able to converse with them and tell them what's on your mind. I think those things are really meaningful in life that are not always talked about during, goals and care conversations.''   11:10 Dignity in death and dying well  Seung explained the difficulties in having timely conversations around death.  ‘'…Ideally, a patient would be surrounded by their loved ones, their family members, their grandchildren, just all around the bed and just holding their hands, Sometimes singing together, I've seen that. And I think that's such a meaningful way to spend your last breath and having your loved ones hold your hand. Now in the code blue situation when you're really sick, that's not always going happen. We try to get family in the room, but it's often a traumatic experience. I think that's not always the way we want to go. We really have to be realistic and say, if our chance of survival isn't that high, how is it that I want to go? Do I envision me going in the ICU bed with a nurse putting lines at me…..how much unnecessary suffering are we causing? You know, we promise to do no harm in medicine in nursing as well. ….There's a lot of futility, when these patients are so sick.''   13:57 Spiritual care in the end of life journey Seung said he has seen a rise in the need for spiritual support in terminally ill patients.  ‘'I think spiritual care is a huge part of that. I think medicine and science has moved away from the spiritual aspect of things. And now we're starting to see a little bit of that come back. Even though it's not as religious now, there's still a movement towards people who want a spiritual atmosphere,…. when we took the spiritual out of the goals of care conversation, end of life conversations, I think that's made it very sterile or very secular. And now that some of the spiritual things are coming back into conversation, that makes it easier for families to talk about. …. How would they want to be remembered? How would they want to spend the last hour together with their family members? Those are really good things to think about and talk about it. ….that's really important and helpful.''   18:18 Serving as a model of leadership  Seung said a focus on serving others helps to enhance patient care.  ‘'… the best leaders I've seen in health care are the ones who really model servant leadership. I've had many managers who their description of their job was to really serve the team, serve other nurses, so that they can better provide care for their patients. I thought it was really empowering to say, you know, I'm going to serve the team rather than just be the boss. I think that's something I always think about as just being a leader and even outside of my job. How can I serve and do what is best for the other people? …that's such a great example of leadership.''     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Seung Eli Oh on LinkedIn Check out VIE Healthcare and SpendMend      You'll also hear:    Seung's career history and experience as a rapid response nurse: ‘'… most of my nursing career has been critical care, rapid response. … you see a pattern of just the way we handle goals of care conversations and end of life care.'' Healthcare providers must be capable of approaching end of life conversations more appropriately. ‘'… it's almost like we've compartmentalized that to say, oh, well, that's .. an end of life issue. We're going to pass you on to the palliative care team…but death is something that every family has to deal with at some point.'' The need to be honest with patients and families: ‘'I think often doctors are too reluctant to tell (families) like it is and really paint an honest picture of what the chances are. …I do a lot of CPR with my job, but CPR is only effective 10% of the time.'' Helping families prepare for end of life conversations at an early stage. ‘'…. that's a difficult conversation, but it's something I really encourage family members to have.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

Telehealth became an essential part of healthcare during the pandemic and is here to stay. Josh Klein shares his vision for its future, and the role of Emerest, with Jim Cagliostro.    Episode Introduction  Josh explains why telehealth is still stuck in 2020, how technology can strip the humanity from healthcare, and why the missing element in telehealth today is social determinants of health. He also explains how Emerest is going above and beyond virtual communities to make real patient connections, and why true leadership is always allowing others to shine.    Show Topics   Leading by example Poorly applied technology can strip the humanity from healthcare Telehealth is stuck in 2020 Digging into the social determinants of health Building virtual patient communities Creating an oasis of caregivers Leadership is letting other people shine     07:59 Leading by example  Josh explained how volunteering as a paramedic inspires his daily work.  ‘'It helps me in so many different ways. As leadership in general, the role of an actual paramedic is truly when there's an emergency, there's usually a pyramid of system where if it's not such an acute emergency, an EMT can be doing this stuff. If it's a trauma, somebody hurts themselves, they don't need help. But if it's a true emergency where the person's life's on the line, if there is no leadership, the emergency will go south. It will go sour. So in order for the call to be successful, the emergency to go well, to have the outcomes that's desired to save someone's life, if they need to get to a hospital alive. There needs to be a lot of leadership in that role and taking control of a chaotic situation more times than others. And that's taught me enormous, enormous values and learning from other paramedics. You know, what I learned in the health care space. I've been blessed to do this for a very long time, more than I'd like to admit already by now. Different people that have different backgrounds, different capabilities. You know, this, volunteer organization has, you know, a few 100 paramedics and seeing how a paramedic that is a shop worker or a baker or a Forbes list guy or a finance guy, how they lead is learning. If you're constantly learning, learning their skills how to engage. So it gives me an enormous amount of learning experience and insight and being able to carry it over to what I do in the, in my workspace.''   10:21 Poorly applied technology can strip the humanity from healthcare Josh said the focus has to be on the patients, not technology.  ‘'Well, first and foremost, thanks for picking that card because I couldn't agree with that one more. And I think it's just a trickle, then there's just a snowball effect how this happened. You know, technology, everybody wants a piece of it in a certain way, but it's more from the business side. Lots of leaders whether it's payers, hospital systems, frankly, or people that are in the health care space. The word technology just became, you know, a thrown around sexy word to say, let's apply technology, let's apply everything. And in my mind, it's driven sometimes, not by all, by certain needs or certain desires, not really wanting outcomes for the people that are receiving care. And I think the biggest fault to that is once they convince themselves that they applied technology, they automatically take a back seat and said, let the machine do it. And that's where you fall off. If you take off the eye of the prize that you want to treat somebody well. In our in our case, it's patients at home. Yeah. We can throw certain technologies. You can throw monitors and, you know, monitor their vitals. And the company is like, oh, I saved a couple of dollars. And that is not what health care is supposed to be. That that is just gonna further break the system by perhaps maybe saving money for certain people …''   12:48 Telehealth is stuck in 2020 Josh explained why telehealth has not progressed since the pandemic.  ‘'(In 2020) … telehealth mushroomed … it was forced upon, frankly, lots of providers. And they relied on just that when COVID came. And there were millions of people that were in need of care and had no access to care simply from a logistical standpoint. You had, hundreds of thousands of patients millions of patients that needed for whether a doctor's visits how many doctor's visits were simply missed because, a, the doctor wasn't available. He was home hiding under a blanket… and the patients couldn't even access them. So there was definitely no question that the telehealth concept, of course, the reason why it mushroomed is, you know, necessity is the mother of all invention as they say. So there was a necessity to connect patients with whoever that is. So the telehealth, of course, made sense and there was a need. So, of course, today that the the simple concept where you can speak to your physician on camera, it was good in 2020 when COVID was there. It's still good today. It still needs a lot of work. It shouldn't be missing these elements, but 2020 really blew that up in a way. And lots of people stayed stuck in that 2020. They stayed stuck in, oh, I can give my patient an opportunity to speak to a doctor, I don't like to speak ill of the way it's done. But so many of these programs are just designed to follow billing codes and trying to make business out of it. I'm an entrepreneur, and I'm all for doing good business and creating companies that, create jobs. But the second you lose focus on the bigger picture, we will see trends with the telehealth with certain entities that have tried. And they might have had amazing intentions. No questions. But they're losing sight of lots of different areas.''   20:12 Digging into the social determinants of health Josh explained the importance of truly understanding patient needs.  ‘'Are they really alone? How long have they been alone? Loneliness is such a broad word as well. Loneliness doesn't necessarily mean that they live alone. Some people are lonely when people are right there in their home. They just might be there. They're just people that are just you know, they like there's some people like to be alone, but it it's truly understanding really what are their needs. A lot of people, especially the elderly, they tend if they don't feel well automatically, besides their mood changes, they truly have whether it's anxiety, depression, and mental health problems. And if the assessment that we do is really get as much information as possible on that individual and put in things in place to address them. So, when we make that assessment, the same way we have a risk assessment on the clinical side of, you know, whether they need a lot of nursing. How much social interventions do they need? Do they need a social worker every day? If somebody has, true, for example, mental health problems, and lots of them sadly do, whether they've had it for all their life, or if it developed over time, or frankly, COVID did them in, so to speak. So is addressing them and helping with that and giving them really tools to have somebody to speak to. Besides that, we have a large social group program. We have social workers that speak to them. We have psychiatry and that truly understands their medications, understanding, managing their medications properly. Well, how many times we've had patients that when we took them on the clinical side, no. There's no mental health problems. Magically when we did the assessment, somehow, we found out, you know what? They can use something to help them.''   25:23 Building virtual patient communities Josh explained how he used technology to build connections for vulnerable patients ‘'…. You know, people just like company. And, you know, the 1 on 1 concept is very, very good. But, if we're talking about home care patients that don't get the opportunity at the snap of a finger and just go out. …an elderly person (will) tell you they don't see many people 8 o'clock at night, a group of 75 year olds getting together for dinner. It just doesn't happen that often. You might see it here and there, you know, where they have a, a $30 free buffet once a month. But you're not gonna see it in a systemic way, and it's not that popular, frankly. So what we really believe was how can we take somebody that's ordinarily home alone, or even if they do have, make them belong to a group. …. and we made groups. …we derived it from artificial intelligence and machine learning, but not before we really did lots of research. Everybody had input. So what we call it a grouping model where the groups are up to between 6 to 10 elderly in a group. And we wanted to give that group legs and have, you know, the best potential for success. And so the nursing department had input as to how that group was created. The social workers had input, you know, where that specific individual can in which group they would fit. And then we use technology to mush it all and to gel it all together. And we still reviewed it as humans to see. So we have now dozens of groups where we have elderly people on our platform. They play games. They talk politics, news, current events, and we're seeing so much success on our platforms where these groups are, and it's lots of times in the day. Some of them are up 5 o'clock in the morning already kibbutzing and schmoozing as a group at 5 AM.''   38:53 Creating an oasis of caregivers Josh explained how Emerest encourages physical interaction and activity for its patients.  ‘'It's very unhealthy to have people just constantly staring at their screen. So besides programs that we do, that we engage with them with exercises, get your you know what out of your bed a little bit or out of your recliner there. You know, we do a lot of yoga exercises with our elderly through our platforms. But one of the things back to the grouping model, and that's the one thing that I promised myself and to the people that that helped me build this, is I don't want that to become that. That's not something that we wanted them to become telehealth potatoes. …. You know, I'm blessed to be the CEO of thousands of caregivers. So in every state and borough that we operate, we built an oasis for caregivers where they can go. And it's like a 5 star spa where they have manicures and pedicures and hair services for free for our home for our home health aids. So the thousands of home health aids that we have, they have access to that. …. So that's primarily on the weekends because caregivers work during the week. So what we're doing is taking these groups of elderly now that have been created, and we're having them come out and have lunch together.''   41:36 Leadership is letting other people shine Josh emphasized the importance of learning from others and leading by example.  ‘'I learn every day from the people around me. And, leadership is letting other people shine. And, you know, to me, the word CEO, the e, has a lot of different meanings. It's emotional. It's so many chief entertaining officers sometimes. And, yes, the number 1 is you have to lead by example. And a different CEO position in the finance world might be different meaning of leadership. In health care, you don't sell a commodity, but you sell care.  If you genuinely do not show the people that are helping you build these companies, you do not really have that same vision, ….. You first and foremost have to care for the people, for the people that are working with you, whether it's the CEO COOs, nurses, home health aids, you have to let them shine. There's no such a thing as a bad idea. I've never ever dismissed an idea. I might have inside thought, yeah, I don't know. But not to let them feel that their voices are not heard, that's the worst thing. Everybody wants to feel that they add value in a certain way.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Josh Klein on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    Growing up in a healthcare community: Josh's early life and career history: ‘'Mom started when I was very young, a nursing agency. And she staffed nursing homes and hospitals…. I grew up where nurses used to come and have dinner.'' What's really missing from telehealth: ‘'But the real thing that's missing in my mind, and that's where we really shine, is the social determinants of health (SDOH) and mental health. And that's where I really believe we're going to be an outlier because for some reason, people are just letting that fall by the wayside.'' Building out support for SDOH: Managing the social and clinical needs of patients. ‘'The nursing team picks up certain things that they will call social work department. You know, the patient just mentioned something to me. I think you should have a conversation with that patient about it and vice versa.. ….my pride and joy is the social and mental health that we're building out. And we're doing lots of different very cool ideas and constantly advancing it.'' How Emerest created a television studio to support the lonely and vulnerable: ‘'What would you want if you're elderly, home, bored, alone, not feeling so well? ….This is just, as they say, studio 1, we're mid construction for other studios.''     What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

Hospitals are under continued pressure to reduce costs and deliver better care. CoFounders of Rebate Insight, Tony Garcia and Jonas Langvad, explain the benefits of rebate management to Jim Cagliostro.    Episode Introduction    Tony & Jonas explain why 100% of rebates go straight to the bottom line, share the 3 Ms of rebate management, and highlight how Rebate Insight's SaaS solution is increasing hospital rebates by 26% or more. They also explain how ‘'dark data'' blurs visibility into rebate management and celebrate being part of SpendMend.    Show Topics   Rebate management should be a priority in healthcare Manual processes make it difficult to track rebates The 3 M's of rebate management Dark data and the pain points of rebate management Benefits of Software-as-a-Service (SAAS) The value of SpendMend     02:29 Rebate management should be a priority in healthcare Tony said in times of financial pressure, rebates go straight to the bottom line to boost margins.  ‘'I think I'll start a little bit at the high level, to get to the 10,000-foot level for hospitals. The financial performance of a hospital is always important, and I think we've had a few interesting years in the past here, coming out of, first of all, covid introduced a lot of additional costs for hospitals, labor shortages, and product shortages for sure that spiked prices. Then after that, we've seen a great deal of inflation and products increasing dramatically in price, so that's really impacted hospitals in a big way. I think right now, just the financial situation, everyone's looking to see what can be done to reduce cost, stay competitive. When it comes to rebates, rebate management, it's historically been one of those areas that maybe hasn't been looked at that closely because it is a little bit of a complex area to manage. I think what ends up happening is when you think about, if hospitals are looking for areas to save money in, to reduce costs, they can have different initiatives. On the revenue side, if you end up increasing revenue by let's say a few million, only about 2% to 4% of that ends up going to the bottom line, because that's usually the margin of a hospital. It's very low-margin on the revenue side. However, if you're able to increase rebates on the cost side, 100% of that is going to go to the bottom line. You have a huge upside potential if you're able to manage rebates well and increase those rebates.''   05:53 Manual processes make it difficult to track rebates Jonas explained the benefits of automation in rebate management.  ‘'I come with 25 years of healthcare experience. I've been a director at a health system in Southern California, and this is how this was all created. It was so difficult to track rebates, and the benefit of tracking them and knowing what is owed and what the vendor should be paying you and if you're going to meet your market share was so important and critical, but it was just too hard because the process has always been manual. Historically to this day, we've had many discussions with very large IDNs, some of the largest IDNs in the nation, and also on the lower end with smaller hospitals, and they all have the same issue. They're all using a manual process. They all have teams of staff that do different things, so it's always been difficult to track rebates. I think now, historically, we created this software that automates that process, where you're not having to go to a spreadsheet every other day, where it's giving you notifications in real time. You're always aware of what's going on in your contracts, where your market share, where your spend is, and just giving you a lot of insight into rebates and making sure that the vendors are paying you out, paying you on time, and also that you're meeting their commitment through the agreement as well. It really helps the materials team handle all that.''   08:02 The 3 M's of rebate management Tony explained the importance of monitoring, managing, and maximizing and how Rebate Insight helps hospitals to achieve all three.   ‘'Looking at this product and taking all the different information that you receive, we found that by monitoring, managing, and maximizing ... those are our three M's. Those really, if you were to see the demo or if you were to see the dashboard, it really kicks in, and you're able to ... under the whole monitoring is monitoring what your health system's doing. How are you handling every contract that goes into Rebate Insight, giving you at a high level all the information you need, and then going into the managing piece where it's more detailed specific to each agreement. Then going into the maximizing, where you're able to go in and if it is fifteen days, five days before your quarter ends or your annual commitment ends and you have to make a decision, you're able to do this all through the software, in real time, in a point-click SaaS product. You're able to effectively go into this product and make decisions or see where you currently stand, all in real time.''   11:11 Dark data and the pain points of rebate management Tony said hospitals share many common pain points. ‘'Some of the common pain points are we don't know what is owed to us. We don't have any expertise and rebate insight. We work kind of siloed. We don't know what AP is receiving. Checks are going everywhere. We're receiving credit memos that people are not aware of. There's just a lot of that what I say is like dark data out there, and no visibility for the health system as a whole. One thing we found while we were creating this is how many people are involved and how many people should be in the process of rebate tracking that are not, just because you have someone like the director negotiating agreements, putting rebates in place, but you have, on the other side, AP that is receiving the checks, or maybe the vendors are bringing the checks to the director. Just a lot of mismanagement of also where checks are. A lot of times checks are lost, so there's nothing really that connects everybody. That's what's so great about Rebate Insight. It's all built in that platform where AP has a module, where directors can have access to that dashboard, and then the materials team has access as well.''   13:56 4 Benefits of Software-as-a-Service (SAAS) Jonas said Rebate Insight can help to support renegotiating contract terms with suppliers.  ‘'Really, I think when we think about value is we think about it almost in different buckets, right? We think about I should say it goes under financial leakage, is you make sure you receive what you're owed. That's a big piece. Second is if you can speed up the actual payment, receive it earlier, then you can gain some value from having that cash on hand. Then third, what we think about is if you can maximize your existing agreements, you have opportunities at a given time throughout the year where you might be able to go to a higher tier because you're so close. You spend a little bit more money to get a bigger benefit. Then finally, when you have a tool like this ... and I think Tony can speak to this as well ... is you get that visibility into all your agreements. That enables you to just have discussion with suppliers and vendors and say, "Why don't we renegotiate our terms? Give me a little bit higher rebate," which when you can track it, that's a huge benefit for the health system and you're going to see that financial return.''   19:22 The value of SpendMend Tony and Jonas agreed that being with SpendMend feels more like a partnership.   ‘'At first, there's always a little hesitation of selling your creation, right, but the value that SpendMend brings to the table with their 30 years experience in the health system, it has just been so great for at least speaking for myself, and I know Jonas will talk a little bit of this as well. I mean, when you really partner with ... and that's what it really feels like. It doesn't feel like, "Hey, you got bought out and that's it." No, it really feels like we partnered with SpendMend, and it just really opens up a lot of doors for us. Again, with that experience, being able to go to certain leaders in the organization and able to have a sales team, a marketing team, is huge. Those all have been great benefits, and super excited and really almost privileged to have that opportunity.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Tony Garcia on LinkedIn Connect with Jonas Langvad on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    Understanding rebates: ‘'For those not familiar with rebates, right, it's basically a supplier that offers you an incentive on a contract. If you buy X number of products, they'll give you let's say 5% back on a rebate. Usually there's some criteria tied to it, but that's sort of the starting point there.''  The benefits of Rebate Insight's SaaS tool: ‘'… we're seeing how systems that are using Rebate Insight increase their rebates by 26% or more by using the tool.'' How Rebate Insight transforms rebate management: ‘'It's subscription-based, cloud-based, which makes it very easy to sign up for, implement. There are no expensive servers …it pulls together all the data from different sources… It really gives you that real-time view of this is where you stand today. You can monitor all your rebates, all your contracts this way, all your compliance.‘' Rebate Insight tracks trends and tiers for hospitals: ‘'Rebate Insight tracks your trends. You could go back and look at the quarter and say, "Wow, my trend for last quarter was tier two, but we're still signed on tier one. Oh, this quarter is tier two as well. The vendors don't tell you that. The vendors rarely come back and say, "Hey, you've been achieving tier two, go ahead and click on it because now your price is dropping 20%."   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

‘'Good is not the enemy of great, it's the enemy of growth.'' Sue Tetzlaff explains the transformational power of a strategy focused on greatness and the formula of leverage, to Jim Cagliostro.   Episode Introduction  Sue shares how creating a volunteer army transformed a struggling community hospital into a profitable, national award-winner, why the patient experience and the employee experience can't be separated and reveals strategies that can move 20% in a patient satisfaction metric in 18 months. She also explains how leveraging greatness in people, service and growth creates a magnet for talent, and why hospitals can never declare victory in greatness.   Show Topics   A moment of realization in a Michigan hospital Good is the enemy of growth  Setting up a formula of leverage Creating a strategy for ‘'greatness'' is not an easy fix The patient experience is tied to the employee experience Growth can happen when leaders ‘'get real''   04:34 A moment of realization in a Michigan hospital  Sue said acknowledging that 75% of employees wouldn't use their own healthcare organization triggered change.  ‘'I remember sitting in a room with the executive team and it was our strategic planning cycle. I had already been there 10 years through three-year strategic planning cycles. We're there at the table again and we're looking that these trends are just as ugly or worse than they were last time. We sat down to craft our strategy for the next three years, and we're looking at them, and one of the things jumped out like no other. It was all ugly, but one thing jumped out to me. 75% of our own employees would not use the healthcare organization that they worked at. And that really reflected of how the community was engaging or not with using their local healthcare services. And so put that in the pile of all the other data that was bad about patient satisfaction, safety, quality, profit, market share, out-migration, everything. When you look at that, all of a sudden, I remember looking up and I looked around at my peers and I said, "I am not going to be on the leadership team that loses this community's important asset. I did not come to this work to do that. And we have to figure it out. We can't just tweak our strategies this next time. We have to do something big and different. If we keep doing what we're doing, we're going to keep getting what we're getting and it is not going to be good. We could actually spiral to closure and lose this important community asset." So that led to me being volunteered, of course, to lead a team to figure this out because it was my moment …''   15:10 Good is the enemy of growth  Sue explained how that realization helped to create the framework of achieving great results.  ‘'You know how Jim Collin says, "Good is the enemy of great." Well, good is the enemy of growth. And my explanation of that is these patterns that we saw. Starting with our very first organization, we saw it there. And sometimes it wasn't only until retrospect and that repeated pattern of looking back that you saw that good is the enemy of growth. So when we first packaged, how do we take this down the road to another hospital, we created a framework called the framework of achieving great results. And in the center we were creating great strategies, then creating ownership and alignment for those strategies to be successfully executed on. And then over time, we added then creating agility because I really believe that the agile and the enduring committed organizations are the one that's going to survive. You've got to be agile. You've got to be willing to change. You've got to be willing to improve. You've got to be willing to grow.''   17:30 Setting up a formula of leverage  Sue said the secret to success is not just in balance, but in leverage for growth.  ‘'So this people, service, quality and growth at first, making sure we were balanced and we truly did have strategies under people, service and growth, as well as finance that we had them all. But then we realized that the magic was really not in just being balanced across there, but really setting up a formula of leverage there where if we invest, especially because we're in crisis there, in people, service and quality and our strategies there, if we invest more attention, energy, focus there and we nail that and move it from good to great, then growing actually just organically happens. Especially when you're a hospital and your community is right around you. You can say you're great all you want, but if it's not true, your community knows it. You can just have a billboard and run more ads, but guess what? You could add more services, but they're not going to come. Build it, they'll come. Okay, people. That is not the reality always, especially when your reputation is whatever you have now isn't good, why is something new going to be good too? Your community and those bad stories in people, service and quality, especially in small communities, those are loud and they're lasting, and you got to overcome that. And it's only through people, service and quality that you're going to overcome that. So the new formula under creating great strategies is people, service and quality, good to great, and then leverage that for growth, which then improves your finances. So it's not just in balance. It's in leverage.''   24:45 Creating a strategy for ‘'greatness'' is not an easy fix Sue explained that in the early stages, the focus is on people, service, and quality before growth.  ‘'……..when I work as a strategist with new organizations that have been fine or good for 20 years, and their market share shows it, and your revenue growth shows it or whatever, is I actually for the first three-year strategic plan I do with them, I put almost all of their emphasis on people, service and quality and tame down their growth plan. It's almost like an early investment of shore this up, move it from good to great, and then now the next cycle is truly a growth cycle. And now you can leverage all of that improvement that's been done, and now your growth efforts are easier, more successful. You're a magnet for talent. You're a magnet for patients. And so I stage it that way. So it's not a quick, easy fix. It never is. None of this is a quick, easy fix, but I'll do that a lot when I'm mapping out a strategy for an organization, is if they need to shore up day-to-day operations, people, service and quality, put your time, energy and focus there for three years. And I can tell you that it will have decades of lasting impact on everything, everything.''   28:48 The patient experience is tied to the employee experience Sue said you can't improve one in isolation as both are tied together.  ‘'And so that's where it started, and that really is people, service and quality. Employee experience, people, patient experience, and we truly, truly believe, Jim, that you cannot improve the patient experience, which is both about safe and satisfying care. It can't just be about service and friendliness and nice. It's important. It's part of compassion and caring, is to be civil and friendly and all of those things. But if you're just that and your quality and your safety sucks, I'm sorry, it's like lipstick on a pig or painting the shack. We really have to have substance behind that of true patient experience being safe and satisfying. But we believe that you can't, and we've over and over again shown this to be true, that you can't really improve the patient experience if at the same time in parallel, you're not improving the employee experience, that they're so tied together that you can't even separate them. People caring for people. Both of those things have to be working well. So those really fit under that people, service and quality pillar. So since so much of our emphasis of our work was definitely on those solutions that made us a magnet for talent, those solutions that made us a magnet for patients were really about improving the employee and patient experience, people, service, quality. That's where we realized that that was where the magic was and then leverage that for growth.''   38:09 Growth can happen when leaders ‘'get real'' Sue said understanding their exact position and trend can help healthcare leaders discern if they need external expertise.  ‘'So get real with yourself. Get real with yourself, and then get real with do you know how to execute on strategies for people, service and quality? Do you really know? Do you have the inside expertise? And if you don't, you need to either figure it out, which I can tell you, it took us six years to figure it out, three years to mastermind it, three years to test it. You can spend that time or you can find somebody that can help you. There are experts out there. That's what we do. I know there are others. There's other formulas, frameworks that can do this work too. But I think you just first have to assess and get real about where you are, and not just where you are right now but that trend. Are you trending up, down, all over the place, out of control and your quality is whatever? That's your sign that you have a problem. Maybe you have to own up to yourself that you don't have the fix. I had a CEO say to me the other day, Jim, he said, he goes, "Well, I think I want to try to fix it on my own first, and then if we fail, then I'll seek some outside help." And I said, "If your boiler broke right now and you didn't have heating or cooling for your patients or employees right now, would you as a CEO go down there and say I'll give it a try to fix it myself before I call in an expert?" He goes, "No." I'm like, "Well, how is people, service and quality any less important than heating your building?" So …my parting advice to frontline leaders is even if your organization truly, truly, truly isn't making this a priority, it can be yours.''     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Sue Tetzlaff on LinkedIn Check out VIE Healthcare and SpendMend      You'll also hear:  Sue's 20-year journey to Co-Founder, Chief Strategist & Executive Officer of Capstone Leadership Solutions, Inc: ‘'My original career goal, Jim, was to be a hospital CEO, and I was checking all those boxes. I became a registered nurse. I got a bachelor's degree in health information management. I got my master's degree in hospital administration. I got my fellowship and my board certification in American College. I got my first VP job in quality and then as a nursing officer and then as an operating officer.‘'   How ‘'creating a volunteer army'' dramatically transformed a small community hospital: ‘'We went to over 900 (employees). We went from losing millions of dollars to making $11 million the three years after we started. Our patient satisfaction went from the bottom 25% of the country to the top. Some of our quality statistics were at 17% compliance. Now we were winning national awards …''   Identifying common patterns to create a common solution: ‘'…it's data and it's opportunities and it's problems. But when you work with multiple organizations, especially all at the same time, doing the same thing, you start to see patterns….this is not just a unique opportunity or solution or problem in one place. … This is a common problem. Can we have a common solution? ‘'   The problem with ‘'good'': ‘'…And so the human behavior around something that's good is I may or may not use it again. I may or may not talk positively about it in the community and I may or may not recommend it to others. And that could be even if it's poor. If it's good, average, it's a may or may not kind of attitude or decision for the buyer. But when something is great, it's their go-to place.''   Why hospitals can never declare victory: ‘'…really John Kotter would say, "Don't declare victory too soon." But I would add never. You can never declare victory on this. You have to just start, keep going and it is the infinite game. There is no end. No matter how good you get, you have to keep getting better in people, service and quality. You cannot give up or you will go backwards.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

The use of telehealth soared during the pandemic and remains a vital tool in patient care. Justin Schreiber explains what makes LifeMD successful, and outlines his vision for GLP-1 medication to Jim Cagliostro.    Episode Introduction  Justin shares the lightbulb moment that led to a change in his focus, the three keys to LifeMD's success, and how compliance and mentality can improve the patient experience. He also explains why he believes GLP-1 is a once-in-a-century life-changing drug, the power of AI to lower healthcare costs, and why hiring the right people ‘'makes magic happen.''   Show Topics   Three key elements for success in telehealth  How technology affects the patient experience Marketing expertise raises the profile of telehealth Maintaining a ‘'patient-first'' focus GLP-1 could be a once-in-a-century miracle drug The future of AI in healthcare Leadership tip: hire the right people   07:02 Three key elements for success in telehealth Justin explained what makes LifeMD stand out in a crowded market.  ‘'There are three big things that I think a direct to patient telehealth company needs to be successful. The first is amazing providers. LifeMD is one of the few telehealth companies that has an affiliated medical group of mostly full-time providers. So we've had to hire some 1099 providers that still work for us 20 or 30 hours a week. But the vast majority of the doctors and nurse practitioners that provide treatment to LifeMD's patients across all 50 states, this is their full-time job and they love it. They're super passionate about it. They work together, they train together. It results in an incredible patient experience. Most other telehealth companies out there are using an army of 1099 contractors. They're trying to make a couple bucks on the side. Oftentimes the incentives are to get off the call as quickly as possible. We have a team of doctors that really cares about building the brand and really cares about providing comprehensive care.''   08:03 How technology affects the patient experience  Justin said tech is the second big piece in LifeMD's success.  ‘'And then, I mean, the second big piece is tech. The technology behind what we do is really complex. I think this is probably the most underappreciated thing in LifeMD. We've had 50 to 100 engineers in the US and we have a dev team in Ukraine as well that have been working now on just our primary care platform for the last three years. We've put tens of millions of dollars into that. It's proven at scale. I mean, so we run a business where we have 750 to 1,000 new patients coming on the platform on any given day. We have thousands and thousands of patients that are on various subscription for different prescription products for our lifestyle telehealth business. It's just a super complex business, especially on the compliance side to comply across 50 different states. And so the technology is really important and that has a big impact on patient experience.''   09:02 Marketing expertise raises the profile of telehealth Justin said performance marketing expertise enhances LifeMD's success.  ‘'And then the third thing I would say is just this legacy-like performance marketing expertise. There have been a number of telehealth companies that have great technology and have probably really awesome medical groups, I'm sure not as good as LifeMD's. But, look, our ability to go out there and actually run an ad and get somebody through a flow and convert that prospect into a customer, it's really special. I mean, we spend $40 or $50 million a year on media, LifeMD on every channel imaginable. We do almost all of it internally. And I think that that ability to control our own destiny and actually go out there and build these businesses through direct marketing within telehealth is really special.''   12:04 Maintaining a ‘'patient-first'' focus Justin said compliance and ‘'mentality'' lead to a great patient experience.  ‘'I think the first thing is compliance. It's making sure that you have the right compliance infrastructure in place at the top to ensure that everybody in the organization, from doctors to nurses, to medical assistants, to even all of the various patient care reps in our patient care center, making sure they're all doing the same thing. A lot of that just comes down to policies and procedures and audits and having a great compliance infrastructure in place, which I feel really good about what we have at LifeMD in that area. Secondly, I think it's just mentality, right? I mean, I think we spend a fortune on our medical group... It hurts. I mean, hiring full-time providers and doctors and nurse practitioners and all the licensing that goes into this. I mean, it's one of our biggest line items at LifeMD on the expense side. And there's not a week that goes by where people are like, "Hey, can't we do all this async? Why do patients need to actually see the doctor? Can't they just fill out a form and we treat them? We could do 50 times as much volume with the same resources. So I think it's just the mentality. For us, a great patient experience, I believe, and great care results in us building brand equity and it results in good retention.''   16:11 GLP-1 could be a once-a-century miracle drug Justin said GLP-1 drugs are offering additional benefits to people with diabetes.  ‘'…most people out there in the medical and scientific world and in the financial world look at this class of drugs as what could potentially be a once a century miracle drug. The class of drugs is called GLP-1s or glucagon-like peptide 1 agonists. There's four kind of big drugs in this class right now that are approved by the FDA. Three of them are approved by the FDA for diabetes. There's Ozempic and Rybelsus, they're both semaglutides. Wegovy is also a semaglutide, which is approved for obesity by the FDA. And those three drugs are owned by Novo Nordisk. And then the fourth big one is Mounjaro, which has been approved. That's a drug manufactured by Eli Lilly that's been approved for type two diabetes. All of these have been approved for type two diabetes, most of them for quite some time, some as many as two decades. The drugs are well understood, the safety of these drugs is well understood. But, look, what they realized as they were giving these drugs to patients for type two diabetes is that in addition to helping to regulate blood sugar, people were losing crazy amounts of weight. The early ones, people were losing five to 10% of their body weight, then came along Ozempic and some of the other semaglutides, and people started to lose 15 to 20% of their body weight. And now Mounjaro, which is Lilly's drug, which will likely be approved for obesity this quarter, the fourth quarter this year, a lot of people in the studies were losing 30 to 40% of their body weight.……One of the other side effects of these drugs is that people that have other addictions, whether it be nicotine or alcohol or any other addictive behaviors, when they're on these drugs, they're finding it easy to give up some of their other addictions as well.''   26:27 The future of AI in healthcare Justin said AI has the potential to lower the cost of healthcare over time.  ‘'Well, I think one of the best ways to maximize the effectiveness of virtual care offerings is through in-home care and in-home tools. Think about everything, all of the things now, and this is a whole area of healthcare that's exploding and it's going to continue to take off over the next five or 10 years. But if you think about all the tools we have just in an iPhone and certainly what can be connected to an iPhone now in the home to diagnose, I mean, look, now you can use your iPhone camera and take a picture of your face and within a second you can see your blood pressure. That's likely to be FDA approved this year. You now have pulse ox obviously on devices like your Apple Watch. I think all of your vitals are going to be easily accessible to a virtual care platform within the next couple of years, as long as... There obviously are going to be certain Americans that are going to be hesitant to share that information with anybody- If you're like me, and probably you, I'm going to be like, let's upload it to the cloud and analyze it for me every morning and certainly share it with my doctor. And then AI is going to be a big part of it. I mean, I think that AI will certainly lower the cost of healthcare over time. A lot of these common issues in primary care can probably be diagnosed and handled using AI down the road with some oversight obviously from a physician.''   30:13 Leadership tip: hire the right people Justin said finding the right people makes the magic happen.  ‘'I mean, look, I never ran a big company or had many employees prior to LifeMD. I always liked having two or three employees at the most. But I think the one thing that I've learned through LifeMD, it's the most important thing a leader can do, is recruiting people that are awesome underneath him or her. And that's what, if I think back on my trajectory with LifeMD and how the company evolved, the biggest catalyst... Look, we had a really awesome co-founder too, which were incredible, but co-founders are entrepreneurs, right? And they get a business so far and typically businesses outgrow them, right? And so what I've seen is as we've built out the C team and gotten the business to a level where we could actually attract really high-quality leaders out of other companies to come in and actually grow that part of the business, whether it be finance or marketing or technology, I mean, these were the hires that not only in a crazy way positively impacted my quality of life and how well I slept…. My strategy has just been find amazing people that you can trust that work really hard, that don't have egos and that are kind of proven and you make a bet on them. And when you get a full team of those like I think we have right now at LifeMD, that's where I think the magic happens.''     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Justin Schreiber on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    Justin's ‘'light bulb'' moment that ultimately led to LifeMD. ‘'… this whole telehealth thing and this idea of technology, virtual care, in-home healthcare … there is no bigger addressable market that I'll ever see in the rest of my life than this. Let's build a company and list it on the NASDAQ, raise a bunch of capital to do some awesome things. So, that's how we got to where we are today.''   The crowded space of telehealth: ‘'… especially in the post-COVID years, during the pandemic, you had a crazy amount of venture capital flowing into startup telehealth companies. I'm sure there are hundreds and hundreds, if not 500 different types of telehealth companies out there that have been funded over the last five years.''   How telehealth contributes to primary care: ‘'The big knock on telehealth is that it's not real comprehensive healthcare, and we put everything possible LifeMD to be the opposite of that….There's a real emphasis on wellness. I mean, there's a longitudinal relationship with the same doctor. All of these things contribute to comprehensive primary care.''    LifeMD's comprehensive weight loss offering: ‘'LifeMD is helping patients not only access these (GLP-1) drugs, but also there's a coaching element to what we do….trying to help them implement some lifestyle changes along with the drug.''     What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

American healthcare is at risk of collapse as one-fifth of nurses intend to leave the profession by 2027. Jennifer Thietz outlines her vision of a new model for nursing and healthcare to Jim Cagliostro.     Episode Introduction  Jennifer highlights the soaring post-pandemic levels of burnout and high turnover among nursing staff, why the four primary nursing models are no longer effective, and shares her vision of building on a one-to-five patient-nurse ratio. She also explains why rebuilding connections helps nurses and patients to thrive, why nurses need to unite and use their voice, and reminds us that all nurses are heroes.    Show Topics   US healthcare is in a state of crisis Nurses are the bridge between healthcare providers and patients Healthcare requires a new model of nursing  Building on a one-to-five nurse-patient ratio Healthcare comes down to human connection  All nurses are heroes     04:12 US healthcare is in a state of crisis  Jennifer said that nurses represent 50% of the workforce but almost one-fifth intend to leave.  ‘'….this is a news release in April this year, and it's from the National Council of State Boards of Nursing, and they gave some really scary facts. We know that over 100,000 nurses left during COVID. They're saying by 2027, 900,000, or almost one fifth of the 4.5 million nurses, intend to leave the workforce. So that's a really frightening stat. We know that 189,000 nurses under the age of 40 want to leave nursing by 2027, 50% of nurses report being emotionally drained and burnt out, and this is the worst burnout in nurses that we've ever seen. So we really are in a real crisis, and we are losing our nurses daily. And without nurses, considering that nurses are 50% of the workforce, and actually touch 90% of patients. So you can imagine, if we don't have nurses, we can't nurse. We can't work in healthcare as it currently is. And I believe there will be a collapse in healthcare if we don't make some changes now.''   07:42 Nurses are the bridge between healthcare providers and patients.  Jennifer said 90% of hands-on care comes from nurses, who are essential to provide a safe and happy environment for patients.  ‘'Well, nurses are fundamental to healthcare. As I've just said, 90% of the hands-on care comes from nurses. We're a huge, huge percentage of the caregivers in healthcare. And if we as nurses can provide care in a safe and happy environment, we can turn healthcare around. We're the bridge between the physicians, between the other healthcare providers, we are the bridge with patients. We are the ones who are there 24 hours a day, 365 days a year. We are the ones who are speaking with the patient, spending up to eight or 12 hours a day with individual patients, so we really are the front-runners. We understand what's going on, and we are the ones who are hurting. Everybody in healthcare is paying a price, but I believe that nurses are paying the biggest price at this stage. And the reason is that they don't... Many of them do not have sufficient help in the units.''   11:21 Healthcare requires a new model of nursing Jennifer said nurses are no longer able to provide care as they want to.  ‘'Now, obviously, we are in unprecedented times in healthcare with this hemorrhaging of nurses, with the costs that are associated with care at the moment. And having been on the floors and seen how nurses work, I think the main issue with many of the nurses who I've been speaking with and who I've worked with, is that they don't have sufficient time to nurse the way they would like to. And the reason I think is related in some way to cost cuttings, where organizations are losing staff in order to stay afloat. And what's happening is nurses are now literally wearing two hats. They are doing their nursing specific tasks, which as the acuity of patients goes up, become more and more complex, more and more difficult, and then they're also asked to do care, for example, handing out food trays, or finding patients who are lost, and transport has got a patient and they're supposed to go to Dr. Smith's office, but he's now lost somewhere and they're making calls, they're doing ordering, they're doing billing, they're doing bathroom breaks, all of this work, which is obviously essential, because that's how a hospital turns around, and that's how nursing care is provided, but I think if we had staff, auxiliary staff, to help the nurses, just to take that load off them so they have the time to do their nursing specific roles, I think that for me would be the way to go.''   12:46 Building on a one-to-five nurse-patient ratio Jennifer explained how using the one-to-five nurse-patient ratio can transform patient care by combining the benefits of two models.  ‘'And so I've looked at nursing, and I've used the benefits of two models. The one is the individual approach where obviously the nurse is involved with the care of the patient, and then a team approach where multiple people are involved, but I've shortened it or honed in on a ratio if possible of one to five, which is what CMS actually recommends. They don't mandate it, obviously, but the CMS is recommending a ratio, patient nurse ratio, one to five, and then involving in that team a nurse assistant that just works with that RN. So you would have one nurse, you would have one nurse assistant, you would have five patients, and then you have two sets of eyes on those patients all day. You have the auxiliary tasks, like handing out food trays, et cetera, taken care of, and the nurse then can go ahead and fully concentrate on their nursing roles. And I would add to this, Jim, which I think is extremely important, is a ward secretary, or a ward clerk we call them, whereby they are at the nurses' station, and they allow the charge nurse time to leave the nurses' station because they're going to be doing the directing of patients, they're answering the phones, maybe the ordering of meals, et cetera, and then charge nurse will then have the opportunity to be on the floor with the nurses where she's really needed, or he's really needed. So that's what I see as the hybrid individual team approach…. this one to one to five would be in units like telemetry, med-surg, oncology, the specialty units, obviously our ICUs, our step-downs, et cetera, have a totally different way of working.‘'   20:31 Healthcare comes down to human connection  Jennifer said the crisis in nursing is affected by the break in connection between patients and nurses, and between colleagues.  ‘'….I think nursing and healthcare in general boils down to the connection we have with our patients and with each other, with our nurses. And our connection with patients, and I'm saying our, but I'm talking about specific nurses, there are other nurses who are working in wonderful work conditions who have the time. I spoke to a nurse last week who said, "Hey, I'm very happy. We have this incredible organization and I'm working in a great team. I have help." Absolutely. And this particular nurse has the nurse assistant with her. So there are many organizations who are doing it right. I don't want to give the wrong impression, but yes, I believe that the crisis in nursing now is happening due to the break in our connection with our patients and our nurses. With each other, colleagues. We need to have that human connection in order to thrive, in order to heal, in order to work to our best ability. And many of us are going into our workplaces every day, and we are given an assignment, and we look down and we see the tasks that we have, and we put our head down and we just plow through those tasks. And we don't have the time to necessarily sit with patients, with each other, to connect.''   27:16 All nurses are heroes Jennifer said in some ways nursing is more difficult now than during Covid and encouraged all nurses to use their voices and speak.   ‘'… I think the most important thing that I'd like to share is my deep respect for nurses, and to really... I'm hoping to empower nurses who are sitting in jobs that are very, very, very challenging. I also worked during the COVID pandemic on the floor, and we as nurses were held up as heroes during COVID, and we were, and we are, and I think we remain those heroes. I think what nurses are doing now is maybe in some instances more difficult than during the COVID pandemic, because then we had the support of everybody. Now, each nurse that walks into a facility remains a hero because many of you are working very, very challenging conditions. And you are highly intelligent, highly skilled, highly motivated, your compassionate heart, you have a right to raise your voice and speak. And speak as much as you can and share with your leaders, if you have ideas on what can happen in your units to help your job, make your job easier, then go ahead and share that information. I think communication is vital. We need the connection. So keep connecting. Keep connecting with each other, pay it forward with each other, look after each other, look after your nursing managers, and your nursing leaders as well. And let's come together and change healthcare, because we are millions strong. We can do it. And we just need to get our voices out there.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Jennifer Thietz on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:  From South Africa and a heart transplant first, to Mexico, via America. Jennifer's 20 years of experience at the patient's bedside. ‘'And I think for that reason, I can really speak to this topic today, because I've been there, I've worked with these nurses, I've been on the floor with patients, and I have a great understanding of what is happening in healthcare.''   Why the nursing world as we know it is unsustainable: ‘'… I'm passionate about this situation as a long time nurse… And I'm hearing stories all the time about working conditions, which are extremely difficult.''   Why the four primary nursing models are no longer effective for modern healthcare. ''… these approaches are, as I say, World War II up to the 1980s. They're old. They are nursing approaches that have been around for a long time, and I don't think they speak to what is happening in healthcare at this point.''   Offsetting the initial cost of a new model of healthcare against higher staff retention levels. ‘'In the long term, the cost savings would be huge. …. And I believe that then the patient satisfaction would go up, because they would have this interaction.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

The art of ruckus making means doing generous work and serving others. Denise Wiseman explains the motivation behind her passion for improving the patient experience to Jim Cagliostro.    Episode Introduction  Denise explains the importance of a positive attitude in ruckus making, why healthcare needs a new paradigm of CARE, and the importance of setting rather than meeting expectations. She also highlights the need to make a ruckus about HCAHPS, the critical role of Patient Family Advisory Councils, and reminds us that all leaders are human – and everyone is a leader.    Show Topics   Making a ruckus is doing generous work  Calling for a new paradigm in healthcare Opening up conversations around the patient experience We need to make a ruckus about HCAHPS Expanding connections outside of healthcare Leaders are human too (and all of us are leaders)   07:32 Making a ruckus is doing generous work  Denise explained how Seth Godin's Akimbo program helped her to understand the definition of ‘'ruckus.''  ‘'So when I was given that opportunity to redefine my career, I took time to reflect and consider on what the right next step was for my career and also for my life. And so I took a few courses from Seth Godin and his Akimbo program and I don't know if you know much about Seth, but he ends his videos and his trainings with saying, "Go make a ruckus." And when he says that what he means, and this is a quote from him, "When we show up to make a ruckus, we're doing generous work. Work on behalf of those we seek to serve." And then he says, "We need to dig in and do something that might not work." And so when he is talking about making a ruckus, he's talking about thinking outside the box, embracing the unknown, being courageous and with a positive attitude and that's everything you'll see from Seth. It's with a positive attitude, stepping out, giving it your all, testing, trying and doing something differently. And Jim, that is exactly what we need in healthcare. And so being a Ruckus Maker, to me, is identifying those things that are problematic in healthcare. We're all aware of them. If you're on LinkedIn or in other forms, you're hearing people talk, complain about the problems of healthcare, right?  And I say, let's identify it, that's fine, but let's then understand enough that we understand the root of the problem, what's really going on to cause what we're seeing and then let's do something about it. And so that's making a ruckus, right? That's doing something about it. Let's stop blaming others, let's stop waiting for somebody else to solve it and let's take action.''   09:39 Calling for a new paradigm in healthcare Denise said a new paradigm of CARE would put the ability to take time to care back into the system.  ‘'So the second part of your question was my call for a new paradigm. And so you'll hear many people talk about the current situation in healthcare as broken and I'm one of those. And in many ways it is broken. Not everything. Not everything is broken, but we are a system in trouble. We have patients who are heavily burdened by many expectations of them, within healthcare. We have staff who are burdened by regulations, organizational policies and practices, by the current challenge of staffing, by the disconnect between those very highest in leadership and decision-making and what actually occurs in the moments of care delivery. Our current paradigm has healthcare that is not accessible to all. Our current paradigm refuses care or at least to pay for care for far too many or inadequately pays and leaves thousands financially devastated for seeking life-saving care. We have healthcare that being delivered on the backs of nurses and clinicians. They are beautifully heart-centered people for the most part and they're striving to do their very best. And when we talk about moral injury, it's true injury, they're suffering. So a new paradigm would be the definition of care and that's all CAPS, CARE. I'm talking about an experience of healthcare where there's trusted relationships between providers and patients, the patient is known by the provider, the gaps in care are eliminated, misdiagnoses and medical errors are greatly reduced if not eliminated. The new paradigm puts care, the ability to take time to care, back in healthcare. Or as my good friend Tom Dahlberg would say, "It includes love and the relationship of all connected with healthcare."   14:03 Opening up conversations around the patient experience    Denise said the patient experience starts at the first moment of engagement.  ‘'….But here's the problem, there's a bigger issue with experience. Oh, so here we go. I should be able to schedule an appointment with my physician within days, maybe weeks of needing one. But in my most recent experience, I had to wait five months to schedule an appointment with a provider. Well, that's a bad experience from the moment I've engaged with your organization. And if I'm going to your ED and I have a two hour or more wait in the waiting room before any treatment has begun, that's experience of care. If I then have questions about whether or not I can trust the care that was given to me for whatever reason, perhaps a misdiagnosis, medical error or just a simple lack of or miscommunication, that's experience of care. And after all of that, I receive a bill for care that I can't pay for or will cause me extreme financial hardship, that is experience of care. And we are completely ignoring that with our conversations on our efforts for the improvement of patient experience.''   18:21 We need to make a ruckus about HCAHPS Denise said progress in the patient experience has been minimal.  ‘'We've not improved experience, not really. The nationally publicly reported data reflects that in those first few years, we did make improvements and that's because at that time there was concern about the money, the incentives that were attached to the results and there was some fuel behind that movement. And in part I think some of it, that improvement, is attributed to Studer Group. There was a lot of effort being done. But in the last decade, I pulled the numbers just recently and I put a thing out on LinkedIn about this. In the last decade, other than the most recent declines in HCAHPS because of COVID, our national data shows we're flat, we've made minimal, if any, like a one point shift improvement across the different components of the survey….And yet we spend hundreds of millions of dollars annually to the industry of patient experience and we've seen little value. In fact, I would actually argue that we're causing damage. So when we look at the survey, I don't have a huge problem with questions on the survey. So HCAHPS, we can look at, but there are actually over 20 CAHPS surveys and more are being developed and there are good reasons behind the questions they select. So communication with nurses and doctors is critical for our patient's safety. We have to be able to understand what we need to do to take care of ourselves. We also need to be able to express how the treatments are making us feel or any other communication.''   25:47 Expanding connections outside of healthcare Denise said band-aid solutions arise when we don't listen to other perspectives.  ‘'… When we only ever hear from the same people, people with our same experiences, when we only experience the same experiences and when our knowledge is only deep, and deep is good, but it's not also wide, there's much that we do not know and our perception is narrow, it does not mean that our perception is wrong, but it's incomplete. And so when nurses only ever talk with other nurses, physicians with other physician, pharmacists with other pharmacists inside healthcare only willing to talk or listen to others from inside healthcare. And this one's really important in my opinion, when those who have positional titles or are considered thought leaders within their field are invited to the conversations or to make decisions, they're the only ones there. We're hearing only from the perspective of that group. We are then only working to solve our perspective of the problem. And this is what leads to band-aid solutions and gaps that we can't bridge. So I think it's absolutely critical for us to have a highly diverse, integrated and inclusive approach.''   36:13 Leaders are human too (and all of us are leaders)  Denise shared her leadership tips and emphasized the need for grace and understanding.  ‘'…in those positions, they're also under a lot of stress, they are triggered. And so I think the most important thing that I have learned working across our country and meeting with many different leaders is that leaders are humans. They are. I believe the majority of our leaders in healthcare, at whatever level they are, they truly come to work each day wanting to do the very best. Often they're not positioned to do their very best and they're struggling. And so when we talk about healthcare leaders, it's an area where we place a lot of blame. I see too much of that where we blame the leaders for the current situation in healthcare. And I think instead we need to seek to understand, we need to understand the very difficult positions they're in and why they are acting the way they are and making the decisions they are rather than just placing judgment on them. We need to be able to extend a hand to help and we need to be able to give some grace, if, when a leader makes a mistake because they will, we need to be able to give them grace and to let them correct. And then I think the other thing is each and every one of us, no matter what our position is, are leaders. And so how can we consider our own way of acting, mentoring, guidance, and leading in order to role model it to those around us, to those above us, et cetera. So instead of blaming and saying, well, they're acting that way, I don't have to be any better. I think each and every one of us owns our own actions and our own leadership in the space that we reside within.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Denise Wiseman on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:  From dietician to Chief Ruckus Maker: Denise's career history and lessons learned along the way. ''What I've learned the hard way is that for-profit organizations are typically, for the most part, for profit before all else''. How an Achilles injury led to a life changing patient experience.  The importance of setting patient expectations:  ‘'So that's a key word there that we're setting instead of meeting, and this is the psychology of experience. For example, a hospital is going to be noisier than your home ... .And so there's an element that talks about how do we set our patients up for that expectation, to ensure that they understand what we mean by the question on an HCAHPS survey about quiet at night. ‘' Why HCAHPS surveys still have too many gaps: ‘'… huge demographic populations are underrepresented in the responses, but as I hinted at earlier, the surveys have many gaps. They're not capturing critical components of experience, they're not elevating systemic issues from our national healthcare system.'' The critical role of PFACS (Patient Family Advisory Councils) ‘'…our PFACs are critically important, underutilized, under-supported. We ask people to volunteer their time when really they need to be a partner at the table with us and perhaps be paid in some method for their contribution.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

WARNING: This episode contains discussions on sensitive mental health topics that include depression, anxiety, and suicide among youth.   Children aged 2-5 have the same rate of impairing mental health disorders as older children and adults. Dr Helen Eggar explains the work of Little Otter in addressing this growing crisis with Jim Cagliostro.    Episode Introduction  Helen explains Little Otter's approach to mental healthcare for children, why mental health treatment hasn't improved in ten years, and why it's hard being a parent in America. She also describes how tantrums can be a ‘'mental health fever'', emphasizes the need for a family focus in mental healthcare, and explains how telehealth provides access to care when 71% of counties don't have a child psychiatrist.  Show Topics   Mental health has deteriorated since the pandemic 50% of mental health disorders start before the age of 14 Acknowledge the distressing impact of the mental health crisis A family focus improves mental health outcomes Tantrums aren't just behavioral issues  The vital role of telemedicine in childhood mental health High quality work always wins out      10:25 Mental health has deteriorated since the pandemic Helen explained how a mental health crisis impacts the whole family.  ‘'What I say about the child mental health crisis is that we were in a child mental health crisis before the pandemic, but it was made much worse by the pandemic and the stress of the pandemic. We've seen significant elevation in particularly anxiety, but also depression in kids. But this report, this white paper that I referenced that we produced was based on over 11,000 families coming to seek care at Little Otter. And when families come, they complete what we call the child and family mental health checkup, which I created. And the idea is we do checkups for height and weight and other variables, but we don't have a way to check up on our child's mental health or our family's mental health, so when families come in, they complete this survey and they immediately get a report back. And the assessment looks at child mental health with separate developmentally appropriate sections for infants, toddlers, preschoolers, school age, and middle schoolers. Then we assess parent mental health, then we assess what we call family mental health, which is stress and the relationship between the parent and partner and the co-parenting relationship. That's what we see all together. We think at Little Otter that we don't just have a child mental health crisis, we have a parent mental health crisis. In our data, over half of the parents met clinical criteria for anxiety disorder and 1/3rd met criteria for depression.   13:27 50% of mental health disorders start before the age of 14  Helen said children are affected by their environment and we cannot silo family members in treatment.  ‘'Because children are impacted by their environment, by their relationships. Another example, of course, is with younger children whose parents are depressed. We know so much about postpartum depression and the impact it has on the mom. And it has a huge impact on the child's mental health. And it really impacts the quality of the parent-child relationship. Those are just two examples where we think to address this crisis where we have to innovate is not to silo the members of the family, carve them off and send them to different people, but there has to be an approach that's thinking at the family level. And I truly think that is our first big innovation at Little Otter. And the second one is to say young children are suffering at the same rates as teens. Teens, it's super important, absolutely critically important to meet the mental health needs of children. But again, if we're going to make a dent in this crisis, we have to start as early as possible. 50% of adult mental health disorders start before the age of 14, but we put most of our effort and our dollars into older children and into adults, and we're not focusing on where we can make a difference with early intervention and prevention. I'm so passionate about that, both where the industry should be focusing, but also educating parents so that they know the signs so they can advocate for what their children need and what they need.''   15:30 Acknowledging the distressing impact of the mental health crisis Helen said a cohesive, connected and relationship-based approach is essential in mental health care.  ‘'I think one thing is that older children show up in emergency rooms with suicidal ideation at higher rates. And those are very expensive interventions, so I think that's one thing. Although the average age in our families, our kids we take care of for suicidal ideation is 10 years old. And we need to know that the second leading cause of death for children 10 to 14 is suicide. Again, it's not something that only happens to teenagers. I also think that it's somewhat more straightforward to provide mental health care to teenagers. And so at Little Otter, it's not just that we see young children, we hire therapists who are experts in early childhood mental health. It's its own area of specialization. And I think that many of the principles of our family mental health approach are embedded in the infant early childhood mental health field because you're never thinking about a three-year-old separate from the parents, you're with the child and with the parents. And so I personally think that approach should be applied across the lifespan. If you have a spouse who's depressed, it's impacting you in a huge way. And if you could be a part of that treatment to help understand and support your partner, I think treatments would be more effective. We're really trying to bring that more cohesive and connected and relationship-based approach to all of mental health.''   20:24 A family focus improves mental health outcomes Helen said improving the mental health of children has a major impact of parental mental health too. ‘'It does. And I can tell you a very cool thing, which is in our outcome data, taking a cohort of over 200 kids who did treatment, 71% after 12 weeks went from the clinical to the nonclinical range. They had great impact. But we saw these were parents who we were not providing direct care for, we were just working with them in our Little Otter approach, that of the parents who had clinically significant anxiety at the start of their kids' treatment, 67% were no longer in the clinical range. And for parents who had clinically significant depression at the start of treatment, 71% were no longer in the clinical range. Even just providing mental health care for children with this family focus, with this engagement with the parents with the acknowledgement of the impact on the whole family, we had a major impact on parent mental health, so we got us two for the price of one. And because we very rigorously have a measurement-based approach and track outcomes using the checkup but also other measures, we're able to demonstrate that our care, even when it's just focusing on the child, impacts and improves the mental health of parents and the mental health of the whole family.''   25:46 Tantrums aren't just behavioral issues Helen explained that daily aggressive tantrums can indicate signs of a deeper problem.  ‘'But I'll give you a good example from my work that I think brings it home, because it can seem abstract. Think about temper tantrums. Kids two to five have temper tantrums. In fact, 75% of two and three year olds will have had at least one tantrum last week. And it goes down a bit at four and five. And the thing about that is that is developmentally appropriate because young children are learning the capacity to manage their emotions, their big feelings, to manage behaviors when they have big feelings. And they're not that good at it, and sometimes they just melt down. However, in my research I found that children who have tantrums nearly every day and who hit, bite, kick, or break something during a tantrum, those children are eight times more likely than children who don't do that to having an impairing mental health disorder. But here's the critical thing. People think about tantrums as a behavior problem. It's as much connected to emotions. Children who have these aggressive frequent tantrums are at much higher rates of having an anxiety disorder, of having depression as well as ADHD or a behavior problem. That's why I call daily aggressive tantrums a mental health fever. It's a generalized sign that something might not be right. It doesn't tell you what it is. You have to go and have an evaluation and look more deeply. But to me, that's a useful knowledge that we can share with parents, right?...To say, "Here it is. It's developmentally typical. But actually, this is not developmentally typical, and let's look a little bit more deeply at it."   32:31 The vital role of telemedicine in childhood mental health  Helen said telehealth is on the only way to provide wider access to mental healthcare for children.  ‘'I think it's a big question, can you do telemedicine in early childhood mental health? And the answer is yes. Again, science has shown that we can do that, and we're obviously doing it at Little Otter. And that is so important. We are experts in delivering telehealth to young children. You don't just plop a kid in front of a computer and expect them to talk like we're talking. You put the computer on the floor, we use the whiteboards, we have toys. We're very skilled at making it an engaging experience. But I think it's critical to understand that it is the only way we are going to address the access problem. United States, 71% of the counties in the United States do not have one child psychiatrist. There are states in the upper Midwest who have zero child psychiatrists. Yes, we have to encourage more people to go in the field, et cetera. But that is not going to be the solution. We have to be able to bring our skills to families where they are, meaning in their home. And this is critically important when you think about the need for specialization. Perhaps you're in an area that has some child mental health services but don't have specialized early childhood services. But at Little Otter, because we're 100% virtual, we can bring that expertise in. It could be early childhood mental health, but it also could be expertise in evidence-based treatment for obsessive compulsive disorder. It's not just the early childhood. The mental health care that works is evidence-based care, not just random care. And parents, I think, need to seek that high quality care.''   38:12 High quality work always wins out  Helen said having a vision and being clear on your values and principles helps to succeed in the long-term.  ‘'…my experience has been, in the end, doing high quality work wins out. I'd say that was true in terms of the beginning of my scientific career when people doubted things. But if you do good science and you have the data to show it, you will be able to convince people. And so I think having just a very clear focus on what your values are and what are the key principles that you are focusing on I think really helps build for the longterm. And I think that's the other thing. I think when we create new things, it takes a long time. And so I think it's very important not just as a leader, but for inspiring the people who work with us to have five-year plans, to think through, okay, I want to be here. And how am I going to get there? And then to support people as they go through that. I think being able to have a vision for something that doesn't exist and then be able to translate that and share that with others is one of the most amazing experiences that I've had the privilege of seeing that when you do that collaboratively... All of science, all of clinical work, this is collaborative work; doesn't just come down to one person. But if you can create those collaborative teams with vision, you can make a huge difference. And I had that in my academic career, and now I'm having the privilege of having that experience in the digital health realm.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Dr Helen Egger on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    A passion for mental health in children from birth to 6 years: Helen explains the motivation to launch Little Otter: ‘'…the earlier that we intervene, the better the outcome is for the kids.'' No change in a decade - the urgent need to address the mental health crisis: ‘'We have a white paper that we just produced called Breaking the Silence: Meeting the Mental Health Needs of Young Children that I wrote. And in it, I look at the rates from when I started my career in the early, mid-2000s to now, 50% of children who need mental health services, only 50% get mental health services. That number was the same in 2013 as it is in 2023.'' Mental health's elephant in the room: ‘'The elephant in the room is something that's the crisis of mental health as a whole, which is really how mental health is funded and the lack of parity of coverage for mental health care compared to coverage for other medical disorders.'' Why it's hard being a parent in America: ‘'We have not built a society that really focuses on maximizing the support for the youngest Americans or their parents so that …the typical parent is facing a lot of stresses that are going to impact their ability to support their children's mental health.'' The impact of the first five years lasts a lifetime: ‘'We know from brain science is that the period from birth to age five is where the architecture of the brain is really set down… What children experience in their relationships and their environments and what challenges they face at the mental health level, if those are not addressed, that is actually going to impact for a lifetime that child's mental health….''  What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

Clinical research has been around for over 300 years. Todd Nicklas explains why it still isn't perfect but still offers benefits for patients and healthcare providers to Jim Cagliostro.    Episode Introduction  Todd explains the history of clinical research through Paul Offit's You Bet Your Life, asks the big question of ‘'replacement or supplement'', and explains why patients are always their own biggest advocates. He also explains the need for monitoring the ‘'gray line'', and why the key focus in all clinical trials is failing early.   Show Topics   Clinical research isn't always the answer for patients  Supplement or replace? The big question for balance Handling complexities in replacing medication  The high cost of getting drugs to market  Focus on failing early  Patient benefits: a case study with Camzyos Teamwork helps the growth process   03:35 Clinical research isn't always the answer for patients  Todd highlighted the importance of a balanced view in clinical research, highlighting ‘'You Bet Your Life'' by Paul Offit.  ‘'So I kind of wanted to start out with that sometimes it is the answer, clinical research for a patient, or sometimes it's not the answer.. I appreciate reading a book by Paul Offit called You Bet Your Life. And ..he went through the past few hundred years in some of the early medical interventions in development and when they were very early starting off, the first blood transfusions that were tried or first types of anesthesia. And when he would dive into those stories, I mean, Jim, there were dangerous approaches. We look back today, really wild, crazy ideas or people died or people had maimed arms and legs from radiology exposure and such, but it leads us to where we are today with radiology procedures and blood donation and transfusions and anesthesia. Just a few examples. He did a few others…So his approach was, there's a point, and maybe we'll get to this later, where you can kind of know where the risks are worked out, but you can't just write it off and throw the baby out with the bath water. There might be something still good here that we need to learn. And so sometimes it could be the answer like, look where anesthesia and blood donation is today. But sometimes it's not the answer. You can look back for the past few hundred years and health authority figures or people at various companies thought that lobotomies were a good idea or sterilizing the mentally ill or bloodletting. You can look at some of these things that today we'd say, yeah, they were dangerous or inappropriate or not what they were intending to. So people can be wrong and people can be right. And so you have to understand that balance first and foremost. I kind of wanted to stress that upfront.''   06:01 Supplement or replace? The big question for balance Todd explained why this question is essential to balance in patient trials.  ‘'But I think the two questions you have to ask when you're trying to balance it is first, does the present, shall I say medication or intervention, does it supplement what is presently trying to treat or help my disease or does it replace the present? And the reason I wanted to lead with that or categorize that is because when I was a research nurse for many years in the hospital, you're working with sometimes doctors that really love the research that you're doing and are an investigator with that research. Some doctors could care less and tell you to go away and say, "Don't bother me. Really, you're going to bother me with this research?" Some doctors might have no clue because they're not even connected with your hospital system. And so how do you interact with doctors A, B, and C that I just gave as examples because you're going to have to approach them differently? I think that's probably self-evident. So you have to say, "Well, listen, it's meant to supplement and here's how it could work already with the present medical regimen that these patients are getting or it's meant to replace the treatment and this is why and this is how you should manage them." So I guess first, does it supplement the present treatment? This is I guess a question that research has to answer: how does the present treatment alone that they're already on affect a certain lab level or a MRI scan or a vital sign that might be concerned about your blood pressure or what have you, versus how much does it affect that measurable point with the two together or the research medication or intervention? We get a lot of time to dive into that, but I just want to leave that hanging out there to think about that.''   10:08 Handling complexities in replacing medication  Todd emphasized the need for clarity with patients, hospitals and in documentation in ‘'replacement'' trials.  ‘'When you're intending to replace the present treatment, well, then the doctors will say, "Well, wait a minute. When does that happen? Is there a washout period? What's the half-life of the drug that they're presently taking and the one that you want them to take in the research study? How quickly can it come on board and give a therapeutic benefit?" These questions, like I said before with the previous point, you need to be very careful in how you convey that to the patient, to the doctors, to the nurse practitioners, how it's in the documentation. Things can get forgotten, as you know. So it has to be clear in the documentation as well. You and I worked with LVADs, which are the heart pump devices. Could it replace their heart failure meds across the board? Maybe. If they have a really great response, maybe you can get rid of a good bit of them. And then the doctor would say, "Well, when would that occur? And how do we do that in the hospital?" So there are tough questions to ask and you might say... Oh, sorry, I forgot to mention this to you with the supplement. These studies are often with supplements, placebo controlled. Well, how do I handle... If I'm not supposed to know if they're on placebo or not, but it could supplement and have some impact, what do I watch for? What blood levels do I keep an eye on? But with replacement, that doesn't typically happen because they need a therapy, they need to be treated for something. So you have to either be getting the old medication or the research medication. It's not as much. So I wanted to mention that real briefly too, but that is another point I wanted to get across.''   15:10 The high cost of getting drugs to market  ‘'Jim, let's say you have a compound, an asset, a drug for your company, and it looks like it could affect a therapeutic area or a disease process that could pull in two million in sales and another avenue that might pull in two billion in sales. Some people might be more led to the two billion regardless of everything else. So I respect that. However, you have to keep in mind, so I've acknowledged that there is some negative approaches to things that are not good and can be shady, but at the same time, research, if you're not in the space, it takes so much money to get a drug approved in the United States with the FDA because the FDA is very careful with understanding all the components that need to be in place and the data that needs to be understood to say this medication should be on the market….. the typical cost to develop a drug is $2 billion on average. And the average time it takes from saying, "Here's our asset in preclinical," which is kind of working with animals and such, to the time it gets approved is about 13 and a half or 14 years.''   19:34 Focus on failing early Todd said that failing early would save costs further down the line.  ‘'Because the big focus today, and I think I might've mentioned the last podcast, is to fail early. So what a lot of companies like to do is to do a lot of high throughput, testing thousands of different compounds and various disease processes and targets in the body to understand where they might fail down the road, and there's amazing technology to figure that out, so they can hopefully pick the right one to go down that rabbit hole, shall we say, and hopefully get an approval because we know-it's such a big investment. And, oh, I didn't say this, but I think a compound, once it first gets found to get FDA approved through all the phase ones, twos and threes, it's like 5% or 10%, something really low. Even if things sound really appealing, the amount of drugs that actually get approved after all these things, we talked $2 billion, 13 and a half years, is still pretty small. Because the FDA is trying to be careful, they want to make sure something's safe and effective, that's the big thing. And it is great that we have both of those things that are important. You don't want something that's just one of those things, I mean safe but not effective, or effective but not safe. I mean both of those don't sound appealing to the modern consumer.''   31:35 Patient benefits: a case study with Camzyos Todd provided an example of how individuals can benefit from research.  ‘'This is probably six, seven years ago now. I did a study with what's now Camzyos, or mavacamten, a BMS drug, and it helps patients that have hypertrophic cardiomyopathy, apologies if I used this last time, but I don't think I did, where it is an overdevelopment of the muscles of the heart to the point that it's typically pushing into the left ventricular outflow tract, which is the exiting tunnel, shall we say, out to the aorta, which goes to the rest of your body and provides blood to the rest of your body. So the muscle as it pushes into that area, it makes the opening smaller and smaller so less blood can go out to the rest of your body to provide blood to your tissues and organs. And at the point that we were doing the study, the only fixes or treatment were either surgery to cut down that muscle or beta blockers and things to reduce the blood pressure that maybe reduces pressure in that area, but those are difficult to really target long-term or even midterm. It does affect the small muscle fibers and you actually see a reduction in that muscle area. So the reason I say this is because I had a patient that did this and it was a very involved, I think it was early Phase 1b or 2a, pretty early on study where he had to come in weekly for 12 weeks and do echoes and MRIs and a lot of blood work. And some of the visits I remember with him, he was in his 20s, were maybe three, four or five hours long, very busy visits for sure. So the question is, I mean, he's a young kid, does he want to have this burden on his life to do all this? He had a good relationship with the physicians there that saw him, and I think that he really thought this could help him prevent downstream problems or give him a few years before that muscle was impacting enough that he might need surgery or what have you. So it was certainly his decision and it was inconvenient, like I said, those visits and such. But he had good results and I was able to, I believe it was actually open label, so I kind of got to see how things were going from his echoes and data and such. But even within the first week or two, we saw really impressive results from him.''   36:41 Teamwork helps the growth process Todd said delegation prevents people from working in silos.  ‘'And I think that what I'm getting at is good delegation is not a negative thing and it doesn't reflect like you don't know what you're doing. I think we as human beings feel like, "Oh, I'm delegating so I clearly don't want to learn that, or I'm not good enough versus someone else." But no, what I found is, and especially now in larger pharmaceutical companies where there's a lot of team members, it's really beneficial to say, "Hey, you're really good at X, you're really good at Y. I should know them a little bit, and I do, and I oversee that, whatever, but I'm not going to jump in. I'm going to let you do it. Can you get back to me in a certain timeframe? Can you help me with this? Can you help me with that?"' It's very beneficial because not only do you kind of know the lines in the sand where people are working and not working, you're respecting your skillset and theirs, and you're working together as a team rather than like, I'm in my own silo. I'm not going to look both ways. I am my own person. I found that to be really, really helpful, and you can learn a lot at the same time. It really helps you learn a lot more than just saying, "I'll do my own thing." I mean, yeah, you might be baptized by fire and learn it kind of, but you might learn it a wrong way, actually. So I think that's probably what I would say and what I've really appreciated in my growth process.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Todd Nicklas on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    The longevity of clinical research, starting with James Lind in 1747. ‘'We can't avoid research. We've been using the clinical research approach for the past 300 or so years….and then there were some studies that you can go back to even in the 1500s, that people would try various things to see what worked better than others.''   Patients don't live in a health vacuum: ‘'…..every patient you have is not going to be in a vacuum and have one disease and have nothing else. They're going to be 80 years old, they're going to have 10 other medications they're taking or four other disease processes that are going on. You need to know what's on board, what's working, what's not working.''   Why the patient is the biggest advocate: ‘'..the thing I really appreciated most was telling the patients the nitty-gritty and really driving home the educational points because then they are there with doctors B and C that might not know or want to be involved in the study and they can say, "Wait, wait, hold up. Don't do this. Or maybe talk to Todd first because this might affect that."    Monitoring the ‘'gray line'' in patient trials: ‘'Because some cancer patients do very early phase one and twos because they have to because of the development process or because of their cancer diagnosis or what have you, you might have to do early on. But are we past that line? Are we not? And what might that line look like? And that's why consent forms nowadays are extremely long because patients have to read all the safety data.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

Around 100,000 nurses left the profession during Covid-19. Ryan Lee, CEO and co-founder of HireMe Healthcare, explains his passion for exploring and resolving giant problems at a deeper level, with Jim Cagliostro.   Episode Introduction    Ryan explains how appropriate staffing can transform patient outcomes, how nursing shortages haven't changed much since 2001, and highlights the power of technology to humanize the hiring process. He also shares the #1 operational inefficiency, explains why there's more to the talent shortage than burnout, and highlights the health system building meditation pods to promote staff well-being.   Show Topics   Trying to do more with less and less Three critical issues affecting patient care The talent shortage is about more than burnout The high cost of travel nurses Technology humanizes the hiring process High staff turnover makes nurse training difficult Two key strategies to transform operational efficiencies     10:41 Trying to do more with less and less  Ryan said Covid highlighted the extent of operational inefficiencies in healthcare.  ‘'(Studies) …found that the increase in responsibilities, the increase in travel nursing and the decrease in resources, greatly exacerbated the mental health strain on nurses. And this is obviously a tangent into how it's become a bit more uniquely of an American problem... We feel it a little more here than in others, but they also found that to be more common for hospital nurses, which checks out. But one of the best ways I've heard it said was speaking with a nurse manager from a major healthcare facility just the other day. It's about trying to do more and more with less and less.  Yeah. And I was actually just speaking with a neurocritical care doc this morning and knowing I was coming on here, I said, "What would you say is the number one operational inefficiency in a healthcare system?" And she said, "There's too much administrative red tape put in place by too many people that don't have bedside experience." And that's not to say you don't need people with different backgrounds, it's critical to have that. But it was interesting to hear, and those are her words, not mine. But it's interesting to hear that take and these operational inefficiencies, and I am definitely way more qualified to speak to this in a nursing staffing context. So it just comes down to how much turnover there is. ‘'   14:53 Three critical issues affecting patient care Ryan explained the impact of inefficiencies and said appropriate staffing could improve these areas.  ‘'There's patient satisfaction for one, which with the rise of value-based care is an increasingly important metric, but the other two are patient outcomes and efficiency measures. And having safe staffing, which is also called appropriate staffing or evidence-based staffing has been shown to improve all of these components. So for patient outcomes, I mean you have anything from the frequency of cardiac arrests, a lot of it just has to do with what happens when patients are in the care of understaffed units. So an increase in cardiac arrest with subpar staffing, an increase in HAIs (hospital acquired infections), which can amount to tens of billions of dollars nationwide every year. That's a really expensive one. More instances of respiratory failure, failure to rescue becomes more common. And overall it increases inpatient mortality rates, which is the very goal of a hospital to avoid. And on the efficiency side, it impacts readmission rates, the length of stay, the turnover time in an operating room, the average time in the emergency department. And coming back full circle, it impacts the staff retention, which it's this vicious cycle that self perpetuates where nurses are understaffed, working in an understaffed unit impacts mental health and wellbeing, which leads to burnout, which leads to more turnover, which leads to more understaffed units. And then it's just this cycle, it's really terrifying to look at because of what kind of an impact ... ‘'   17:32 The talent shortage is about more than burnout  Ryan said issues causing the staffing shortage haven't changed much since 2001.  ‘'…..there is truly a talent shortage. That's a real thing. It's not just this burnout phase, this increase after COVID, nurses fed up with the status quo and everyone leaving in droves. We lost 100,000 plus nurses last year. It's not just that. There is an actual talent shortage here, and that comes from several things. There's a pipeline issue, for instance, education is a huge ... There's a shortage in faculty talent to train our nurses. There's way more qualified applicants for nursing schools than there are available seats in nursing schools. That's part of the recent ... A hundred million that the Biden administration just pledged to attack the nursing staffing crisis is addressing the education pipeline. So it'll be really interesting to see how that plays out. …..But there is a talent shortage and there's reasons. If you go back, I'll look to this survey done by an organization, a think tank called Health Workforce Solutions. This was in 2001 where they talk about the reasons for the American nursing shortage. And it comes down to an aging population, still more true today than it was back then. They were talking about Gen X being the primary generation in the nursing workforce, which now we're looking at Millennials, an aging nursing workforce, still the same. The average age of nurses is over 50, nationwide. They had to do a lot with the work environment. They said fewer resources and more demand. This was in 2001. None of this is new. … Everyone in a healthcare environment needs more money… There's so many different demands on finance, and often the nurses struggle to enact changes.''    23:44 The high cost of travel nurses  Ryan explained how the pandemic changed the culture of travel nursing  ‘'… the real basis for travel nursing was living in various places, having an adventurous life, getting a chance to fill in where needs were at a temporary high in certain areas, be it flu season, whether you're doing it to go fill in for a flu season in St. Louis or whether you just want to live in Denver, Colorado for three months. That was the basis of travel nursing up until the pandemic really. And that's when labor costs just skyrocketed for that. And it became almost imperative for the nursing side. You're looking at people making two, three times as much as you and the hospital's paying eight times that at some points. I mean, the average cost for an hour of agency labor got up to 275 an hour during the pandemic, which is utterly insane. That would be amazing money for a nurse if the nurse saw even close to half of that. But the average pay for travel nurses was still around $125 an hour versus the usual $50 an hour. I mean, so you're looking at being able to afford two and a half FTEs for the same price as a travel nurse, but why would you go take an FTE position when you can make almost three times what you're making? So it made sense for nurses to take on these roles. I knew a lot of nurses who were living in Charlotte and working in Winston-Salem, and they were technically a travel nurse, but not like when you were a travel nurse, Jim, where you moved to California to do your job. They were just driving from Charlotte to Winston two hours every day, and that made them a travel nurse and eligible for that kind of pay. So that's the system we made. And obviously, I mean, our health system nationally spent $24 billion in one year just on travel labor, which sounds absurd, but when you do the math, 275 an hour spent times our workforce that shifted into travel and the hours demanded of a short-staffed healthcare system. It was quite amazing to say the very least there.''   28:34 Technology humanizes the hiring process Ryan explained how HireMe Healthcare technology makes the application process easier.  ‘'From the hiring side, it makes it more efficient, it simplifies it, and this may sound strange given that it's technology based, but it humanizes the process. And that's what HireMe Healthcare sets out to do is to humanize the process.. So let's go from the nurse perspective first. So you are applying for a job, but you're applying for multiple because you want to find that right fit. So you're going to fill out a new application, your resume exists, but it has no point because you have to fill out applications for hospital systems through their system and through their portal individually each time, typing the same information over. …technology can play a role by offering a one-stop shop personal profile. … it's a great way to have all the necessary boxes that need to be checked for a specific job can be in one place, and then you get to take the quick step forward towards the human side of the process. Is this nurse a good fit? And HireMe Healthcare uses matching technology to pair nurses based on individualized nurses, individualized job descriptions, looking to find the person behind the resume, and the person, the people, the team behind the job description. It's not just quantitative….. I mean by having our one-stop shop personal profile, and then each customized job description, it allows hiring managers to have these candidates ranked for them just based on the check boxes and the components. And then adding in qualitative components to find out what kind of a fit someone's going to be on a particular unit.''   34:46 High staff turnover makes nurse training difficult Ryan said when nurses ‘'flip'' every 30 to 90 days, effective training isn't possible.  ‘'… Right now, it's hard to really focus on training your staff when they're turning over as quickly as they are. A lot of first year nursing students or first year grads entering the nursing workforce, they turned over some 36% I believe it was last year, and they're losing a third of grads that need the most training of all right off the bat, and that means they're going to bounce to another job. … if you're flipping to a new hospital every 30 to 90 days, like travel nurses or disgruntled first years that have a, this isn't what I expected. They're not around long enough to endure the proper training that they need. And also training comes into requiring resources, and those resources like the resources for hiring and everything else are becoming more scant, the time spent. We talked about, oncology is actually a great example of this. It's a hyper-specific practice that has a bunch of, just as they describe it, little things that make it very unique that only are necessary for oncology nursing, but they don't have the wherewithal to hire someone full-time, someone who's trying to transition into oncology. They don't have the resources to hire someone and just employ them full-time for the training necessary to become masterful in such a critical practice that has so many nuances. This is true across the board that not having enough resources to train your nurses leads to subpar training. And a lot of that training focuses, as I said, on protocols and those protocols can be unique.''   40:02: Two key strategies to transform operational efficiencies  Ryan said embracing technology and taking action on mental health can make a difference.  ‘'… a couple of things we've seen have been very effective, authorizing critical staffing pay has worked. Nurses getting paid for what they're actually up against. There's building in-house nursing staffing pools, float pools have been very effective within to really have labor that understands your protocols on hand. That's been very effective. Nurses like getting paid more, but when you really talk about what's the real trigger here, it's not "If I got paid more, I would be happy in this job." The most effective measures hands down are those that address the mental health and wellbeing of nurses. And I also see a lot of efficacy coming from those that are embracing technology. … And I would say the two biggest things hospitals can do are treat their nurses well, and I mean actually taking action towards mental health. Novant Health is building meditation pods, for example. I thought that was something really cool.‘'     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Ryan Lee on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    From law school to HireMe Healthcare via Uganda, a passion for human rights, and a pandemic; Ryan's varied career journey.  The current vacancy rate in nursing is causing problems in achieving nurse to patient ratio. ‘'… right now it's at 16% a little over, which is a lot of gaps to be filled. That's a lot of nursing positions that are needed.'' The impact of Covid-19 on nursing turnover. ‘'At the height of the pandemic, turnover got up to almost 30%. It was a little over 28. And so that's almost a third of the entire national workforce just turning over. And that doesn't include the specialties that had significantly more.'' How using an old address on a resume can filter applicants out, rather than in.  The impact of asking for nurses for voluntary overtime. ‘'According to the NSI retention report, 99% of hospitals are doing this, and it's not very effective as you can imagine, especially if we look at the impact on nurse wellbeing and nurse mental health.'' Leadership lessons: The far-reaching impact of burnout versus the need for self-care, compassion, and gratitude. ‘'The best thing you can do for other people is take care of yourself.''    What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

Cardiovascular disease is the leading cause of death in the US. Clifford Thornton explores the impact of technology on medical devices, cardiography and treatment, with Jim Cagliostro.   Episode Introduction  Clifford explains the two types of echocardiograms, the benefits of 3D versus 2D echoes, and why it takes $72 million and a decade to launch new medical devices in the US. He also highlights how spending on cardiovascular care has risen to $600 bn a year and offers a Top Gun analogy to emphasize why healthcare leaders must carry out competitive and environmental scans.    Show Topics   Two different types of echocardiogram  Advances in technology have transformed echocardiography 3D echo versus 2D echo A $72 million barrier to new technology  Choosing the right medical device for your patients Staying ahead in your market (learning from Xerox)      05:50 Two different types of echocardiogram (echo) Clifford said there are two main types of echo, surface and invasive.  ‘'So to really answer your question, echo is basically an ultrasound or sonogram of the heart, which is why we also refer to it as a cardiac sonogram. So those who perform this test are called an echocardiographer technician or a cardiac sonographer. There is a movement to change it to an echo specialist. Some people are not so thrilled with the technician annotation. I don't have a problem with it, but there's some discussion around that just for everyone's awareness. Of course. So echoes, they can be broken down into two main types and they basically use a different type of probe. One is on the surface and one is invasive. I say invasive, but through the esophagus. I guess it is invasive. The more common and more easily performed surface echo, or you can call it a vanilla echo, is the transthoracic echocardiogram, which we also call a TTE as an acronym….So that's the one type and the other, and this is a little more complex, this requires a healthcare team, a clinical team. So it requires the performing cardiologist, whereas the surface echo and echo tech can do it alone, just the tech and the patient.‘'   10:34 Advances in technology have transformed echocardiography Clifford said both patients and healthcare employees benefit from the impact of technology.  ‘'Look where we've gone from our Texas instrument scientific calculators to smart watches. And I remember always running with the Sony Walkman, the Sony cassette Walkman and the Discman, and now we have iPods. So echo is no different. It's amazing, right? To answer that, echocardiography and its related technology because as we know, it relies a great deal on technology. So meaning the design and engineering of the cardiovascular ultrasound systems, it has actually evolved immensely since the beginning, and that was about 40 years ago. You see as techs, we joke around about those early machines that were beef, like little tanks to push around. And just like other techs, they've gotten more and more compact and lighter. And that of course makes techs' lives much easier and more ergonomically friendly. I'm sure you know from a nurse's standpoint, how important that is. Actually, the number one occupational injury for nurses is moving patients in the country, ergonomics. So we as techs love these new machines, me included. So for example, one thing I love about what's called the Philips iE33 system, it's one of their more modern systems is that the monitor actually pivots for angles in different directions to so many physicians. It's really neat. So since I'm actually an oddball, lefty scanner, most echo scanners are righty, for me that's super helpful. Most ready techs, they're facing away from the patient, but the positive for lefties is I'm facing the patient. They can actually look at the screen. So this type of flexibility with the machines, it's a godsend, especially for bedside echoes where we go and do the echo in the unit.''   13:17 3D echo versus 2D echo Clifford said 3D echoes give a more real perspective of the heart, enhancing interventional procedures and patient care. ‘'Really though, the most meaningful advance for echo, what really has changed, it has been the growing availability use of 3D echo versus the standard 2D. So there's been a growing availability of 3D echo over the last decade or so. And today I would say there's about 75% of availability of 3D echo….about 35% of all US labs probably use it routinely. So you can see it's become pretty standard. The clinical benefit, it may not be readily apparent sometimes, but I thought it was pretty neat. I definitely found it to be a more real perspective of the heart. But there really is a benefit to the 3D TEE, and it actually plays a pivotal role in the growing prevalence of interventional procedures. Especially things like transcatheter valve replacement. Some other important advantages of the 3D echo include it eliminates geometric assumptions, quantifying complex geometric shape volumes, the ability to view structures from any perspective, and also assessing a lesion in what we call simultaneous multiplane. So with 2D echo, as tech cardiologists, we have to kind of imagine things, but the 3D gives it more of this real visualization.''   17:17 A $72 million barrier to new technology   Clifford said it takes a decade and $72 million to launch a new medical device in the US.  ‘'On average, it costs about $72 million to start a new medical device in the United States. You need a good amount of money. It's a dynamic, but very challenging intersect between the medical science and business. But I would say the main challenge with all this is it takes around a decade, and I know you're very familiar with this, it takes around a decade or more to develop and refine and test these medications and new medical devices. What could happen in the span, the market evolves and you see new entrants, the economy changes. So this timing aspect, Jim, it's really difficult, extremely difficult. Also, unfortunately, we've seen a lot of biotech, venture capital firms actually exit the United States or pull back significantly. I think the risk is scaring a lot of people. Very risky. For those launching something in this space, some advice. I would say, you really want to make sure it is quite novel and really have a compelling case and the proof of concept, that's your bread and butter. That's a critical early milestone.''   20:39 Choosing the right medical device for your patients  Clifford explained the key elements hospital leaders should consider in choosing the right medical device.  ‘'Yeah. That's another very important question. It's become difficult to sort through it. You're right there. So my underlying philosophy that I learned from experience and also by studying a lot of successful leaders is that you want to always aim for high quality and strong results. Okay? You want to have your binoculars pointed in the right direction and everything should fall behind that. With that being said, I think the key for hospital leaders is, one, they want to look at how the technology, how it fits into their existing suite of services and how it aligns and how it can bolster their existing services. Two, they must consider if they have the infrastructure, the staff and the resources to support a certain program, say like what we talked about, their percutaneous valve replacement. If they don't have the tools, it doesn't mean never, it means now they need to start building and selling a business plan to amass that capability on all levels, which means the tech, the staff, and related expertise and the infrastructure. Build a business case for that. There are then... Of course, we talked about before with the medical device tiers, the regulations. You got to take that into account.''   28:59 Staying ahead in your market (learning from Xerox)   Clifford said competitive and environmental ‘'scans'' are vital with rapid advances in technology.  ‘'And finally, I think this is really key. We talked about this, the piece of change. We talked about the windows of opportunity and so forth, and what we need to do or leaders need to do, and I mean they need to do this constantly and also rigorously, is to do what we call from marketing people, we talk environmental or competitive scans. And the reason for this is you never know what technology or competitor can come out of a field or to identify new opportunities. A lot of people know Xerox was invented some of the early internet technologies, but they just didn't capitalize on it. They maybe didn't look at the competition out there. And now we have Google and there was Netscape and then Google, and the leaders out there. Now Google almost dominates online advertising. So you want to be aware of what's out there…. on average today, companies have only about a three-year window to make a profit on a given product or service.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Clifford Thornton on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    Inspiration from his uncle, and a passion for fitness; Clifford's journey into cardiology.  Putting the power of a human heart into context: ‘'They say in a lifetime an average heart pumps enough volume of blood to fill more than three super tankers. So just to give you a picture that equates to around 1 million barrels of blood.'' Why a good pair of shoes is critical working in cardiac care: ‘'….for one of my first or early echo jobs in Naples, Florida, the job description listed the ability to walk, I kid you not. seven miles per day as a requirement for the job.''   Keeping the focus on people: ‘Just an example, in New York state, they just made a certain nurse to patient ratios mandatory, meaning it's a state law in their intensive care unit. So they have to adhere to these nurse to patient ratios in all New York ICUs now. So managers, they need to work around all these kinds of things and take it into account.''   The cost of treating cardiovascular disease: ‘'…shortly after Medicare was instituted, cardiovascular spending in the United States jumped to around 100 billion a year within 10 years. Today that figure how much we spend on cardiovascular to treat cardiovascular disease in the US is 600 billion a year. And globally, I would say it's around 1 trillion.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

Gratitude is the foundation of a happy working environment in all sectors, including healthcare. Scott Colby explains how the power of gratitude can transform our professional lives, with Jim Cagliostro.   Episode Introduction  Scott explores why gratitude is a form of self-care, why it's good business to implement a gratitude practice, and the impact of workplace loneliness. He also reveals the reason that 79% of workers leave their jobs, the transformative power of a handwritten note and how 36 questions can build long-lasting connections.   Show Topics   Lessons from Guatemala for healthcare leaders Gratitude is a form of self-care The power of handwritten notes  Treat people like humans, not transactions Loneliness causes disconnections in the workplace How 36 questions build relationships    06:09 Lessons from Guatemala for healthcare leaders Scott said that work is often a reason people are unhealthy in the US,  ‘'From my perspective, what I see is workers are overwhelmed, they're stressed, they have things to get done. I think in the US I think specifically we have a put your head down and get the work done no matter what the expense is. And often I think it's at the expense of the employee, the team member, the healthcare worker. And so I think that's a mentality. It's like, "Hey, we need to get the job done no matter what. And if it takes working long hours, if it takes not getting to take a lunch break or taking any type of break, we just have to get it done." And sometimes I think people feel like the work environment is not conducive to taking care of our own personal wellbeing. And then sometimes I know for people, they have challenges just asking for help. That was a big difference in Guatemala. Now keep in mind, I was there for a short period of time, but the community came out to welcome us. And the other thing I didn't share is they were getting their hands dirty alongside the volunteers and actually did a lot of the work, but not at the expense of their health. They did it alongside of each other and like, "Hey, we have a common goal to build a new classroom and we're going to do it as a community, but at the same time, we're going to welcome strangers, we're going to play soccer, we're going to be in the outdoors and take breaks." And I just think it's a different mindset here where we work, and I know specifically as I still do some individual health coaching with clients who are looking to lose weight and improve their sleep and lower their stress. No matter what industry they're in, it seems like work is a big reason that they're unhealthy. And it stinks because as an employee, if we're unhealthy, we're not going to do our best at work.''   10:18 Gratitude is a form of self-care Scott explained why having a gratitude practice is beneficial for physical and mental well-being. ‘'I believe it's essential that we have our own gratitude practice first before we even bring it into the work environment. Well, I'll give an analogy, and most people probably have heard of this, is to, when you're on an airplane before they take off, they're reading the safety instructions, put that oxygen mask on yourself before you help other people around you. So just imagine if you don't put that oxygen mask on yourself and you pass out, you can't help anybody else. And so I believe if we're feeling down and depressed and negative and then our work says, "Hey, we're going to start implementing gratitude." Well, we're not going to be full participants because we don't feel good ourselves, we're feeling mentally, maybe physically sick. And so gratitude is a form of self-care. So the studies show that if you have a consistent and regular gratitude practice, you will feel more optimistic, you're going to be more positive, your stress is going to be less, you might have more energy, sleep better. Whole host of benefits to practice personal gratitude. So I feel like that needs to be in place so that you are kind of more fit and more strong to give it out to other people when you start implementing that at work.''   13:54 The power of handwritten notes Scott said handwritten notes are a simple but powerful way to express appreciation in the workplace.  ‘'Now, the reason I like handwritten notes so much is if you think about the way we live our lives currently, we're in a rush, we're getting messages from everywhere, like social media, text, email, and probably 100 other ways that I didn't name. And even if we're getting a thank you, which sometimes we don't, they're often just quick text messages like thank you. And they're usually for things that we did or for gift giving. Think about how would you feel if all of a sudden at work you received a handwritten note from a coworker who took the time to actually buy a card, get an envelope, mail it to your home, and write a heartfelt message of how they feel about you and what they appreciate about you. Not even looking about, "Hey, you're doing a great job" or "Thank you for filling in for me when I had to miss a day." But just like, "Hey, here's what I love about you as a person. You're funny. You make me laugh every day." If you got that from a coworker or a boss and it came into your mail, which we know most mail is bills and ads, and you're getting this envelope and it's a handwritten envelope and you open it up and you're like, wow. If that's from a coworker or boss and they just pour their heart out to you, you're going to be like, "I feel really good. This person really cares about me as a human being" and it's going to change your attitude in the workplace. So you are going to want to do a better job and probably be more productive and you're happier overall and maybe want to stick around the workplace and not quit your job. And so I think that's why gratitude can be shown in many different ways at work, but I think handwritten notes is one of the most powerful ways that you could do so.''   18:20 Treat people like humans, not transactions Scott shared an anecdote to illustrate the importance of leading with gratitude.  ‘'And so I consider leading with gratitude, especially whether you're a one man company or you have a whole organization with hundreds of people as treating other people. And so I know we've talked about how we treat our coworkers, but let's say how we treat our patients, our residents, our clients, treating them like humans and not like a transaction. So got a couple good examples for you based from my own personal life. When I lived in Denver, I had two cats, one of them named Nomar and Nomar had to get two teeth pulled one morning. And so as our pets are getting surgery and whatever is going on with them, we get nervous, we're anxious. So that morning I went to my favorite coffee shop called Fluid, and Fluid is a company and organization, they serve coffee, but they really got to know me over the years as a person. They knew that I had two cats. They knew I took a trip to Guatemala. Well, that morning I told the barista Coley, "Hey, my cat was getting two teeth pulled." This is very coincidental, but she had a cat getting teeth pulled that day as well. She just did something simple. She said, "Your coffee is on the house." And that made me smile. It took my mind off my cat for a few minutes, and it wasn't a company saying, "Hey, we need to milk this transaction and make sure we get money out of you." It was like, "Hey, Scott is anxious today. How can we put a smile on his face for a few minutes?" And so that stuck with me. And then later on that day when the vet office called me in to pick up Nomar, they said he did a good job. It's easy just to have, "Here's your cat. Pay us $1000." While that did happen, what they also did was they gave me a certificate, and the certificate was for Nomar, and they called it a Certificate of Bravery. And they said, "Nomar was a brave boy today." And it may sound corny, but if anybody praises our pets for those pet lovers out there, we just love that company. And so this vet did something very simple. They made a certificate of bravery for Nomar, and that just made my day.''   23:40 Loneliness causes disconnections in the workplace  Scott said helping people make connections and build friendships at work boosts engagement and productivity.  ‘'One eye-opening statistic, it's not talked about, I think as much as maybe appreciation or workplace wellbeing, although it's part of it, is loneliness in the workplace. And so a statistic that came out a few years ago is 61% of employees feel lonely at work, they feel disconnected. And again, that's going to hurt engagement and productivity, and you're not going to want to stay there longer. On the other hand, 70% of employees in a survey said that having a friend at work is the number one critical factor to workplace happiness, which I love saying that. So I think one of the things I would really invest in is creating these deeper connections in the workplace and even friendships. I know maybe we don't talk about that much. Creating a friend at work. …. the jobs that I had when I had friends at work and we maybe did things together or we got to know each other on a more personal level, that made work more fun. It made it more tolerable, even if there were things about the job I didn't like, and then you have a second thought about quitting your job because "Hey, I don't want to leave a job that I have friends at." So there are different ways that you can create these human connections at work, such as writing handwritten notes or taking a break with them outside and sharing a laugh or sharing a meal together.''   30:30 How 36 questions build relationships Scott said research by psychologist Arthur Aaron showed the positive impact of getting to know your coworkers. ‘'Arthur Aaron was a research psychologist decades ago. He wanted to answer this question, how can we in a laboratory setting create instant intimacy between strangers? So what he did, he got a large group of people, brought them into his laboratory, and what he had done, he created, after some trial and error, he had created a list of 36 questions. They started out more general and then got more intimate, and he paired people up. Mind you, these people were strangers and they just took turns back and forth asking each other these questions. Just imagine if you're in a room with some other person, maybe a coworker that you don't know very well, and that you ask each other these 36 questions. By the end of that, you're going to be like, gosh, I know this person a lot better now. I know their likes, dislikes, what they're going through. And so what Arthur Aaron found out is I think it was 57% of the people in the group that were strangers wanted to hang out with their partner again in some other setting after the research project was over. So they got to know the person enough that they wanted to hang out together after the fact. And then two people from the study, one pair actually got married and invited everybody from the study. So really asking these kind of open-ended questions like what is one word that describes how you're feeling about life right now?    Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Scott Colby on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    How a trip to Guatemala inspired Scott's personal gratitude journey. ‘'I started to kind of examine my life, like why am I complaining all the time? Why am I focusing on the things that I don't have instead of being grateful for my life and what I do have?'' Why stepping back is important in the working environment: ‘'The thing about pushing yourself so hard is it leads to illness, whether it's physical illness, emotional exhaustion, mental breakdowns…. studies actually show that when we can take breaks and step away for a few minutes, we'll come back to our work more recharged and more productive.'' The importance of valuing people in the workplace: ‘'… 79% of the people that answered the survey said they left their job in large part because they didn't feel appreciated in the workplace…it's one thing to recognize you for your work, but it's another thing to feel appreciated as a human being...'' Alternative questions to ask when "How are you today?" isn't enough: ‘'…the standard answer is, "I'm fine." When in reality we probably have 50 other emotions that aren't fine that we could have expressed, but we're not comfortable expressing them …'' Leadership tips: Understanding that business is personal ‘'…get to know people on that level, and I think that's going to make a big difference in your organization.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.    If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

To improve outcomes, we have to improve systems. David Dibble explores a systems plan to fix the systems problems in healthcare, with Jim Cagliostro.   Episode Introduction  David explains the law of dissipating structures, how systems, not people, produce 94% of outcomes, and why reorder is a ‘'flight towards chaos.'' He also explains why the C-suite and frontline employees are different systems in healthcare, highlights the importance of a ‘'pull'' strategy, and shares why systems improvement means everybody wins.      Show Topics   Systems, not people, produce 94% of outcomes Understanding the law of dissipated structures Covid exposed the fragility of systems in healthcare Overcoming resistance to change in the C-suite 3D change management uses a ‘'pull'' strategy The ‘'golden triad'' of change agents  You can't solve problems with the same thinking used to create them     02:39 Systems, not people, produce 94% of outcomes David said the work of W. Edwards Deming, and Illya Prigogine was his inspiration for working in systems.  ‘'When I first ran into his work I went, oh my gosh. I mean, this whole notion that systems were producing 94% of outcomes and not people, I mean, that was news to me. I had always, like everybody else, assumed that, well, if we just got the people to behave differently we would get the results that we wanted, and it turned out that was not actually the way things work. So I learned about the power of systems. And then at the same time I ran into the work of a brilliant man named Ilya Prigogine, and he had won a Nobel Prize in 1977 for his law of dissipated structures. And so I ended up taking Deming's work and Prigogine's work, and maybe a few other bits and pieces out there, and looking at how I could implement that work in my own business. And it turned out to be a real boon for us. We had, at the time, I think about a thousand competitors nationwide, and after we implemented this systems improvement model in my own business, we probably rose into the top 15 in quality, technology, service. So all of a sudden our business was better.''   05:59 Understanding the law of dissipated structures David outlined the steps of dissipated structures which lead to ‘'reorder'' and natural system change.  ‘'Well, we are actually experiencing (in healthcare) what happens when the law of dissipated structures is at work anywhere in the universe. And the law of dissipated structures is actually very simple, but it's incredibly powerful and we don't get to vote on it, it's basically doing what it does. And what it does is it dictates that all systems will resist change when the environment is calling out for them to change. So we normally think of resistance to change as not a good thing, but it turns out it's actually necessary to create systematic change. So it resists change, and in that resistance to change it creates more complexity within the system. That complexity requires more energy coming into the system than the system can dissipate. Now, this stresses the system, and stress causes dysfunction in the system, and as the system continues to resist change, eventually it becomes so stressed that it can't contain the stress energy anymore and it enters what Prigogine called reorder, and reorder is basically a flight toward chaos. And of course, a flight to chaos means that we can't even identify it as a system anymore, but the energy is still there from the original system, and now it begins, slowly, generally over time, to come back together into a completely new system. And that completely new system is operating at a higher level of functionality in the changed environment, and is, again, stable in the changed environment, until it again begins to resist change again as the environment changes and goes through the process again.''   09:51 Covid exposed the fragility of healthcare David said the law of dissipated structures is at work in healthcare right now. ‘'I think the thing that's most important for what I would call mainstream healthcare, these are the big medical centers and everything that's attached to the big medical centers and the center of the macro system, is that the law of dissipated structures is at work in your organization right now, top to bottom. It is most evident in care delivery, and particularly since COVID, because what COVID did is it exposed the fragility and the already stressed care delivery systems, particularly in acute care settings. And what that did, COVID literally pushed some of those acute care settings into reorder. And the thing that is, I think, really important is that stress in systems is passed on to the people who work in those systems, and it's passed on to them both physically and mentally. And so we start looking at what's happened to staff, exhaustion, and then on the mental side we've got burnout and PTSD, and all sorts of things that are basically driving them off the job. And I think people, management and leadership in healthcare, should be very aware of what is happening down on the care delivery level, because that care delivery level is literally producing those numbers that are so important to leadership. They're producing the revenue numbers, they're producing the cost numbers, they're producing the margins, and unless we go down and we start improving those systems and start saving staff from these toxic systems down there, it's definitely going to affect those numbers that leadership and management are focused on.''   13:49 Overcoming resistance to change in the C-suite  David explained why focusing on the numbers is the way to communicate with the C-suite.  ‘'So when you talk to the people in leadership, I talk to them about the things that are important to them. I talk to them about profits and, okay, how do you really maximize profits? … So you can go in and you can say, "Well, let's talk a little bit about how can we maximize profitability, and how can we create huge ROIs for doing something, and how can we do it with the least possible risk to you," And this is important, "and you not really having to change much of what you're doing." You know how it is up there, it's like, oh my God, they've already tried so many of these things. The programs came in, even Deming, you can't implement it and sustain it in healthcare, and then it was Total Quality Management and Six Sigma and Lean and Lean Sigma and Toyota. None of them can you implement and sustain in healthcare, because all of those programs are not really programs, they're management models… let's say, at the top, you have to change your management model, and that has just never happened. It's just not going to happen. So in speaking to the people in the C-suite, I would talk about the things that are important to them, I would talk about the numbers. In talking to the people that are actually delivering the care, I would talk about what's important to them. I would say, "Okay, we're going to be looking at improving the quality of care, improving safety, taking the stress out of the job, reducing burnout, reducing turnover, addressing shortages." I would also talk to the people at the top about addressing shortages, I mean that's, I think, a potential existential problem for everybody.''   17:32 3D change management uses a ‘'pull'' strategy  David said a pull strategy is 100% voluntary, fixing systems and people at the same time.   ‘'I think one of the things that's really important too is the implementation strategy. If you look at pretty much all of the systems improvement programs that healthcare has attempted to implement, they all use a top-down push strategy. So the top buys into the program at least and says, yeah, we're going to implement, I'll make it a lean, and we're going to have whatever we need to do, but basically we're going to push it down into the organization. And eventually it's going to be pushed onto staff, and staff is going to be told, "You're going to do this." …and so now we get the pushback. And so what staff does is they know, they just wait it out, it'll be another flavor of the month, this too shall pass, and eventually the energy that was on getting this new program going starts to fade and things go back to pretty much the way they were. So whatever it is that we implement has to reverse that, and you have to use a pull strategy. So for instance, when we implement 3D change management, it all uses a pull, it's 100% voluntary, top to bottom. Nobody is asked to do anything they don't want to do. And the other thing is that in the implementation of the model, it must be healing to the people who implement it. In other words, you've got to give them their voice. You've got to actually work on the things that are important to them. They have to see that they can be successful in making a difference, and that all is healing. And so the idea that not only are we fixing the systems, we're fixing the people too at the same time.''   21:20 The ‘'golden triad'' of change agents in healthcare David explained how just three can successfully succeed change.  ‘'So we've made it so inexpensive that you can pretty much find the budget to get started pretty much anywhere. So it has to be really inexpensive. The ROIs, you've got to point out what is the return going to be for this? And then finally, you have to get a commitment from them not to kill the program before it can show success, which is generally within 90 days. So if we just have that from the top, we're in good shape. Now the bottom, all you need to do is you need to seed it. Now, it's better if you can go beyond seeding, but to seed it into a hospital, and you really only need three change agents to be trained, you need a change agent nurse, a change agent physician, and a change agent from admin, and titles don't matter, but just someone who cares about other people and wants to help and wants to do good, and that, we call it the golden triad. We can train those three people and literally seed it into pretty much any healthcare system, and we can start the work and the work will grow organically. You don't have to do a thing. The success is where it's been seeded, they'll talk about it in the hallways, and that sort of thing, and the next thing you know there'll be other departments saying, well, when do we get to do this? So it's a totally different way, and notice it's all a pull strategy. We're not going into a department and saying, "Okay, you're going to have to do this now." I think this is the setup that allows for a 3D, whether it's problem solving, change management, or systems redesign, to be successful.''   25:06 ‘'You can't solve problems with the same thinking used to create them'' David explained why implementing changes means being willing to expand your mindset. ‘'I think if you were looking at legacy programs, and stuff like that, yes, it is overwhelming for everybody, but I do not think this is overwhelming. I think it's just a matter of being willing to open your mind a little bit to another possibility that's completely different than everything else that we have looked at. I would call it from legacy mindsets. I mean, Einstein said, "You can't solve problems with the same thinking used to create them," and I think that we have quite a bit of that at the top in healthcare, and it's not a bad thing, we're all in the same boat. The mind naturally filters anything unlike itself. It's a dissipated structure. It's there in the same thing as the systems. And so it's not bad, but if we really want to look at expanding and taking the overwhelm away and getting started, then I think we have to expand our mindsets a little bit to include, it's not overwhelming and it's actually fairly straightforward.'' Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with David Dibble on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:  If we want to improve outcomes, we've got to improve the systems. ‘'It turns out that the physical universe, from the macro, which might be a cluster of galaxies in deep space, to the quantum level, is all systems and subsystems, and in nature, 100% of all the outcomes that we experience are a function of those systems and subsystems.'' Thinking differently about the C-suite, the ‘'profit maximization system.'' ‘'Their job is basically to maximize profits and make sure that the financials are good. Now, the people in care delivery aren't really interested in that that much. They're different systems.'' Why team players are vital for success: ‘'If you don't care about others and if you're not a team player, you can't do this work.'' The law of dissipative structures is not waiting around. ‘'…the thing to remember too is, there's a little bit of a ticking clock on all of this….and at some point the law of dissipative structures is going to have its way unless we intervene, particularly at the care delivery level for healthcare.'' Leadership tips: Why we all need to take time out to reflect and expand our awareness. ‘'But in order to go beyond what's already there, I think we need those moments of reflection, in particular around what are the things we do on automatic that just have not been working.'' What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

An estimated 48 million Americans provide care for someone over the age of 18. Caregiver Melissa Fisher shares her personal experience with Jim Cagliostro and asks, how can we do better?    Episode Introduction  Melissa shares the four challenges faced by caregivers today, calls on doctors to recognize family and patients as a ‘'unit'', and highlights the ‘'unpaid, untrained, overwhelmed, burned-out'' reality of caregiving. She also emphasizes the need for a pathway for dementia care, and asks why the beginning of life is so well-orchestrated in healthcare, but the end is not?    Show Topics   The rise of caregiving  Four challenges facing caregivers Patients and their families are a unit What we don't measure, doesn't matter ‘'What do you think we should do?'' Creating pathways for dementia care ‘'Don't shut me out!''   07:04 The rise of caregiving Melissa outlined the complex reasons that have led to an increased need for care.   ‘'It just feels like all of a sudden we're all looking around and going, "Oh my goodness. We've got a lot of people who are needing care." And we also used to live in close proximity to one another. My parents, they moved away when I graduated and pursued their lives where they wanted to be. So I understand it, but we're spread out more. Kids move from rural towns. They're going to other parts of the country to make their way. They aren't staying in the homestead anymore. We also are having children later. My parents were able to save more, and many of them had homes. Americans are also, as I'm starting to realize, fiercely independent, and that's part of the problem because my mom sees her position as if I am there and helping her, then she is losing her privacy. She wants to maintain her own home. But I think back another generation, and my great-grandmother lived with my grandparents all under one roof. They helped with the raising of the children. So it just feels like there's been this shift in who's caring for who. People are living longer, but not necessarily better. Half of all caregivers who helped older adults do so for someone living with dementia, and 83% of those are family members, and many of them are still working.''   09:51 Four challenges facing caregivers Melissa said most caregivers are ‘'unpaid, untrained, overwhelmed and burned-out.'' ‘'Those would be my four (challenges facing caregivers). Time, cost, personal health, and training or resources. Time, I work a full-time job, and it's demanding. I absolutely love what I do and the organization I work for, but I am strained to find time for it all. I think that I'm not alone in that, and talking to my friends and reading a lot of things online. I know that time and its finiteness is that I just don't have enough of it. Also, money. If I've learned one thing, it's either I need to be extremely rich or incredibly poor. I know that sounds really blunt, but getting access to support and services for the majority of Americans right now is not feasible. If you can't afford help, then who's going to do all the work? Unpaid, untrained, overwhelmed, burned-out individuals, likely adult children, are that. I've become a bit of a cynic because I see my father in a nursing home, and my mom is paying $12,000 a month for his care, and the person in the bed next to him is on Medicaid and paying nothing. Again, I want care for everyone, but I'm also recognizing that I either need to be really well off, and then who's helping pay for college and all the other things and costs of living that are what they are? But money is, to me, a massive challenge. Personal health stress means personal needs move to the back burner. Physical and mental health are compromised. Case in point, I've had a couple of really bad mental health situations where I was overwhelmed to the point of even causing, I don't know what you call it, stress hives from head to toe. I have felt depleted. My eating, my movement, all things have been sacrificed at some point in time. I think a big challenge for caregivers is how does one... Because people say, "Oh, make time for yourself." When?''   15:10 Patients and their families are a unit Melissa outlined the difficulties in getting the right care for dementia patients.  ‘' Get us connected. Think of us as a unit. When my father was diagnosed with FTD, finally, after three years of trying to get help in a diagnosis, I started saying, "We all have FTD." Often, how we come into your systems is events. It's initiated, not as a preventative or proactive planned thing. It's usually a crisis.  I read something the other day that really hit to the problem that ends up in our emergency rooms. 75% of families have been about their needs with their older family members. As a result, they're showing up in the ER, and now the talk needs to happen. Believe it or not, these moments of crisis in the ER are often the first time that things are being discussed. So that's a case in point, and I'll share a little story about this, but I would say that before we end up in your ERs, our primary care providers have an opportunity that needs to be formally presented. That is conversations with their elder patients about what they do when something happens and get them set up to make sure that someone is supporting them. One of the biggest issues that I'm facing right now is that I don't feel connected to my mom's care. When she goes in, she goes in the morning, she spends 2.5 hours getting her hair and makeup done, and she does her very best to show time. That's a term that a lot of people know about, where we're going to show up and we're going to show that doctor, I am fantastic. Really, they're not. But if you start checking the boxes, do they have POA? Is somebody on their medical? Are they proxied? Are they part of the electronic health record? When your disease progresses, what plans do you have for your housing? You mentioned you live in a two-story home with no full bath on the first floor. What are your plans? I think these talks have to happen with the patient much sooner. I think that it has to be a part of the formal exam. I don't necessarily think that's happening because every time I try to have these conversations with my mom, I feel like we're talking about asking her to go relocate on the moon.''   27:11 What we don't measure doesn't matter Melissa said healthcare can't improve unless hospitals ask caregivers about their experience.  ‘'I felt like I was staying in all those situations, and what we don't measure doesn't matter. If we're not asking the right people many times, how can we learn if we don't ask the caregiver about their experience? We're not asking caregivers. I find that interesting because my mom in the hospital can't clearly even remember that she broke her hip and/or femur, and yet you're now sending her an after-patient survey. Then I'm looking at it, and I ask her, and she's like, "I don't know. I was on so many medications." Are you getting what you need to process improve? I don't know how, so I just want to call that out. Then for rural healthcare systems, which my parents are in a rural place, technology, I understand is expensive, but if you don't make investments in it for the caregiver, that's detrimental. The manner in which I have to communicate with my mom's primary care provider is woefully behind. The visit summaries are vague. They're not written in a way that I can decipher what they talked about in their exams. I'm actually heading to where my mom and dad are this Saturday, and I've asked for her next appointment, which I will be present in. Please tell me what your caregiver communications plan is moving forward. I'm asking, I want to know. Are we having a five-minute call after mom's appointment, or are you calling me in? Or are you going to start writing after visit summaries that don't remind me that my mom once had a C-section? That's the top of the notes. I'm like, "Come on, it says she's married, but it doesn't say she lives alone."    33:08 ‘'What do you think we should do?'' Melissa explained the difference when a doctor finally included her in decision-making.  ‘'I insert myself a ton, but it's sending it out there. So if she comes to visit me or I visit her, I always send a message back to her doctor and say, "Here are the four things, or whatever number." And I bullet them out, respecting her time, and I say, "This is what I'm seeing. You need to know this because you're not seeing this. Because you have 10 to 15 minutes with my mom on a visit, and she has all these things going on with her, but you're not seeing this." But let's just say this. So I mentioned my aunt's initial encounter with area hospitals and all the emergency rooms she attended. But the first one during her 10-day stay was where I finally felt like I was part of the team. The assigned hospitalist who had just come on for his next long shift, we got really lucky there, so we had one hospitalist at the beginning, which made it much better with me. He addressed my concerns. He huddled. We found times when I would say, "I'll be here today. When are you round?" And he'd tell me his rounding time. Then I would be like, I think he was impressed. He was like, "Okay, let's huddle." And he's like, "God, do you work in healthcare?" I knew what words to use, but he's always checking with me. He called me proactively. He even called me and asked me questions like, "What do you think?" There is nothing better. I'm getting goosebumps just thinking about those conversations where he's like, "What do you think we should do? What do you think about the medications?" That's great. I wish more asked me for opinions and thoughts, I know not everyone is as involved.''   38:24 Creating pathways for dementia care Melissa urged hospitals to act now to develop a model of care for dementia.  ‘'Wherever they may be, caregivers as a group are coming together. Know that. There have been recent federal and state bills to address the rights and needs of caregivers at the policy level. In April, the president signed an executive order to increase access to high-quality care and supporting caregivers. The order directs health and human services to consider testing a new dementia care initiative that will include support for respite care and provide more support to family members, when caregivers, when a loved one is being discharged from the hospital, get ahead of it. Don't wait for the policies to be enacted. Differentiate now, and I'll say that again. Treat the patient and caregivers as a unit. Develop a model of care for dementia. I heard that UCLA designed a dementia care program. They tested it. It statistically reduced patient behavioral problems and lowered caregiver distress. It's not new news, but I ask myself, "Why hasn't this been widely spread?" We have pathways for cancer. We have pathways for cardiac and other diseases. Why should dementia be any different? Palliative or not, do not discard the needs for therapies and ongoing support.''    42:07 ‘'Don't shut us out‘' Melissa offered strategies to improve care and urged healthcare providers to consult caregivers.  ‘'Identify and evaluate your survey tools. What survey do you need? Do you really improve things? Does it even exist? I know and understand that CMS is the driver for most hospitals, but so is consumer choice. If you weren't talking to me, you don't know how I feel about your brand, you don't know how I feel about your system. That's critical. Yes, CMS, we need to look at them and think about what's missing in their metrics as it pertains to caregivers. But that's going to take more time. So why not now? And I think we should be looking at home health too. Transitions to home care, especially for dementia patients. Not just upon release from your brick and mortar. Where is the next opportunity? And challenge your models. Empower your teams to look at the care they provide through the lens of the caregiver. Incorporate more dementia training, and let us help it design it with you. That's my big one. Don't leave me out of it. Help me help you and be a part of that design. Ask me what you could do better. Ask me where you see opportunities. Tell me your pain points. So that's what I want to say, Jim. I think that's the big opportunity here. We're partners in care for our loved ones. Don't shut us out.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    Calling on hospitals to do better: ‘'It's all been made more challenging by not feeling like I'm seen or recognized by organizations and systems. I have experienced barriers. I've watched my own mom's rapid decline after years of being my dad's caregiver, and I keep having to ask myself, "Can't we do better?"  A difficult experience during hospital discharge: ‘'Those transitions in care have me thinking, "How can you just discharge her?" And it was very fast, like rapid fire. They wanted to get someone else in the bed…. I was thinking about when I was discharged after having my baby, which is a long time ago, but I got loads of help, classes beforehand, and follow-up. Why is the beginning of life so well orchestrated, but the end is not?'' An ‘'on the job training experience'': Why the best help for caregivers doesn't necessarily come from the doctor's office or on hospital discharge.  Caregivers need to be given more credibility and included in patient care: ‘'….just trying to get people to believe us is a big problem. They're asking the questions of (the patients). My aunt, when she was being bounced around the ERs, they were talking to her, but yet we're all over here shaking her head, going, "That's not true." Or, "That's not real." She was delusional. It sounded true. It sounded real, but it wasn't real.'' What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

Medication non-adherence leads to preventable hospitalizations and costs US healthcare $500 billion each year. Bruce Berger explains how motivational interviewing can help, with Jim Cagliostro.    Episode Introduction  Bruce explains that motivational interviewing is still the most effective intervention for substance abuse, why adherence hasn't improved in 40 years, and why discharge counseling should be provided the day before patients leave hospital. He also shares how MI interventions reduced the patient dropout rate from 13% to 1.2%, saving $93 million for one biotech company in four months, and urges healthcare leaders to stop objectifying patients.      Show Topics   Motivational interviewing (MI) began in the 1970s Why MI is not about motivating patients  All of us are sense-makers Genuinely connecting with what's emotionally important to patients Restricting patient time is at the heart of burnout Healthcare needs to stop objectifying workers and patients     03:54 Motivational interviewing (MI) began in the 1970s Bruce explained how MI was originally developed to treat people with substance abuse problems.  ‘'Well, motivational interviewing was first developed by a clinical psychologist named William Miller, and it was developed back in the '70s to actually treat people with substance abuse problems. And here's the irony, Jim, to this day, it is still the most effective intervention for substance abuse, and yet, we hardly hear about it in healthcare. We've got an opioid crisis, we've got substance use and rarely do you hear people talking about using motivational interviewing to intervene. And I've done a number of webinars on this. And here's one of the reasons why, we are huge in healthcare on evidence-based medicine, but not evidence-based communication. And in fact, this year, for the first time, the American Council on Pharmaceutical Education is including motivational interviewing as part of their accreditation standards. I'd like to think I'm part of the reason why, because I wrote a five-page single-space letter saying, how can you talk about evidence-based pharmacy and medicine, but not evidence-based communication?''   05:17 Why MI is not about motivating patients  Bruce said people might know how to communicate, but often lack the skills to be effective. ‘'And we graduate people who think everybody knows how to communicate, but that doesn't mean they know how to do it effectively. And so, what MI is, motivational interviewing is a set of skills and a way of being with patients. It's kind of a misnomer, it's not about motivating patients, it's an interview, in a sense, to explore the patient's motivation. "Okay, now you've found out you've got diabetes and the doctor has told you, "You got to take this medicine, watch what you eat, get some exercise." What do you think about all this? In other words, how important is it to you to get your blood sugar down? Tell me in your own words, what does having diabetes mean to you?" The idea behind motivational interviewing, because it's patient-centered, and you asked how is it different than what we do? We have this literally crazy idea in healthcare that we're driving the bus and the patient's a passenger, the reality is the patient has always driven the bus, what we're trying to do is influence the route. Does that make sense?''   09:33 All of us are sense-makers  Bruce said changing your approach to patients helps to overcome non-adherence.  ‘'….all of us are sense-makers. Even as we're talking right now, we're deciding whether we make sense of each other based upon what we bring to the conversation. So we're trying to train people to listen for, how is this patient making sense? And in their sense-making, what information is either missing or misinformation? Let me give you a really simple example. Patient with high blood pressure says, "I don't know why I need this medicine. I feel fine.'' Now most healthcare professionals will look at the patient and say, "Listen, you can't tell when your blood pressure's up. You can't feel when it's up." And they might as well just say, "Stupid," at the end of that sentence. We would say, "Because you're feeling okay, you're really wondering, why do you need this medicine?" What's the patient going to say now? Exactly. And what will they have learned? That I've listened to them without judgment. Now I'm going to say, "That's a reasonable thing to ask. Would you mind if I shared some thoughts? And I'd like to hear what you think." You notice the sharing?'' We're negotiating here. And so, now I would tell the patient that, "Unfortunately, high blood pressure is one of those conditions that doesn't have any symptoms, and the first symptom is stroke or heart attack. This medicine can greatly reduce your risk of having a stroke or heart attack even when you feel okay." I'm now not going to say, "Therefore, you need to take it," I'm now going to say, "Where does that leave you in terms of thinking about taking the medicine to reduce your risk?" So I've listened to what the patient has said, I've heard in their sense-making that their sense is that if you feel okay, everything's okay. My job is to help them understand how you can feel okay and be at risk.''   18:34 Genuinely connecting with what's emotionally important to patients  Bruce said it's important to understand what's meaningful to patients. ‘'….we had an asthma patient that wasn't using her daily inhaler. She said, "I just hate being reminded that I got this thing." And I said, "Let me ask you something. What could you do?" I said, "If your asthma was under control, what would that allow you to do that you find difficult now?" She teared up and she said, "I could play tennis again." Now we found out what's important to her. It doesn't matter what's important to me, she's only going to be motivated by what's important to her. And so, we then start talking about steps that she could take to play tennis again by using the medication, and she became adherent, but you had to explore what was meaningful to her….. And I'm not talking about being false, I'm talking about genuinely connecting with what's emotionally important to the patient, and you've got to do that in order to really have influence in a positive way. And so saying to that patient, "You love your grandkids. You miss not being able to spend time with them. You want a future where you can spend time with them." And you see what I'm doing? I'm helping build pictures.''   22:53 Restricting patient time is at the heart of burnout Bruce explained why healthcare has a systems problem which affects patient care and adherence.   ‘'One industry is moving in a totally opposite direction (to other industries), healthcare. There are so many toxic systems out there that are putting profits ahead of people, people meaning their workers and the patients. We are watching burnout at a level we've never seen before because healthcare systems are basing staffing on things like number of prescriptions dispensed, number of immunizations given, RVUs, "Oh, you should only be spending 11.2 minutes with the patient and no more, even if the patient needs more time in order to have an effective outcome." Somebody asked me the other day, "Well, what am I supposed to do if I only have, at most, 30 seconds with a patient?" Well, no amount of motivational interviewing training can solve that problem, that's a systems' problem. There's a couple of videos on YouTube with me showing what happened with an asthma patient. The patient's daughter had been in the emergency room three times that year because the mother wouldn't allow the daughter to use the chronic inhaler because she looked it up and saw it was a corticosteroid, she misunderstood what that steroid was. She didn't want her daughter using a steroid. Everybody chastised her at the emergency room. I showed her understanding and in fact, said to her, "You're really worried about your daughter using a drug that you think can harm her." And for the first time somebody understood her. After we were done, the whole conversation took six minutes, the kid had not been in the emergency room for at least three years after that……And what's really horrible is we have people that are graduating from nursing school, pharmacy, school and medicine, they have a code of ethics, they have standards of practice that put patients first, and yet they go to work for organizations that set up a moral conflict for them because if your primary goal is to put patients first and the staffing makes it impossible, this is the heart of burnout and chronic stress.''   31:50 Healthcare needs to stop objectifying workers and patients Bruce said if healthcare workers are objectified, they objectify patients, and care suffers.  ‘'…if there's one message that I would give leaders in healthcare, it was you have got to stop objectifying your workers and patients. In other words, when you treat people as objects or like they're replaceable, anybody could do the job, the job's interchangeable, and you don't even give them an opportunity to have input into what's happening, you're objectifying them. And objectification begets objectification. Oftentimes, when we objectify healthcare workers, they objectify patients. It's no longer a human being, it's the diabetic in 214, that's not a person. And I'm saying, objectification is a major source of organizational problems in the delivery of care. The people in charge have got to start allowing for input on how to fix these problems and the people that are working in them and take them seriously. Right now, they're not.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Bruce Berger on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:    Bruce's inspiration behind motivational interviewing: ‘'We've got data that shows that for the past 40 years, the rate of non-adherence to medication regimens hasn't changed at all, it's almost 50% in year two of a chronic illness. And I wanted to understand better what's going on.'' Why MI is a meeting of experts: ‘'You as a patient are an expert on what you know and understand about the illness. I need to be listening for where the gaps are.'' How MI interventions reduced the patient dropout rate from 13% to 1.2% and saved Biogen $93 million, in four months.  Discharge counseling should be carried out the day before patients leave hospital: ‘'They're a captive audience, they'd want to talk to somebody. When they're ready to get out of the hospital, they don't want to listen to us going through their med list.'' Essential healthcare leadership advice: ‘'Human beings are hardwired relational. If leaders get that, they will treat the people they lead much differently. They'll know they couldn't have gotten to that place without so many people helping them.''     What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

Why do healthcare providers struggle to develop meaningful connections with patients? Lonnie Hirsch explores the key barriers to building relationships with Jim Cagliostro.    Episode Introduction  Lonnie shares the ‘'three lacks'' that get in the way of effective patient engagement, why patients must be empowered to take ownership of their own health journeys, and reminds us that, while healthcare is episodic, health is a constant. He also explains why patient engagement is not a marketing issue, why its highest purpose is outcomes, and the need for hospitals to ‘'care for the people who care for their patients.''   Show Topics   Strengthening relationships between patients and healthcare providers  The ‘'three lacks'' in patient engagement Effective marketing is a one-on-one conversation  Patient engagement begins with trust The highest purpose of patient engagement is outcomes Understanding the emotional weight on your customers 04:26 Strengthening relationships between patients and healthcare providers  Lonnie outlined his motivation for focusing on patient engagement.  ‘'Certainly, what gets me going is anything that contributes to solving the challenges that are standing in the way of more people having more awareness and access to affordable, high quality healthcare. That's a big deal, and it's become an increasingly more important focus for me is how can I help, how can Forefront help with that message and that connection? Secondly, I'd say anything that helps people navigate the really cumbersome healthcare, I call it a labyrinth. Many people find the whole experience of trying to navigate their healthcare to be enormously confusing, convoluted, maddening, mystifying, certainly, very frustrating. So those issues are very important to me and increasingly a priority focus. I'm also big into educating and empowering more people on ways they can live healthier lives and avoid preventable disease. And if I had to name one other thing that gets me going in the morning, I'd say it's building or strengthening relationships between patients and the healthcare professionals who are providing their care.''   09:09 The ‘'three lacks'' in patient engagement Lonnie outlined three key reasons why healthcare misses the mark with patient engagement. ‘' ‘'And there are three that I would put in that category of what I call lacks. I'll explain what I mean by that. The first is the lack of enough time for healthcare providers to interact meaningfully with their patients. And if I had to prioritize the challenges for better patient engagement, that would probably be at the top of the list. But close behind would be the lack of belief and trust by the patients based on their experience that the people trying to get them to engage, really know them. Understand them as individuals understand their concerns, their fears, their motivations, and frankly, really care about them. It's hard because there's so many people that need the help and organizations that are providing that care are under a lot of time pressure, which goes back to my first lack. But that issue of a patient not really believing that anyone in the organization really knows them or even cares to know them is a big challenge in terms of getting patients to engage. And the third lack that I would prioritize is the lack of human interaction between episodes of care, not just during them, by the healthcare organizations to make sure that patients understand and feel understood and heard regarding what they can do or need to do to improve their health and live healthier lives. Not just when they're sick or feeling poorly, but at all times.''   13:19 Effective marketing is a one-on-one conversation Lonnie said that a personalized approach is needed to overcome barriers around issues such as language, traditions, and education.  ‘'…But I would say that the cultural issues are the biggest challenge, and that's because what we call culture really includes language, meaning, someone's first language, education, family history and traditions, people's biases and beliefs. All of that really goes into culture. And that obviously requires a very personalized approach that isn't easy to scale or automate as we were talking about. You can automate text-based communications based on things like the primary language of the patient, but the other cultural influences are really much harder to scale. And again, it goes back to what I said before about effective engagement, requiring the patient to be and feel understood and cared about as an individual. ….when you're effectively marketing, you are really having a one-on-one conversation with someone else, even if that message is going out to thousands or tens of thousands of people at the same time. And increasingly more of the marketing is being more personalized as well, if you will, according to individuals or smaller cohorts. But if it isn't a one-to-one conversation, it's not going to resonate with the patient and just makes the effort to get more engagement, more difficult.''   16:15 Patient engagement begins with trust Lonnie said that healthcare providers don't offer the time required to build trust with their patients.  ‘'…this really goes to the heart of patient engagement or the challenges when engagement isn't happening. Because at its core, patient engagement is all about trust and all about relationships. No relationship, no trust. No trust, no engagement. And the other part is people don't trust an institution. They don't trust a hospital or a system. I mean, trust is a human emotion, so you can't cultivate trust with an entity or an organization. The trust is between people. So patients are only going to trust people who they believe understand and care about them. I'm kind of repeating myself here to make a point. But they believe that they have some kind of a connection to somebody or some people who understand them, care about them, and what's best for them. And I certainly think that most people who are working on patient engagement in healthcare organizations understand that, but they don't really have good solutions because of this inability to provide the time that's required to build that trust between the patients and the healthcare clinicians and other professionals who provide their care. Which includes specialists by the way, not just primary care providers. So when you talk about what does a lack of trust look like, it looks like patients who don't follow through on what is in their treatment plan, patients who don't take their medications or even fill the prescriptions, patients who don't respond to attempts to schedule their appointments, patients who express their frustration in other ways. In most cases, it's passive disengagement. It's not like they're out there banging on your door or complaining. They're just not emotionally connected. And so they don't feel there's trust, they feel they're on their own, they access the care they need the best way they can figure out how to access it when they need it. But there's no relationship, so there's no trust.''   22:15 The highest purpose of patient engagement is outcomes  Lonnie said measuring outcomes is a more important metric than surveys, appointments, and medications.  ‘'…. If a patient is engaged, you're going to see it in the outcomes. You're going to see it in medication adherence going up. You're going to see it in health improvements related to the treatments. You're going to see it in follow through on their scheduling their colonoscopies or their mammograms or their prostate checks. You're going to see it in reduced A1C levels or reduced triglyceride levels. Ultimately, isn't that the highest purpose of patient engagement? Or at least to me it certainly should be. And as far as assigning or building patient engagement teams or patient engagement leaders, it's part of the process, but it's also a trap. I see this happen in healthcare organizations a lot with what is categorized under also patient experience, which is closely related to patient engagement. And a health system will hire a head of patient engagement or maybe a couple of people to lead their patient engagement efforts, and give them that title and that responsibility, but then it becomes kind of an impression that it's somebody else's job. "Oh, well, our patient engagement director or our VP of patient engagement or whoever holds the title, they're the ones who are responsible for moving the needle.”  It's an impossible task and a trap, because patient engagement and patient experience and all of those issues happen at the point of care. So everybody has to be involved in it, or it really doesn't take hold and it doesn't resonate.''    28:20 Understanding the ‘'emotional weight'' on your customers Lonnie said healthcare providers can build connections by acknowledging the pressure on their patients.  ‘'But you have to remind yourself when you're in that setting that every patient who's in front of you is carrying an emotional weight, and they're bringing that into that encounter. They may show it, they may hide it, but it's there. And so thinking about this being just, this is my day and this is how many patients we have to see, and this is what we have to get done, and this is the documentation we have to provide, and this is the next room that we need to move into for the next patient. Yes, all of that is necessary to have a functional organization. But when you lose the perspective on the emotional weight that customers, and I'm going to call patients' customers here, bring into each encounter, you're losing the chance to have that connection. You're losing the chance to build trust. You're losing the chance to have patients want to engage, want to take more ownership in their own health, want to feel like you are on their side. And I'm not saying it's easy, but I see it all the time. I understand it, and it's a big challenge in terms of this whole topic of why patients don't do what they really should do, even if they understand the reasons that they should do it.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Lonnie Hirsch on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:    Lonnie's definition of patient engagement: ‘'…patient engagement is about empowering patients to actively take ownership of their own health journeys and supported by and in collaboration with their care providers. And to have access to the information and resources that enable patients and their loved ones to be and feel more in control of their health and healthcare.‘' Healthcare is episodic, but health is a constant. Why healthcare organizations need to be part of a patient's lifelong journey to increase engagement.  Why patient engagement is not a marketing issue: ‘'Even though that's often where patient engagement initiatives land, patient engagement is a relationship issue between individuals and their care teams. If you don't solve for that, all the best marketing tactics and communications won't really move the needle.'' Patient engagement has a business case too: ‘'But if you need a business framework or a business rationale for it, improving patient engagement goes to the financial bottom line and profit line of the organizations as well or doesn't, depending on whether they're effective with it or not.''  Leadership wisdom: Why healthcare providers must prioritize ‘'taking care of the people who take care of your patients.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.    If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

As nursing shortages continue, occupational risks for healthcare workers are on the rise. Janelle Barowski discusses effective strategies to combat this growing issue with Jim Cagliostro.    Episode Introduction  Janelle draws on her nursing and writing experience to explain why staffing levels are at the root of workplace safety issues, how unsafe ratios are leading to unsafe choices and the need to shift the mindset away from martyrdom. She also reiterates why the General Duty Clause of the OSHA Act should be recognized, and why being positive, kind, and forgiving of mistakes is essential in nursing leadership.    Show Topics   CDC statistics on workplace safety hazards Why a mindset shift is the first step  Effective management strategies to improve safety  The General Duty Clause of the OSHA Act  Removing barriers to reporting concerns  Nurses are turning to non-traditional roles  Responding to workplace incidents      08:11 CDC statistics on workplace safety hazards  Janelle said that unsafe ratios can lead to unsafe choices if nurses don't have sufficient support.  ‘'I already had my opinions on what I thought the most pressing workplace safety hazards were, but I wanted to see what the officials were saying on this. And according to the CDC, the most common workplace safety hazards were: sharps injuries; chemical and drug exposure, so for cancer medications, radiation exposures; back injuries from repetitive tasks, which has happened to me multiple times so I can definitely speak to that; violence, which we've seen in the news lately, stress and latex allergies from exposure over time, which I learned in school, but I had totally forgot. And in my opinion, I have really zoned in on stress because that's something that I speak to all the time, is chronic stress and burnout, particularly in acute healthcare facilities where they might not have much of a work-life balance or control on patient ratios and order, things like that. And I just want to highlight that unsafe ratios can lead to unsafe choices due to not having enough support. And that can compound some of those other issues that we mentioned there. So not having enough support might lead you to pick up a patient that you really shouldn't be picking up, in a way that isn't supportive for body mechanics. So suddenly you have a back injury. And that also relates back to having to miss work, which can cost the facility money having a robust per diem pool to have people to plug into those spots. So it also always comes back to what affects the facility as well as what affects the floor and the cohesiveness there.''   11:55 Why a mindset shift is the first step  Janelle said a mindset shift away from profit to nursing safety can help to improve conditions for healthcare workers.  ‘'I think it definitely has to start with the mindset shift. I think that so many things need to be shifted in the mindset, especially with the healthcare industry. I understand that profit is so important. We really can't run anything without profit, but at what point are we sacrificing the healthcare workers that have our feet on the ground? …you can fix the nursing shortage by bringing in more nurses, but if you don't fix the root problem, those nurses are just going to leave the next year. So I think that really speaks so loudly to the issue. And I also looked up another statistic and it said, the average cost of turnover for a bedside nurse is $40,000, and that can range from $28,000 to $51,000. So the average hospital can lose $3.6 million to $6.5 million per year just on nurse turnover, which I think is wild. So even if you don't necessarily shift that mindset from profit, if you're still thinking about profit, it's still a huge loss. So I think we should shift from profit, but even if you're not. …. And fixing these issues also can reduce medication errors. It can reduce the OSHA fines, which sometimes are over a $100,000 for these hospitals. Nevermind jury awards, which can be more than $3 million. So these fines, they really stack up on top of losing a good nurse, which is really expensive too.''   14:45 Effective management strategies to enhance workplace safety  Janelle highlighted effective steps from increasing staff levels to training and education.  ‘'…the most obvious one is increased staffing so that everyone feels safe. No one should want to call out for help for lifting a patient, for anything like that, and not to get anything back. Increasing the wages to make it a more competitive field, especially because you see other areas right now, like tech, that are just soaring past the wages for nurses. In other growth industries too, engineers, other growth industries where nursing has stayed pretty stagnant….. I also think that there should be limits on shift duration just across the board. I think it's wildly unsafe for nurses to have to stay past their 12-hour shifts if someone calls out, because they legally can't leave their patient. And that also leads to unsafe choices like needle stick injuries, back injuries, chronic stress. No one should be working these 16 hour shifts. It's just not safe. And then in a perfect world, mandating staff ratios too, where you're not running around for hours and doing long med passes to the point where you can't take care of your own physiological needs like hunger or using the restroom. I think that that should just be a basic human right that's built into your nursing day. And then there should be training and education and policies on proper lifts, reminders like that. And also, I think it should be more commonplace to say no to shifts from management, because it just compounds on that chronic stress and also that guilt.''   19:06 The General Duty Clause of the OSHA Act Janelle said employers are legally required to provide a safe place of employment, an issue which needs highlighting.  ‘'So one interesting thing that I found when I was researching this, is that the General Duty Clause of the OSHA Act actually addresses workplace safety issues and requires employers to furnish employees with employment in a safe employment place, by recognizing hazards that are likely to cause death or serious physical harm. I feel like a lot of people don't know that, and I feel like I didn't know that until I saw those words and I was like, they're supposed to do that? It makes sense. But to see that clause that there's actually a built-in clause that says that your employer is supposed to recognize and fix hazards that cause death and physical harm. So it's their responsibility, and I think that's saying that there's a clause out loud, just brings that light to it. So yeah, I think that's huge to just recognize that for a second.''   20:57 Removing barriers to reporting concerns  Janelle said fear can make people nervous about raising safety issues.  ‘'I think there's a lot of caveats and there's a lot of issues to why these things aren't addressed and why nurses and healthcare workers face issues in reporting safety concerns….. And I also think that some healthcare workers are afraid. They don't want to lose their jobs, rock the boat, or be targeted by their peers or administrators. I think there is a definite feeling of fear of reporting and thinking that their shifts are going to get cut or that they're going to be assigned really heavy patients or that there's going to be some sort of a retaliation….. I think the first thing (admin) can do is develop a no retaliation policy and let their facility know that they will not be retaliated on for bringing their concerns to light, and have that policy posted. And I think also having shift meetings or team meetings to bring up issues periodically in case people don't want to find the time or can't find the time. Because also, like we said before, nurses sometimes don't even have time to use the restroom. So really, when do you have time in your shift to find a manager, when you don't even know where they are, to tell them this thing? Sometimes it's out of sight, out of mind. So I also think it's the responsibility of the administrator to find the time to check in with their employees. And I think sometimes a group meeting could be helpful because one nurse might speak up and then three other nurses are like, "Oh my gosh, yes, I experienced that too, but I'm just whizzing through my day and I didn't think to say it."   28:54 Nurses are turning to non-traditional roles  Janelle said healthcare is failing to pick up on trends that impact workplace safety.  ‘'I'm starting to see a lot of nurses turn into non-traditional nursing roles. So roles that are against the bedside. I mean, look at me. I am now a writer. I am still at the bedside at a diminished role, but I have left for the most part. And I'm starting to see more and more nurses that are interested in other non-traditional roles like writing, podcasting, consulting, health coaching, that type of thing. So I think I'm definitely seeing a rise in that. And you can't blame them. Who wants to be abused, who wants to not use the restroom for 12 hours, who wants to starve their entire shift? When you're working remotely, you're not abused, you're working your own hours, you're setting your own wage, and you're making your own clients. So I mean, it's a no-brainer. And it's sad because we need bedside nurses, but they need to be treated correctly. So it's also sad because you're waiting for the healthcare industry to pick up on these trends, and they're just not, and the nurses are leaving.   31:51 Responding to workplace incidents  Janelle outlined steps to address potential issues for abuse, which again comes back to the same root cause.  ‘'So once again, I think an increase in staffing really is the root cause of a lot of these issues. So I think if you get to that moment and your deescalation techniques don't work, you should activate the protocol that you've been trained on. I think that there should be a clear protocol with every single facility. I think that the nurse should immediately remove themselves from the situation, and alert an appropriate team that has already been designated to respond. And I don't think it should be that nurse's responsibility to respond. I think that at that point, that nurse should be removed and should start putting their selves into a recovery mode. And I also think that the patient should be taken care of as well. I think it's important to notice that you're not leaving the patient in a deficit and you're not sacrificing the nurse. It's like a two-part system there. So whether it be trained security guards that are also trained on an empathetic communication level, or nurses that are somehow like a response team, but you call a code, an alarm goes off, and it's also subtle and someone responds in that way. And then the nurse should be given a break and a cool off period, and their caseload should be temporarily managed by a float nurse so that they just have a moment to just decompress. Because also you have to think about what care that nurse is going to be providing after they have been physically or verbally assaulted. It's not going to be the best care that they can. So it's also about taking care of the nurse, but it's also about taking care of the patient, patient-centered care. So making sure that their caseload is covered, once again, appropriately staffed.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Janelle Barowski on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:    From anatomy classes with mom, to Reddit reptile pages, via nursing: Janelle's varied career journey to becoming a medical writer.    The impact of fatigue on nurse safety: ‘'Working long hours, particularly for nursing, doesn't give the body time to recover from fatigue and can also increase the risk for other musculoskeletal disorders.''   How workplace safety hazards are interconnected: ‘'I think that when you would start to fix one, you would see a chain reaction and you would start to see other facets being fixed.''   Moving away from ‘'martyrdom'' as a mindset: ‘'Why is this a badge of honor that we wear? Martyrdom is not acceptable in any other industry. Why is it acceptable in ours? And this is what is leading to the nursing shortage among other things.''   Leadership advice: Why it's important to be outspoken but well-spoken in leadership, and why being positive, kind, and forgiving of mistakes is essential. ‘'… because everyone at the end of the day is a person who's just trying their best. I think that mindset really helps.''   What To Do Next: Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

Post-pandemic burnout is affecting healthcare workers at every level. Certified Counselor Jahmaal Marshall shares his insights for effective self-care with Jim Cagliostro.    Jahmaal explains why his ‘'secret sauce'' is to understand who people are, how uncomfortable places help us to grow, why healing begins by disrupting our narrative, and the importance of boundaries in overcoming compassion fatigue. He also shares why every hospital needs a resilience worker, how to advocate for yourself, and why we get what we tolerate.    Show Topics   Background to LLC: A journey through loss ‘'I want to know who you are'' Growth occurs in uncomfortable places Power positioning to ensure sustainability  Disrupting the narrative  Overcome the need to people please Leadership lessons: Learning to advocate for yourself     03:46 Background to LLC: A journey through loss  Jahmaal explained how the loss of his father led to a season of darkness that shaped his future. ‘'Three days after I got home, he got critically ill. So we found a hospital for about two and a half months, a time of hardness, a time of misery. On December 5th, 2017, God called him home. I went through a long season of darkness. I mean, the celebration of life for him was amazing. The gospel was preached. Hopefully your guests just know I'm unashamedly a Christian, but I do have a broad audience of people who don't believe what I believe and that's fine. We walk together. But I went through about a year, and I would say six months for sure, of toying around with wanting to be an atheist, an agnostic. I hated God, hated Jesus, hated the gospel, hated everything I was. I questioned everything I was as a man, a leader, a counselor, a teacher, just all that stuff. Questioned everything I had poured into other men and families. I'd spent years, my best years really, serving other people. I'm like, "Well God, how could this happen?" So I hated God. I hated Jesus.''   13:03 ‘'I want to know who you are.''  Jahmaal explained why getting past the ‘'surface stuff'' is the secret sauce to Listen Then Speak.  ‘'…..in that northern Virginia, southern Maryland, DC area, and I'm right in Washington DC, it is cutthroat around here. You live and die by what you do. The first thing people ask you, especially guys, as soon as they see you, "What do you do?" So, I knew interviewing, I did not want to focus on what a person did and that what they did didn't define them. Especially as a person who's a counselor, who's looking into human behavior and how a person thinks and who they are, I want to know who you are. Getting my guests in that space, when you ask someone who they are, they'll throw up in your lap for lack of better rhetoric. So that actually is a part of this secret sauce to Listen Then Speak. I want to go past all the surface stuff of what you do. I want to find out about your faith, your background, your lack of faith. I've had atheist, agnostic, Buddhist, Muslims, anything, because I can learn something from everyone. Just because I believe what I believe doesn't mean that I can't learn and doesn't mean that I can't be informed. I want to learn about the highs, the lows, the hills, the valleys. That's what I love about autobiographies because that gives me the full story, not just the highlight reel of who you are. So in about 30 to 40 minutes, I'm getting a bit of the fullness of their story by not focusing on just on what they do. We can put that in the show notes.''   15:03 Growth occurs in uncomfortable places. Jahmaal revealed how his early experiences helped him to understand the fear of rejection that he sees in his clients.  ‘'I'll share a little bit of my testimony because for the longest time in early childhood, early teenage years, I didn't want to be uncomfortable. I lived for being in my comfort zone. Many people, and you've seen in my content, I honor my dad. I love my dad. He was my best friend. For 12 years, we were best friends. I'm nearly 40 now, but the first 22 years was hell on earth. Okay? He was like my worst enemy. Before God changed his life, he was an alcoholic and a drug addict. He used heroin and crack. So you can imagine, what type of household and environment that created. So I walked on eggshells and I grew up with a huge fear of rejection. Most of the clients that come to me, they have some fear of rejection inside of them. It may not be as traumatic as my childhood, but it's a series of things that have stockpiled, that have brought them to a belief system that they have to go overboard just to avoid rejection. So I avoided rejection. I avoided anything uncomfortable because the very place I lived was so uncomfortable. Anytime I'm out the house, I'm not going to be uncomfortable. When you take those subliminal hits, it informs the way you move about the earth. I avoided uncomfortable situations and uncomfortable conversations. So now the inverse is true. It's like, no, let's get into it. That's why that's my hashtag. Let's get into places that are uncomfortable because that's where the growth occurs.''   18:01 Power positioning to ensure sustainability.  Jahmaal said healthcare workers need to challenge themselves to practice boundaries to avoid compassion fatigue.  ‘'….we don't see how we're running ourself into a brick wall and we don't realize how worn out we are. We intend to do that which is good. Our intent is well, but it may be misplaced. And it's like, "Well, there's a sick person in front of me. What do you expect me to do?" However, I would challenge your audience and I challenge myself, are you practicing the needed boundaries so you don't end up full of bitterness and resentment? …… compassion fatigue is almost where you're working more hours than is needed. You're going overboard. You're doing what is not even required of you. In your field, it's difficult to speak to that because sometimes it's life or death. If I'm not in position, if I don't do my job, this human individual will become just a body. This will be a terminal. We don't want that to be the case, or there is disease on that or there is prescription that didn't need to be prescribed. It could be any number of things. So I don't want it for your audience. It's not lost on me the very real factors that you face. But I would challenge everyone as I challenge myself, especially in caretaking, to examine your motives and how are you power positioning yourself-... to make sure that there is sustainability. If you're not power positioning yourself for sustainability, what is the mindset that feeds you constantly placing yourself on the front line with your gas out? At some point you won't be there at all.''   24:16 Disrupting the narrative.  Jahmaal said committing to your own healing and wellness is the first step towards moving beyond autopilot.  ‘'I actually want to disrupt the ongoing narrative in your mind that's actually informed your behavior. So begin to seek out someone who can actually disrupt that narrative because when you're on autopilot, you know no other way. There's a scripture, I'm going to preach for a second, that says, "There's a way that seems right to a man, but it ends in death." So there's a lot of ways that seem right to both you and I that seem like, "Oh, this is fine. This is okay." But what is it producing? Is it producing fruit or is it producing a briar patch of sticks because we are burned out and because there is compassion fatigue and because we are caretaking, but we're not taking care of ourself. So encourage them to begin to seek out that help, get honest with yourself and then begin to go into your calendar and set aside time. "Okay, if I've made this decision, I need to make a commitment to my own healing, to my own health, to my own wellness." Sustainability is key. I think we don't think of that a lot. One of the books I work with clients through, depending on the client, is Steve Covey, Seven Habits of Highly Effective People. I love his quote that says, "Begin with the end in mind." Okay, if I continue at this rate, what does the end of this look like? So to really go through that process with yourself so that you're serious. One thing I have clients do is write down your why. It's a whole sheet that I go through, a whole Google sheet. When you see who you're fighting for, it actually not only puts restraint on you being on autopilot, but it actually redirects you to be more intentional about your time, the way you're living your life, about your output, but also about your input and really dealing with the false guilt.''   29:40 Overcome the need to people please. Jahmaal said that people pleasers become that way through a series of events in their lives.  ‘'Well, I want to go back, want to say, even with the question born people pleasers, none of us are born that way. We get that way through a series of events, and it may not even be anything traumatic. It just may be a series of events that stockpile in a narrative, again, that goes into our mind that says, "This is the way you function." So if you think about children, you got four beautiful girls. Children are the greatest recorders of information but the poorest interpreters. So anytime there's a people pleaser, and I want your audience to hear this, they have started out as a parent pleaser. I wanted my parents to be happy. Of course, my childhood was a bit more traumatic than your average person. So that growing up in fear of my father, I thought every other man had some X factor that I didn't. I knew I was being rejected at home. I didn't want to be rejected anywhere else. So I found myself going overboard in everything. I was a straight A student. ….. So each one of us has a hunger inside of us based on the belief system and the narrative internally. That's going to be what drives you….. With people pleasers, their hunger to please others, their hunger to not kick up any dust their hunger to not trouble the waters is what drives them. It can even drive you into certain professions or drive the way you navigate that profession. When you're in that and you have that desire to serve, a lot of times you're doing more than is required because it's feeding something in you. It's driving you to obey that thirst.''   35:33 Leadership lessons: learning to advocate for yourself Jahmaal said overcoming the fear of rejection can help you to begin to advocate for yourself.  ‘'…. I had problems because I refused to advocate for myself because of my own fear of rejection. So I had to get help. Before I became a counselor, I invested in my own spiritual, physical, and mental wellness. So I'm not encouraging someone to make an investment that I haven't made. I spent months doing the hard work. I would encourage anyone in leadership or who is pursuing leadership, learn how to advocate and learn why you don't advocate. I wasn't advocating because I was in fear. Once I dealt with that fear of rejection, I began to advocate in a way that positioned myself for sustainable success. Part of the onus is on you. I know some of the fear can be, "Well, this is my bread and butter, this is all I got. I got mouths to feed." Those are very real things. I won't discount that in any way, shape or form. But also, you get what you tolerate. You teach people how to treat you, and you need to learn specific ways to do that, and then learn the mindset of why you have not done that in the past and how to do that going forward.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Jahmaal Marshall on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:    Digging into the weeds: Why establishing boundaries is vital to help people to move forward. ‘'It takes 90 days for the neuroplasticity of the brain to change and actually to begin to move in the direction it was intended… We have to dig into the weeds.''  Advice for the healthcare C Suite: budget for a counselor or resilience worker for your staff. "'..if you're not budgeting for counseling staff, people who are certified, resilient staff, you are doing your company a disservice and you're actually burning out your employees and you're creating high turnover." Why we're all like Mack trucks in a sense: ‘'You go to the Walmart parking lot around like five in the morning, what do you see? You see these huge, larger than life, trucks, and they have about eight mirrors. Even with that many mirrors, that truck still has blind spots. It's still stuff that the driver and even the passenger don't see. You need the perspective of others.''  Learning to interrupt your thoughts: ‘'Your mind is the control tower of your body. Your thoughts tend to overwhelm you, especially when you don't interrupt them, your thoughts tend to become true because it becomes your reality.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

The healthcare demographic is changing as younger generations move into the workforce. Ryan Dos Reis shares his advice on leading and motivating employees with Jim Cagliostro.    Episode Introduction    Ryan reveals how advice from a world cup soccer referee influenced his leadership style, why the ability to ‘'reset your day'' matters in CTICU. and explains why we should forget generational stereotypes in the workplace. He also shares his mantra of ‘'direct, motivate, develop'', why hospitals need to hire with intent, and why communication and listening to understand are key to successful leadership.    Show Topics   Lessons from a world cup soccer referee Resetting your day in the face of challenges The joys of critical care  The importance of performance evaluations Look at the individual, not the stereotype Direct, motivate, develop Clear communication and listening to understand     03:03 Lessons from a World Cup soccer referee Ryan explained how his experience as a referee informed his leadership style in healthcare.  ‘'I was refereeing for like about 15 years. I was able to referee up until like the Second Division of professional soccer in the country. There was a lot that went into that, a lot of fitness testing, a lot of regiment, but then also a lot of leadership aspects of coaching. Going out to the field, what do you look like when you're off the field? How are you presenting yourself? Are you well-groomed? Making sure your shirt's tucked in, your socks are off and not necessarily down, or your socks are fully up, so that whole presentation. Then, also command presence and your aura that you bring when you're either off the field and then on the field. That was something that was really instilled in me by a former World Cup referee at the time. That was something I always worked on is, how are you communicating with the players on the field? How far are you away from them? Then, also that perception is reality. Maybe I'm talking to them face to face, but maybe from somebody that, I don't know, half a mile away, it might look like I'm screaming at them, so just being aware of like my body mechanics, my language, my body language. All of that, then, translates into nursing when you go into leadership. It's a lot of that, so I find myself, even to this day, and I've been a leader now for about three or four years, I find that I play back a lot of what I learned through refereeing in my leadership style.''   07:57 Resetting your day in the face of challenges  Ryan said the nature of critical care means your carefully planned day can rapidly be flipped on its head.  ‘'Yeah, you know, it's every day is a new day. I have a little agenda book, and yesterday before I leave I write down all the things that I need to work on today, coming in on Friday, so it's all written down. Then, you walk in and there's multiple other things that happened. I walk in and maybe there's a patient that now all of a sudden is on ECMO and you're just like, "Oh, where did that come from? They weren't here yesterday." Then, maybe there was another patient who came up from the OR who was also really sick, and the nurse was feeling a little overwhelmed and had a lot of questions. Or maybe we had a newer charge nurse that needed a little bit of support, and then maybe something happened overnight where they wanted to run it through you. Now, you're walking in where you're thinking like, "Okay, my day's set," and then next think you know it's like people are coming in and picking at you like, "Hey, I want to talk to you. Hey, I want to talk to you. Oh, you just released the schedule. I wanted to talk to you about that." Now, before you know it, it's 9:00 and you're like, "Wow, I haven't even been in my office yet to go through some of the things that I just wanted to go through." I think that sometimes can be challenging in these critical care settings where you think that you have things mapped out for the next day, and then you come in and it's like flipped over on its head. Just being adaptable, being flexible to just know how to reset your day and not let that completely ruin your day, I think, is a really big challenge that leaders in a critical care setting will face.''   07:57 The joys of critical care  Ryan said that seeing patients recover is one of the most rewarding parts of nursing.  ‘'There are a lot of joys actually that come with the job and from both aspects. It's the patient that was here, maybe the patient was someone who was a little difficult and then maybe didn't do so well, and now went to the OR and came back. Then again, doesn't do well and we have a code on our hands, but we're able to revive them and they're pulled through, and then you're able to go in and visit them and see them. They're talking to you, they're doing well. They're all teed up for potential discharge in the next couple of days, and it's like being able to sit with them and just having that conversation, just kind of like seeing where they are and seeing what they remember, it's so, so rewarding as a nurse. Not even just as a leader, just as a nurse in general, so rewarding to be able to see that and take that moment with them. That's one big joy.''   11:55 The importance of performance evaluation Ryan outlined his performance evaluations and emphasized the importance of one-to-ones to build staff relationships.  ‘'I think the other piece of it is one of the things that we do here and all the managers have to do is we have to do performance evals, but then we've actually started doing one-to-ones with all of our nurses. I find those one-to-one being so beneficial. I just finished up all of my one-to-ones with every nurse and it's a moment for me to just connect with them and say, "Hey, so you're a preceptor, you're a charge nurse. How's that going for you?" Or, "Hey, you're not precepting, you're not a charge, but we've identified that you would be good at that. What are your thoughts on it?" Trying to see how they feel about it, and not necessarily saying like, "Hey, you need to precept, hey, you now need to be in charge," but giving them the opportunity to have a say in that. Then, the other piece of it is also looking at like, "What are your goals? You set up goals last years. Where are you in achieving them? If you're not quite there, what can I do to help support you? What can I do to make sure that you get there?...We set out these goals together. You need to meet them." I think just in general now with the new generation and across the country, we need to really be mindful of we're here to help. We're here to foster relationships and really make sure that everybody's growing and not so much just like leaving you alone to just sink or swim and, "Oh, you didn't meet your goals? Great, so now you're not going to do well on your eval." It's not the same. That's the one thing that I will say is we've been doing here and I think has helped with keeping people feeling like they're a part of a team.''    15:35 Look at the individual, not the stereotype  Ryan highlighted the importance of looking at individuals, rather than trying to categorize them ‘'I found that there's times that I think we generalize generations of like, "The Millennials are X, Y, and Z, and the Baby Boomers are X, Y, and Z, or A, B, C, D. The Gen Z's are now W, X and Y." I think that sometimes the generalization, okay, we have an idea of what that generalization is, but now let's look at each individual because maybe each individual person might not necessarily fit that generalization because their upbringings might have been different. I think that it's really important to kind of hone in on each individual person and understand what makes their inner clock tick. I do think that sometimes coming into nursing, and a lot of it might depend on where you came from in terms of schooling, but my mindset is maybe they don't know or not aware of the empowerment and they're not aware of what we can actually do and what we can actually change. I recently had some of this, a discussion with a couple of nurses where they were asking all these why questions like, "How can we use this on a back check valve, but we can't use this type of sticker on a Alaris pump? Is it an infection prevention issue? Is it this?" I just sat there and I was smiling the whole time and I thought to myself, "You know what? I'm just going to chime in." I was like, "You know, if you find evidence that would support best practice on how to manage a CVL, and if you think that it might not coincide with what our current policy is, then bring that forth and let's challenge the policy. Let's challenge the status quo and say, 'Hey, we found this. It's validated evidence. We currently practice this way. Could we take a look at this?"(things) can be changed if you have the supporting evidence behind it. I think that sometimes people aren't aware of that. Here's the generalization. I do think that the younger generation is very much like, "Okay, well, the organization, the institution is saying that this is what we do, so that's what we have to do." They don't necessarily always think outside of that box to be like, "Oh, maybe I can challenge that."   20:44 Direct, motivate, develop – three tips for intergenerational management Ryan explained his mantra for successful leadership.   ‘'Yeah, actually, I have a piece of paper on my wall that's actually currently covered up, but I will uncover it for a second, and it says... There's three words on here. It's direction, motivate, and develop, and that to me are the three key things that I have to focus on. I need to provide direction for the unit and for all the nurses that are here. I need to motivate each individual nurse and tech on the unit. Then, I also need to look at development. Where does each one of them want to go? In terms of, for example, let's say my charge nurses. It's like, "okay, we need to look at the charge nurse and the charge nurse role. So I have been spending a lot of time on making sure that we have monthly meetings with my charge nurses. I send out an email every two weeks with just any operational updates, things that they need to worry about or focus on. Then, I also provide them some of the learnings from our academy that we have here on leader of self, so things on emotional intelligence, things on how to deal with disruptive behavior or conflict because those are not things that we typically get. Any institution typically it's like, "Okay, hey, you're going to be in charge." You go to a charge nurse class, it's maybe four hours. Then, you do some type of shadowing experience on the unit, but we're not really providing the charge nurses with those soft skills on being a leader, which is charge nurses really being... You're air traffic control. We're now asking these people to four-hour class, maybe one or two shifts of orientation. Then, we're saying like, "Hey, now go manage all this traffic, patients coming from the OR, patient's leaving, nurses coming, calling out, patient placement calling you, asking you to put a cath lab patient here and there, and you're trying to figure all this out while also rounding the unit, so supporting the team, and making sure that people are taking breaks. Yeah, yeah, so to me, it's really important that we spend some time developing and figuring out what it is that they want, and I think that's key.''   23:54 Clear communication and listening to understand  Ryan shared his leadership advice for working with a new team.  ‘‘It's really important that you as a leader, even if you're new to the position or new to the role, that you set up where you want to take the unit, where do you want, what's your vision for this unit? How does it align with the hospital vision and mission? I think some of that comes from just getting to know your staff. When you're first onboarding and you're first starting out on a new unit with a leader, I think it's so crucial to meet each individual employee, each individual team member and just do a like, "Hey, how are you?" introduction. Get to know them outside of work a little bit about work, and then get to know what makes them tick and where do they see the unit going. Then, you kind of categorize all of that and put that into buckets, and then you come with where you want to take the unit and you create a mission or vision for that unit that is embedded with what you got from each employee with also some of your core values. Then, you communicate that out clearly to everyone so everyone knows exactly where you want to take this unit and where we're all working towards. I think it's so important to be very, very clear with that because that comes down to that first word that I mentioned, direction. …. In terms of things that I've learned that I really put into practice today is listening. It's so important to listen to understand and not listen to respond.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Ryan Dos Reis on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:  A need to get involved; Ryan's early career in healthcare, from med-surg and progressive cardiac care to CTICU. ‘'I really love leading initiatives and really looking for initiatives and really looking for areas where we can improve. Knowing that we have that say to make that happen.''   The joy of supporting new nurses through their onboarding and orientation, ‘'Just seeing how much they've matured, not only just as a nurse but as an individual, is really one of the biggest joys that for me, at least, I just sit back and I smile. I'm like, "Man, I did something right. We did something right here as a leadership team, and look how wonderful it is to see somebody just propel in this environment."   The importance of ‘'hiring with intent'' in a post-pandemic era. ‘' … they're not leaving because it's me. They're not leaving because of the culture. They're leaving simply because maybe there was just this funky time when we were just hiring to try to fill voids.''   Encouraging young people to challenge the status quo in healthcare. "Figure out like, "Could we do something different?" The answer is always yes initially until we meet a roadblock and say, "Actually, we're not going to be able to do that because of here's why." Right? ‘'   The move towards servant leadership, ‘‘At some point, it was transformative, the transformational leader, and now it's like, "You're still a transformative leader, but now it's also like, "Well, there's a servant leadership aspect of leading nowadays that needs to come out."    What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

The ongoing staffing shortage is one of the biggest challenges facing the healthcare sector. Meri Halilovich and Henry Lang share their strategies for creating an effective hiring process with Jim Cagliostro.   Episode Introduction  Meri and Henry explore how a repetitive application process can deter candidates at the first hurdle, why the resume is only a starting point for hiring managers and offer vital interview tips for job applicants. They also explore the importance of understanding culture, highlight the ‘'revolving door'' of staff retention and share why diversity and inclusion are vital to attracting and retaining talent.   Show Topics   Healthcare's hiring process has to be more creative Fixing a complex application process The role of the resume in hiring Beyond the resume: interview tips for candidates Why culture matters in successful hiring Understanding why your employees leave How regular one-on-ones enhance the workplace The importance of diversity in healthcare     02:12 Healthcare's hiring process has to be more creative  Henry said the current staffing shortage means HR must utilize social media and other creative ideas to attract applicants.  ‘'Well, you have your historical approach. You have an applicant presented to HR. HR goes out and does traditional recruiting methods, job fairs, put it on a website, and put it on your hospital website. Have maybe some type of incentive program for people to pull people in. And that has been the traditional or the old school method for bringing clinical and administrative and backend staff into the healthcare environment. But with the demand for healthcare employees right now, the shortage of healthcare employees, things have had to become a lot more creative when it comes to candidate searches. Extra efforts are needed to be made. Our organization got involved in healthcare recruiting because of that, because of the amount of time and energy that is required for organizations to find talent. Things that are in place today. You have to have a presence in LinkedIn. You have to have a presence on social media. You have to use creative ways to get the attention of the small pool of applicants that are there to fill these positions. The tools that people traditionally run from, the locums and travel. Well, those are tools that you should look at positively to let people come in and experience your culture and then even provide opportunities for permanent staffing.''   07:36 Fixing a complicated application process Henry said the repetitive nature of the application process can deter candidates.  ‘'If we're talking even a lot of managerial and administrative roles require a level of certification, they require a lot of background checks. Anything that organizations or successful organizations do to go ahead and implement someone to streamline that process. There's nothing more frustrating when you go to apply for a healthcare position and you fill out... You need your remote practice insurance, you need the billing stuff, you need just a normal application. So when you filled out the application, I gave you references, I gave you all of my information, I gave you my licenses, I gave you all of this information. Then I go to fill out another link and it's asking for the exact same information again. And anyone who can help go through, what are we asking people and how many times are we asking the same information and is there any way that we can streamline this so that they ask, we fill out this one form and it goes to all the different sources… But a lot of those places are all asking for the same information. And a lot of people stay in jobs that they don't like because they just don't want to go through it again.''   11:07 The role of the resume in hiring Meri said the resume is only the starting point for hiring managers.  ‘'Any great hiring manager will know that a resume is essential, but it's absolutely not the only thing they should look into. A resume is just a document that represents candidates' professional achievements, and it is essential since oftentimes it's the only thing the hiring authority has in front of them. And based on that, they're deciding if they are going to invite this person to interview or not. Basically at this stage, a hiring manager is just screening the resume and making sure the applicant has necessary certifications or license or years of experience or anything else that might be required for that job. So absolutely essential at that stage. But now there are different many sublevels and levels actually that will play at exactly the same level of importance of bringing in this person as an employee to the organization. One of them will be in-person interview, and this is something that I see candidates being a little bit, I would say, unsuccessful if you will. It might not be the perfect word for it. When a candidate comes into interview, they strongly rely what their resume says about them and that's all they want to talk about. When in reality they don't understand their resume screening, it's done and approved, that's why they brought you in. Right?''   12:32 Beyond the resume: Interview tips for candidates  Meri provided helpful insights for candidates, including the importance of asking questions.  ‘'Exactly. This is the time when candidates should wow their manager, the hiring manager. They should walk into that interview knowing and representing themselves like they are the one, they are that perfect person they are about to hire and all they should do is act that way. What I mean by that is they should display, they are a great team player, they should talk about how they envision themselves as a part of this company, what they would like to do and achieve as well as deliver as a new hire, they should show enthusiasm, knowledge, and interest about the company and how amazing the delivery is going to be. That's when they create this picture and vision for the person that is listening, the hiring authority, "Well, wow, they are actually the one. Already have a great resume and now I'm hearing what I want to hear from them." That would be one tip that I would give to a potential candidate who might be listening to this. Another thing is that candidates often during the interview avoid asking questions. I highly recommend, inquire about more information besides what job description provides. And this way a candidate might display and in some way manifest the idea that they are already part of the organization. And as I said already, going into an interview, applicants should represent that idea. They are the one, the perfect person that employer is looking for. So asking more, learning more, that absolutely helps them.''   17:56 Why culture matters in successful hiring   Meri explained why successful hiring isn't only about the applicant.  ‘'Obviously, time and experience takes all the hiring managers to the next level and they develop the skills. They're firmly connected with emotional intelligence and ability to evaluate character. When you think about it, Jim, it's in a short conversation, hiring manager needs to evaluate so many different things in order to decide if this applicant should be moved to the next round or not. I would say an essential part of this task is how well this hiring authority knows the organization or actually people in the organization, I should say, analyzing who and how a new hire will fit with a team, who they will report to, who will report to them, might also play a crucial role in decision making. Here we're opening the door to this multi-level process where a million little things play a role if the answer is going to be yes or no to the next round. And as you can tell by my last statement, sometimes it's not actually the applicant itself, but who they're going to be around with. And they should definitely coordinate with their teammates who might attend that meeting as well. Plan the time and agenda and sharpen their skills when it comes to selling their company. What do I mean by selling their company? When they end this interview with a great candidate who has amazing resume, he or she is providing great answers to their questions, it's time to step up or the hiring manager to step up and do the right thing and save that candidate.''   28:32 Understanding why your employees leave Henry said employers need to go the extra mile to take care of their new hires (and all employees).  ‘'.. We talked about the skills and tools of the decision maker and once they select the ideal perfect candidate, it doesn't happen that things work out perfectly for various reasons. It could have absolutely nothing to do with the culture. It would be the shift they're on or the hours or the commute or the spouse's job or the childcare issue. There are so many factors. But the organization needs to go the extra mile and always put time and energy into ensuring staff are taken care of. And you may have ultimate goals for your organization in terms of patient care and safety, but those things are going to happen if the employees are taken care of. And one of the efficient ways is to do one-on-ones. Everyone has probably experienced some type of exit interview and that's the time that you get to really let it all out and say the things that you wish had happened and the problems. Imagine having that interview while you still work there. People are like, "I wish you would've asked me these questions before I was leaving." And back to the point of that transparency, to really work with people to let them understand what the challenges you face. People know, they understand the challenges we face. We have X amount of people, we have to cover X amount of rooms, we have this many resources to take care of this, to treat people with respect, to let them know what's going on and then be open to hear their feedback. Because the feedback that you get, especially if you don't wait for the exit interview to get the feedback, you may find some solutions to your problems that are literally right there amongst your team if they feel a part of the organization. They all are sharing references with each other and getting ready to go.''   31:11 How regular one-on-ones can enhance the working environment Meri said the human touch ensures your employees feel valued.  ‘'There are a lot of organizations out there that do, if not weekly, then they have monthly sit downs one-on-one, very quick 15 minutes, "Hey, how are you doing? What's going on with X, Y, and Z? I know you mentioned last time we spoke," and go from there. That way they connect better on a human level. They understand why perhaps that employee might be a little off at work if they are. "Oh, okay, their child is sick," for example, or something like that. And then that gives the opportunity to employee to go, "Hey, I really love X, Y, and Z, but A, B, and C are really killing me. What can we do to improve? How can we"... you know what I'm saying here? It definitely impacts not only productivity but happiness and that feeling of being valued in the work environment. This is definitely an example that does not touch healthcare, but in my personal experience, the company that I worked for, we had morning five-minute huddle where it was like, "Hey, good morning, did you get your coffee? What do you have going on today? How can I help you? Do you need longer lunch today because you need to run errands?" It was literally like that. Nobody ever needed anything from that manager, but just them telling you that in the morning made you feel so empowered that you went twice hard at work that day. That feeling valued, being human to one another, I think it's essential in this example.''   33:17 The importance of diversity in healthcare Henry explained why diversity is essential to attract quality talent and reduce turnover.  ‘'Let's start with the facts. PricewaterhouseCoopers, 85% of CEOs report that applying a diversity and inclusiveness strategy has increased their earnings. Also, the same workplaces report that their employees are happier and more productive. Now, this leads us to the reason for this podcast. Happy and productive employees boost the ability to attract quality talent while reducing turnover. And if you ignore diversity and inclusion, you can harm the organization in so many ways. Just here's a couple. Unintentionally generate a culture where discrimination is present. You don't have any diversity. You create this environment because of lack of diversity. Employees' similar backgrounds do have similar viewpoints about the work you do, which then drives the workforce to do groupthink where new ideas and opposing opinions in a group of people are suppressed. And diversity is everything. It's not just racial diversity. There's age diversity. Young people, young generations are more diverse, so if the organization does not embrace diversity and inclusion, you're missing out on some excellent younger employees that can provide new point of views and help you prep the future as well as help you grow your organization.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Meri Halilovich on LinkedIn Connect with Henry Lang on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:    Post-Covid changes in the job search; how rural hospitals can offer the opportunities that other health systems can't. ‘'It's just a matter of packaging all of that in such a way that it shows the beauty of maybe going to some of these places, the ability to buy a home, or the ability to practice to the full extent of your license because you're in a place that you're allowed to do so.''  Why there's no quick fix to successful hiring. ‘'I just see small little chunks of it getting addressed and improved. And while we are doing that, we might over-complicate the next section of the process.''  Why every candidate should be ‘'humble but confident'' during an interview.  The interview process has a critical impact on retention. ‘'Because the reality of about, we're talking about the hiring process, the problem we're struggling with is the revolving door of retention and the interview process is critical to your retention.'' Advice for leadership: Developing a culture of positive relationships, and ‘'Being a good human, bottom line, it takes you to the next level.''    What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

As healthcare continues to move through a challenging transition, Ronnie Kinsey explains to Jim Cagliostro how he works with healthcare leaders to surpass their greatest goals and resolve leadership gaps.     Episode Introduction  Ronnie highlights the importance of exposing clinicians to the business side of healthcare, how ‘'one to one to one up'' leadership can lead to multiple gaps of ‘'abyss potential'', and why people must prioritize behavior and check things at the door. He also explains why all leaders should consider an outside resource for support, why coaching is not therapy, and how attitude is key to successfully nurturing leaders.      Show Topics   Healthcare has to incorporate the business side  The challenge of one to one to one up leadership Promotion can result in leadership gaps  Behavioral procedures take priority in healthcare The impact of culture in filling gaps  Developing leaders comes down to personality and attitude Frontline employees can resolve hospital painpoints 04:19 Healthcare has to incorporate the business side  Ronnie said that clinicians must be prepared for the business side of healthcare at an earlier stage.  ‘'There are so many people who got into healthcare with the idea of delivering care. They wanted care. But then you and I have had conversations. You're doing the business side of healthcare now as well. There is the whole business side of healthcare, which cannot be ignored. I think that clinicians schools could probably potentially do a better job of preparing clinicians for the business side of healthcare. Because …..if the bills aren't paid and if there's not access to plan for growing for the future, we've got a problem. So that's got to be there, but I think that it has to be really ingrained into the clinician earlier on. That would be one of my big asks for the new educational shift is that clinicians just be much more attuned to the business side of healthcare. Definitely don't lose the caring side, but be aware of the business side.''   07:30 The challenge of one to one to one up leadership  Ronnie explained gaps happen when people leave as most hospitals only have one leader on the frontlines.  ‘'You on average have one leader per category of management. So the front lines, whatever, until you get up to the C-suite and it's divided other ways. So say you have one leader that you report to, then that's at one level and that leader reports up to another leader at another level. So it's generally a one to one to one up. Well, what if that chain breaks and one of those ones goes out? There's a break. There's no extra time to fill in for that missing person per se. And again, remember we just said it takes about four months to replace them. Well, how to bring the next person up to speed, how to even try to get them close to knowing the personalities that play on that particular whatever we want to call it, the ward, the unit, the floor, the department, service line, you can name that. So look already where the gap comes in. So then from the front line, some people are wondering, "Well, who do I go to?" Okay. We can give them names, we can give them a title and that's fine. That person doesn't have extra time for you. They already have their financial responsibilities because they're in leadership…. So now are they short of resource? Where do they go? There tends to not be just so many extra hands sitting around waiting to help out because systems are really under constraints overall, especially after COVID, right? We're under a whole new redefinition of the healthcare system. It's been coming, I'll say it's for sure been coming since EHR. Well, it became no exception after COVID. … I can make that example at every level, all the way up.''    10:12 Promotion can lead to healthcare leadership gaps  Ronnie explained why promotion can result in a cycle of resentment and resistance if clinicians aren't prepared.  ‘'And again, leaders aren't necessarily born, but leaders can be developed. So then their lies the gap. There lies the gap. So often it happens in healthcare, somebody did so well in the clinical side, they're going to get promoted. Well, guess what? They like the idea, sounds good. They want to grow. They'd like to do something new and at another level. But boom, what if they're not prepared for the business side? What if now they're not prepared to hold somebody accountable. A, they didn't show up on time. B, didn't say the right thing. C, didn't have the right thing and you know where that goes? Then there's the accountability and the disciplining that takes place. Well, then you have resentment. Then you have resistance. Are you following me on the gap yet? Do you see where this turns into a huge cycle? And then at the same time, you need to be delivering care and healthcare efficiently, appropriately, timely and properly all the rights. Right person, right time, right thing, right place, right outcome, right? Applying all of those things, but your time factor doesn't increase. People don't have extra time to work on these things.''   14:28 Behavioral procedures take priority in healthcare Ronnie said people have to check certain things at the door, set expectations and hold others accountable in the working environment.  ‘'I'm going to share with you part of why I'm a coach now. I hired my first executive coach when I was working with a large pharmaceutical company to give a presentation overseas to our sales team and it had to do with behavior. And the executive coach says, "You can have your thoughts. You're entitled to your thoughts. You should have your thoughts, you're a human being. On the job, in this role, these are the behaviors that we'd like to pay you to perform." Boom. Cleared the sky like I'd never seen before. When I heard him say it the way he said it, he said, "You're entitled to your thoughts. You should have your thoughts. You're very welcome to have your thoughts, but on the job, please follow these behavioral procedures that we're asking you to follow."… The new phraseology seems to be like, "Bring your whole self to work." Well, you are anyway. And we are human, we have needs, we have issues. There's a time and there's a place for certain things you may or may not agree. And as adults, as professionals, as mature people, we do learn to check certain things at the door while we perform other things. It's just kind of understood. You'll be able to do that if you are a well trained, good intending, well hired professional. ….We have to set expectations and we have to hold people accountable. We know this is not ideal. We know that it'd be easier to be at the beach with ice cream right now or something like that. But we're now at work and we're doing this and we plan to do this throughout the next eight hours or the next 10 hours, 12 hours for the next three months, for the next three years, whatever it is, are you the right one to carry this behavior out with us during this time?''   20:53 The impact of culture in filling gaps Ronnie explained why bringing in people short-term can create more gaps down the line.  ‘'It's going to take six months to a year before trust develops really, really developed. Because every place of work has the stuff that people do not want to publish and talk about immediately. Every place, anytime you put two people together you have a culture. And we know that culture is important in every place and cultures are unique. Not to say that one is so one off like none in every other place, but every place will never have exactly the same personalities, exactly the same dynamic, exactly the same location, et cetera. So if you're bringing someone, say, who's temporary. Okay, you're here for three months. They have already checked your due date at the door. Okay, welcome. You're here in June, so see you later in September. You're three months. So they've kind of like got that circle around you we're just going to be nice for three months, sometimes. People can work well together. But also for the people who are staying, that's not their long-term solution. There lies another gap. Who's going to be here in October for them? Whether it's an option that that person could get hired on long-term or not, you're still in test phase. People may be withholding what are the real issues? Because what's going to get done about them anyway? And then some people worry, did I say too much? Did I reveal too much about what's really going on? Is it going to look bad on me? Because remember, it's easy to shoot the messenger.''   25:20 Developing leaders comes down to personality and attitude  Ronnie said that the right attitude is essential in leadership, but not everyone can be coached.  ‘'So if we took two terms to work with, let's talk about, okay, there's personality. That's one thing. And then there's attitude. I want to go with attitude. I want to put weight on attitude. The right attitude can take you very far. So then there's kind of the innate attitude. Some people just have that bright shining sun in the sky attitude and they can weather the storm, what have you. Some just truly have that. Some can be shown to look at the sun rather than the mud. Okay. I like that. I heard a quote recently. "Two prisoners looked out from the prison bars, one saw this mud, the other saw the stars." What's your takeaway from that? Exactly. Yeah. You get to choose what you see. One saw a dirty, dismal, hopeless situation and the other one saw hope and aspiration. So attitude can be nurtured and developed, but it helped a whole bunch. If you already bring it, if you already bring it, the nurture curve is shorter. And by the way, as coaching goes, not everyone can be coached. Not everyone is willing to be coached. It's a possibility. It's not a guarantee.''   32:18 Frontline employees can resolve hospital painpoints  Ronnie said that frontline employees can offer viable solutions for the C-suite.  ‘'How can you be the solution? What solution can you bring or suggest? Okay, let's go back to the pay grade conversation. This is one thing I want to take down to the lowest level. I think that companies who could ingrain into their people, I don't know if it could be an incentivized thing, can you look for the solution? Can you bring... So you've got a pain point, you've got a block, you've got a cog in the wheel. What in your view, what is the solution to bring that out? Because no one's going to know the pain better than you if you're in it. If you ask me if I'm up in the C-suite, there's no way,I would have to go and do some research. I would have to bring a meeting together to really understand what it is they're going through down there. Were you at the front line, pass the pain points up, but not looking like a complaint. What are one to two viable solutions that you see for your pain point? Bring that. Try to think of a solution-based approach. I hear your pain. Thank you for bringing that up. What do you think the solution is?''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Ronnie Kinsey on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:    The impact of EHR on burnout in healthcare. ‘ I was involved in transitioning from pen and paper to the computer and I saw huge resistance from the clinicians involved and the leaders involved….The idea of burnout has been around for quite some time, but I began to see it really unravel when we started launching EHR.''   How multiple gaps can lead to ‘'abyss potential.'' ‘'… maybe you need to take off. Now, I'll circle back, there lies the gap again. I'm not saying wrong. I'm just saying this goes back to the gap. You need to be out. We got that. If you have the flu, please be out. Now our schedule will be a bit disrupted. So there goes back to a gap. A potential gap. And if not noticed and managed effectively and timely, you're going to have a mess.''   Why it's vital to consider an outside resource for support – and why coaching is not therapy. ‘'I want everyone who might be listening to know that you should never have second doubts about getting any help that you might think you need or want for your mental fitness. Coaching is not mental therapy. … You can get mental toughness from a coach, but it's not therapy. There may be therapists who do some coaching per se, but generally coaching is not therapy. I wanted to put that out there.''   Hospitals need to get a new wheel, not recreate one (and two inspirational quotes from Walt Disney and Elon Musk).      What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.  

Healthcare marketing has seen a shift from ‘'patient'' to ‘'consumer'' in recent years. Doug Pohl explains to Jim Cagliostro how a focus on heart and emotions can help to reconnect hospitals with their patients.   Episode Introduction  Doug explains why hospitals need to prioritize ‘'humanity'' over the bottom line, how to become a two-way mirror to build patient relationships, and why Business 101 is all about listening. He also shares how his experience as a singer/songwriter helped him to understand the power of storytelling, and why true leadership is about helping people climb the ladder.   Show Topics   Hospitals need to focus on humanity in marketing Losing the community connection Healthcare marketing is a two-way mirror Business 101: It's about listening Tapping into the power of storytelling Leadership is about helping people climb the ladder 06:54 Hospitals need to focus on humanity in marketing Doug explained why the shift to ‘'consumers'' from ‘'patients'' creates a deeper problem.  ‘'I feel like a lot of them are doing a decent job, in that there's been this shift to people, you can't necessarily even call them patients yet, but to view them as consumers. So, they market to us as consumers. And I get that, and I think it's effective in some ways, but my personal view is if we're treating people as healthcare consumers, there's a deeper problem that we're not addressing. And I think to ignore that is a long-term mistake. So, I think it's really important that we focus on people's humanity and do it in some powerful ways. You and I talked previously, there's some commercials out there that tap into the emotions of what people are feeling when they go into a hospital, whether as a patient or a loved one or whatever the situation is, a clinician, whoever. Everyone has these strong emotions that come with them into a healthcare facility. And understanding those, having genuine empathy, feels like a weak word these days because we use it so often. But genuine concern for those feelings and for those people and wanting to help in real ways, even if it means less efficient business or a lower bottom line, but focusing on the heart and the emotions, I think is really the best path forward for marketing. And in my opinion, for operations in general.''   09:13 Losing the community connection  Doug said the acquisition of a smaller hospital by a larger system pushes patients aside.  ‘' I think it sort of starts in-house with a disconnect with the clinicians and administrators and everybody who works in that system at that regional hospital, where they feel less of a connection with their organization, they feel like things are being imposed on them by the mothership, and all of a sudden everything's changed. They feel a disconnect. They feel pushed aside. They feel like they're not as important as they should be, and perhaps as they used to be. And I think there's a trickle-down that comes from that. They pass on those feelings to the community, whether in the hospital or outside in their personal lives. It does change how people feel subconsciously, at least. I live in a small community, and we do have a small regional hospital that's connected to a larger one, but we're friends with the nurses and the doctors. We see them out in town and at the gym, and we talk to them, we hear their struggles, and we hear how tough it is for them. And so, these feelings are being shared in the community, and it does impact you as a patient that when it's your turn, you go and you know what people are going through, and there's this sort of inherent disdain for the organization as a whole because of it.''   12:36 Healthcare marketing is a two-way mirror  Doug explained why every brand needs to reflect the audience back to themselves.  ‘'In marketing, our job as a brand, any brand is to be a mirror, but it's sort of a two-way mirror. So, we want to reflect the audience back to themselves. The things that bother them, their challenges, their pain points, whatever you want to call it, we acknowledge those. We say, "Here's what's going on with you, we understand your situation." So, we reflect that, and we can do that not just by saying it, but we have to say it in the right way. So, we also reflect their exact words. That's why getting those videos, those voice recordings are important. Hear that, get that voice of customer data, in this case patients or whoever it is, but get their actual words and use it. As an organization, you might call a certain program, you might have an in-house name for it. Let's just use our imaginations here. But when you start marketing, people don't understand that. And maybe you're doing your research with your audience and you realize they're actually using a different name for it. Well, name, use what people say and give it back to them. That helps them feel more connection, that sort of subconscious connection that we can't measure, but it makes a difference. It really does. Once you have that and you genuinely understand, then you're able to present your solution or offer it in a way that feels natural. It doesn't feel salesy, it just feels like an extension of that connection.''   16:31 Business 101: It's about listening Doug questioned exactly how much the needs of the patient are being heard today.  ‘'How much listening is going on? Are organizations not just listening, but actually hearing and absorbing and really taking patient's needs to heart? Yes, there has to be a balance with operations and with the financial concerns and all of that. I get it. But at the end of the day, none of that matters if patients aren't happy. And I'm going to go back to the beginning here. There's this trend of calling patients consumers. If your consumers aren't happy, you need to change something. That's the whole point of the business. You have to have people happy to get them to spend money, otherwise they're going to go somewhere else, right? Business 101. So, I think the most effective way is to look at how we're listening. What are we doing? Where can we improve to listen better? And once we listen, then what are we doing with that information? Are we genuinely being that mirror? Are we giving people what they want? Or are we just putting on a light patina onto what we wanted to do anyways?''   18:15 Tapping into the power of storytelling  Doug said overlooking the human experience leaves out 80% of the marketing story.  ‘'This is something I've been thinking a lot about lately. Stories are so powerful. It's incredible. And back in my songwriting days, it was always about the story. I'd make a point to go talk with whoever I could, wherever I was at. I wanted to go talk with strangers and just get them talking, just hear their stories. And it's amazing, people almost always want to share. I would write songs based on their experiences, based on what they told me. And those are the songs people love the best. They were real. They were actual stories that had a beginning, a climax and an end. And it was similar to their own lived experiences. So, again, it was taking people's stories, hearing their own words, and feeding it back to the audience. And so, it's the same thing that we can do with our marketing. We tell those stories. It's not just a disease. It's not just a treatment or a condition or whatever. It's a real person, who has parents and children and jobs and concerns and bills and whatever. That's all part of it. And to neglect all those different aspects of who they are, of what makes them human, that's to leave out 80% of the story or more. That's the meat that's really going to help connect with people, because everybody has those things. Not everyone has... pick a condition. Not everyone has diabetes, but everybody has bills and parents and jobs or whatever. So, that's how we connect, is by telling the whole story. It has to be a 360 view. And when we do that, I think it really opens up some amazing possibilities for what we can do, not only to create successful marketing, but to actually help and do what we're trying to do with healthcare.''   27:28 Leadership is about helping people climb the ladder Doug said leading by example and turning to help others means everybody wins.  ‘'My first management experience came from my job as a lifeguard in college in the summers. And my first year, I started off with a great manager who led by example. He never asked us to do anything that he wouldn't do himself, and he made sure we all saw him do it first. And then when it was my turn to be manager, I didn't do that. I was lazy, and I would just assume people knew that I could do things. And I learned very quickly that that was a big mistake. Now, what I try to show my team is, not only can I do it, but I can probably do it better than you because I have done it. I did it for years, and now I want to help you get to my level. So, then we can all grow, we can all benefit. Everybody wins. So, I think my leadership advice that I try to remind myself all the time is, lead by example and then turn around and help the next person up the ladder.''    Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Doug Pohl on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:    ‘'Everybody has a different story.'' From professional country music singer/singwriter to healthcare content marketer. Listen to Doug's unique journey.    Following your instincts and avoiding ‘'normal'', how going with gut instinct was Doug's trajectory. ‘'I've never wanted to be normal. In high school, that was my only trajectory, was just to do something different and just go with my gut.‘'   The power of storytelling: Why listening to people's stories is the first step to connecting with your patients. ‘'Not because we have a particular end in mind, because we want them to support an idea or to reinforce something that we might already know, but genuinely because we care.''   If a message misses the mark, it's not the fault of our audience. ‘'Anytime we're communicating, if someone's not understanding us, we sort of put the blame on them, but really the onus is on us. So, the question should be asked, "How can I do better? What is it that I'm not doing or that I need to improve in order to help them understand what I'm trying to say?"   Giving data the time to filter through. Why healthcare's unique nature means results take time. ‘'Anytime you're working with people, it's going to take a long time. So, you want to be flexible, but you need to allow the data to come in.''     What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700  

Lauren Pasquale Bartlett is the first Chief Marketing Officer at Ingenovis Health, healthcare workforce solutions providers. Here, she shares how hospitals can benefit from a clear purpose, and how to achieve it.    Episode Introduction  Lauren discusses how purpose is every organization's North Star, how it creates passion and reveals the survey that shows people prioritize purpose over profit She also shares Ingenovis' ACT (Advocacy, Careers, Tools) program, discusses the rationale behind ‘'building a home for healthcare talent,'' explains why support from the C-Suite is vital to achieve purpose, and outlines how leading by example can impact an entire organization.    Show Topics   The purpose of Ingenovis Health Highlighting the human element of healthcare Bringing your purpose and mission statement together The common challenges of achieving buy-in How to bring purpose to life Leading by example and leaning into purpose   01:54 The purpose of Ingenovis Health  Lauren explained how Ingenovis Health became one of the largest healthcare staffing companies.  ‘'… I'll start with Ingenovis Health because it's kind of new to the market. Ingenovis Health was founded in early 2021 with the merger of four leading healthcare talent providers, and at the time, that was Fastaff and U.S. Nursing, Trustaff Travel Nursing and CardioSolution. So those four companies came together in the early of 2021, and we've since acquired three more. So now Ingenovis Health is one of the largest healthcare staffing companies in the industry. We're about a $2 billion company placing around 10,000 doctors, nurses and allied professionals in positions nationwide. They're mostly travel positions, Jim, temporary positions, some permanent, but really, really large reach in who we place in our clients nationwide. As Chief Marketing Officer, I'm responsible for the marketing, the brand, the communications, and as the first chief marketing officer of Ingenovis Health, I also had the unique opportunity to contribute to the development of the purpose and the mission for the new organization.‘'   04:04 Highlighting the human element of healthcare Lauren said we need to be aware of the impact of ongoing trauma on frontline employees, especially after the pandemic.  ‘'…we have to just keep the human element at the core of it. And you know better than anybody, when you think about how much the nurses are dealing with from long shifts to understaffed units, lack of PPE during COVID, I think you could easily disassociate yourself from the idea that those are real people with their own lives and families, and they're dedicating so much of their energy and their attention to their patients. So it really is a very human industry, and you have to, again, keep them at the core of it. One of the things about our nurses, our doctors, our allies, is that they're just experiencing stuff that other people don't experience in their jobs. So they're seeing a lot of death, particularly during COVID. They're experiencing traumatic events along the way, and oftentimes they're called to come back in on days off, even though they haven't really had a sufficient break just because there's not enough help. So you really have to keep thinking of them as you define purpose in anything that impacts the healthcare industry.''    10:34: Bringing your purpose and mission statement together Lauren illustrated how Ingenovis Health linked their purpose and mission statement in a post-Covid context.   ‘'The mission statement for Ingenovis Health is that we create ecosystems where healthcare talent can grow, thrive, and deliver the best patient care. And so as I was mentioning before, another thing that was coming out of COVID was you'd find a nurse or a doctor who had just done 18 months of COVID assignments back-to-back and really needed a break. And so through the merger of our seven different companies, we provide those opportunities that they can choose based on where they are in their careers, their lives, or their psyche. So for example, someone who's really burned out on bedside can come to our company healthcare support and get a mental rest. Maybe take a one year or two year assignment as a case manager, someone who's working remotely, just not bedside, but still apply their clinical talents. On the flip side, you might have a nurse who's trying to quickly grow their experience and accelerate their earning potential, and they can take a one week strike assignment with U.S. Nursing, working a 60 hour week in a high stress situation where there's really very little orientation and training, and that grows their value and their experience. And we offer the same thing for doctors. Doctors within our locum tenens company, VISTA can take short or longer term assignments around the country and through our brand CardioSolution that places cardiac specialists in underserved communities, rural communities nationwide for one to three year assignments. So there's a lot of variety there. And depending on where you are in your career, we feel you've got the home, you can stay in this ecosystem and still have a lot of different experiences.''   19:40 The common challenges of achieving buy-in Lauren said the key to delivering purpose is the support of the C-Suite.  ‘'What I've seen is that you do need the support of the CEO or your executive leadership or your managing director, whoever it is, or people don't take it seriously. And not everybody is always going to be the optimistic, hopeful champion of your purpose that you are envisioning. But those folks can get on board if they see it in the leadership above them, and they can at least believe, well, this is where he thinks we should be going, where she thinks we should be going. So again, that top-down leadership is vitally important, and then you have to be serious about it. It has to remain a focus in your strategy as well as operations. So did you hire the proper people? Are they properly skilled? Did you devote resources? Did you give it attention? Are you talking about it? Because if you're not authentic in your commitment to the purpose, it becomes pretty clear, especially during tough times when you have to make difficult decisions about where to invest time and money.''   22:08 How to bring purpose to life Lauren said Ingenovis try to understand the voice of the clinician and recognize their teams to bring their purpose to life.  ‘'Some of the things we do, in addition to trying to understand the voice of the clinician, we also make sure that we take time to recognize the opportunities to reward them, recognize them, like Nurses Week, Doctor's Day, Mental Wellness Week, these are the things that we try not to miss, and we try to say, you're thinking about it, we're thinking about it. Let's make a big splash with the resources we have. We've also had a very successful PR campaign over the last few years where we've been able to secure placements for our nurses and our doctors on really large media outlets, including the Today Show multiple times. Good Morning America, CNBC, Fox News, really, really big news outlets who are giving our nurses and doctors a voice and a chance to be heard. And that's an authentic way for us to bring the purpose to life because going back to that research we did before developing the ACT program, how can you develop a program if you don't know what people are seeking, what they're dying for? One of the things we heard is that the nurses felt like they weren't listened to and they didn't feel like they were part of the conversation, and they got a lot of hero accolades in the beginning of COVID, and then it really died down and got quiet. But it's not because they stopped doing exactly the same thing. It's just our attention moved on to other things.''    24:56 Leading by example and leaning into purpose Lauren said the customer must be the focus in all areas of leadership.  ‘'…. like anything in marketing, just be thinking about your customer. And for me, again, I made such a big shift. I was working in sports for a long time. I made this shift into healthcare, and I've just learned so much and grown to respect and value the contributions of everyone in this industry. It's complicated and it's often challenging. There's many opinions about who's the villain and there isn't one. It's just a really complex market with financial pressures and these shortages that are happening. So just always be thinking about your customer. The other thing I would say is lead by example, because it's just amazing how much other people will mirror your attitude and your actions, and you want to be a force for good in your organization. That I think the last thing I'll say just based on our topic today is lean into purpose as part of driving clarity and focus for your teams. So you're not only creating alignment, but you're also inspiring passion for what you do and why you're doing it, and giving them a sense of pride in the mission. So that consistency in action and messaging is really important.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Lauren Pasquale Bartlett on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:    Linking purpose and passion: ‘'I think different companies do it in different ways. For us, we look at the purpose as the North Star, the guiding light, your vision for what the company stands for today and in the future. And the mission statement for us is how you achieve that grand vision. So in other words, the mission statement is what you're creating along the way to fulfill on your purpose.''  Creating a clinician focused clinician first purpose; the rationale behind ‘'A home for healthcare talent.''  How purpose creates passion, and the study that found nearly three quarters of respondents believe purpose should ‘'have more weight than profits''. Creating the ACT program (Advocacy, Careers, Tools). How Ingenovis Healthcare committed to improving the careers and wellbeing of its clinicians. ‘'That was us bringing the purpose statement to life, and it's a program that we're investing in.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700  

Growing numbers of nurses are struggling with the demands of their profession.  Jenny Finnell explains the benefits of mentorship and the expanding mission of Nurses Teach Nurses to Jim Cagliostro.   Episode Introduction  Jenny shares her foundational belief in ‘'paying it forward'', how everyone has a role to play in mentorship, why nurses need a safe zone, and the impact of the pandemic on burnout. She also highlights the financial benefits for hospitals supporting mentorship, her global vision for Nurses Teach Nurses, and why a 45% rise in demand for advanced practice nurses reinforces the urgent need for support.   Show Topics   Journey to CEO and Founder of Nurses Teach Nurses The reality of a career in nursing Providing a safe zone for struggling nurses Learning to cope with suffering and death  How the pandemic contributed to burnout Encouraging nurses into mentorship The benefits of mentorship for hospitals      02:35 Journey to CEO and founder of CRNA School Prep Academy and Nurses Teach Nurses, Jenny explained how Nurses Teach Nurses grew out of community.  ‘'I've been an anesthesia provider now for nine years. Prior to that, I was a medical ICU nurse for three years. I've been in the realm of nursing for 14 years in total. Back in 2018, I actually got on social media for the first time since prior to grad school and I called myself Jenny CRNA, and I started getting direct messages on, "Hey, I've been facing a lot of setbacks and failures. Can you help coach me on how to get into CNA school?" I started doing that and I handed out my cell phone was chit chatting with people, probably about 10 or 15 people when I actually decided, "Wow, this is getting to be a lot. Let's make a Facebook group so I can talk to everyone at once. I'm kind of a broken record sometimes, so that way I can say one thing and have everyone hear it." I had a network, I had a community. I knew program faculty, I knew a lot of CRNAs, a lot of CNA leaders. I really pooled on my community to really help these nurses. They were finding a lot of success and just overjoyed with the help they were receiving. Before I know it, that group grew to 6,000 people. I was finding myself spending a lot of time mentoring and coaching, and that's when I started CRNA School Prep Academy because I was kind of burning myself out, if I'm being honest. I was working 40 hours a week, had two little kids and spending 20 hours teaching for free. I'm like, "Wow, I really want to do this, but how can I monetize my time?" CRNA School Prep Academy was born and where Nurses Teach Nurses comes into play is I've been doing CRNA School Prep Academy and mentoring for three years now and we've mentored over 5,000 ICU nurses and went through the pandemic during all that time.''   08:13 The reality of a career in nursing Jenny said nurses are the only people who relate to the needs of other nurses. ‘'…I think what's hard is the reason why I like the concept of Nurses Teach Nurses is no one can really truly understand the footsteps of a nurse unless you have been there. It's like being at war and being in the trenches with someone else. You understand what it's like, and that's what nurses need. They need that relatability piece. They need their peers to fall back on for that support. I knew now was the time, because I don't want to see this happen to our profession. I want to see a big change happen in a big way. Sometimes I think I'm crazy for dreaming up all the things that I hope to accomplish. I think a lot of people are stepping up to the plate, but we have to try to tackle this big problem in our country. We're all going to be in big trouble. We rely on nurses for healthcare, and we need to help them flourish in this profession, not deter them and help them leave, which is all we've been doing. While this is not one thing fixes all, I do think providing support and mentorship and career opportunities, career advancement opportunities, connection with community, that's a huge part of it. We've never had a platform to really stick together and do this. I hope to create this big platform to bring nurses more career opportunities and satisfaction.''   12:42 Providing a safe zone for struggling nurses Jenny explained why the absence of the right support is having a significant impact on nurses.  ‘'So I think a lot of nurses struggle with guilt and wanting to leave the profession that they thought they were so passionate about and loved. I know a lot of ICU nurses feel that way. I didn't cut it, I didn't cut it. I thought I was capable and I clearly wasn't. It's not their fault. They just didn't have the right support system. I think that's part of the reason why we're seeing these nurses in the first few years burn out because they were struggling and they feel alone and they're scared, they're fearful. All this media that has been pushed in the media, they're afraid to go to jail. They're afraid to be put in prison. They're afraid to make a mistake. They're afraid my coworkers are going to think I'm stupid. I'm not capable. They don't tell a soul. They don't think they can even talk to their coworkers or they're afraid they're going to be a black sheep now in their unit. What I think about Nurse Teach Nurses is, we can provide that safe zone of, I don't know who you are, I don't even know where you work. Let's talk. I know you're a nurse in the ICU, in the medical I C U. I need support. I feel like I can't get it on my unit because maybe it's a toxic unit and I wish that wasn't the case, but it's true. I think all nurses need access to a safe place to ask questions.''   16:23 Learning to cope with suffering and death  Jenny said young nurses in particular need support in dealing with the trauma of their job.  ‘'…. if you think about where you are when you graduate nursing school at 21, 22 years old, you really are, I feel like I'm aging myself, but you are a very young adult, if not a very large child. That's for my own self. Right? I know for me, speaking back when I first started in the medical ICU, I saw death all the time. I didn't live through a pandemic. H1N1 was the scariest thing I saw. I saw girls my age dying, having babies in the ICU on ECMO and Prisma and things like that. It was terrifying to go into a room with someone on my birthday and take care of them on their deathbed. That being said, it was so hard for me to cope. That was the only time in my life I could probably say I was clinically depressed. It's because I was faced with the fact that I was taking care of death and suffering all the time, and it really broke my soul. I think as a young adult, if you don't have a good idea of what death is to you and what it means for afterlife and all of the things that you have to really think about as you get older and you typically do when you have more death around you, it's abrasive. It's like a gut punch in the stomach. It's a hard face of, this is a really cruel, harsh world we live in. As a young adult, it's hard to cope with that. You feel like maybe you're not strong enough and you kind of take this badge of honor. I should be tough and I don't want to cry. I cried one time so much in the ICU that I actually got a tear duct clog the next time.''   21:10 How the pandemic contributed to burnout Jenny said a focus on mental health and support through mentoring can help nurses to cope with managing complex emotions.  ‘'… I do think the pandemic poured gasoline on a fire essentially where it was already burning and now we're burning more. We're seeing a more noticeable statistical exit. I also think that the stress the pandemic has put people in a mental state of not having the energy to talk about it and to deal with it. I experienced this particular experience when I was in grad school where just the idea of coming home from a stressful day and trying to talk about it, I was like, I can't. I'm empty. I can't. The whole idea of talking about it rehashes those emotions and feelings and stress to where that in itself seems like a huge chore. I think that's where nurses are at right now. They don't even want to try to deal with it because that in itself would be the breaking straw that could kill them. Mentally and physically, burnout and doesn't just affect your mental status, it affects you physically. The stress hormone, cortisol does wreak havoc on your body, panic attacks, high blood pressure. There are a lot of things, no sleep, insomnia. There are a lot of physical problems that develop from emotional stress that's not handled. I think we've let it go so far that we just, I don't think there's a way to turn a hundred percent back, but what I do think is going forward, we have to focus on mental health and support and guidance and the outlet for these nurses to share what their emotions with someone who gets it, someone who's lived through it with them, who can give them that sounding board of you're not abnormal. It's okay to feel these frustrations, anger, grief.''   28:31 Encouraging nurses into mentorship  Jenny said mentoring offered a huge opportunity for professional growth and fulfillment in the nursing profession.   ‘'…how can we get someone's interest in doing this? That's why, again, they monetize their time. Do you go out and garden for an hour, or do you spend an hour on a call with a nurse? Both are really rewarding, but I think it's just getting someone in that habit of, okay, I'm being rewarded for my time and I'm getting people kind of used to that. This is a normal relationship to have between nurses. Yeah, what my fear is, if we don't make a big change to allow nurses to connect with other fellow nurses and bring in all of the expertise and like you said, the retirement nurses brains or experienced brains to share with our next generation, we are missing a huge opportunity for growth both professionally and innovativeness for the community, but just fulfillment wise for the actual nurses who are currently doing the job.''   35:31 The benefits of mentorship for hospitals  Jenny said partnering with hospitals is beneficial to nursing, without requiring a financial investment.   ‘'What I would say is it's no risk in my opinion with promoting mentorship among nurses, especially through the platform Nurses Teach Nurses because it's self-fulfilled. It doesn't require an investment from a hospital. Nurses are clearly already willing to pay for someone else's time. If you go to Nurses Teach Nurses and read through the testimonials just within the anesthesia space, they're glowing reviews. Again, with the first month that we actually were open, we were already profitable. Again, this could be looked at as a partnership or maybe could even be a partnership where again, we could actually help the hospital system not only provide mentorship, but again, if it's a partnership program where, again they're sending us nurses who need the mentorship, it could be a really beautiful relationship where both parties could win. I think that finding ways where we're not going to drag more money out of the healthcare system because I'm very aware that most hospital execs feel like there's just no more money to spend. I get it. I've been fortunate enough to be a part of monthly meetings where I currently work as a CRNA, and we talk about stuff like financials, and I know some hospital systems are really in dire constraints. I think that we need a solution that's not going to pull more of those resources out of the system, which is why I feel like the system kind of fuels itself and which is why I designed it that way. I want it to be, if you think of Fiber or Upwork, it's kind of like a freelancing marketplace. This is kind of what this is.'' Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Jenny Finnell on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:    Jenny's motivation behind Nurses Teach Nurses: ‘'I wanted nurses to support nurses. And I also believe in the power of nurses mentoring, precepting, teaching, supporting. Nurses Teach Nurses was born, which is an open marketplace where nurses can act as a freelancer and get paid for the time they spend mentoring.''   From resume edits and transcript audits to mentor coaching, why everyone has a role to play in mentorship.   Why the pressure to prove themselves can have a negative impact on nurses. ‘'It's a very female based profession…there could be something that women feel like they have to prove because we've always been kind of held a different standard and to men.''   The need for mentors: why the increase in demand for advanced practice nurses emphasizes the need for mentorship. ‘'I've read a statistic that we're going to grow by 45% with the need for advanced practice nurses by 2027. That's huge. The fact that we're going to grow by 45%, that's double what most other career paths are.''   How Nurses Teach Nurses helps health systems: ‘'For every 1% decrease in hospital churn, I think I read that it saves $250,000 for the system.''   Phase 1, 2, and 3 for Nurses Teach Nurses: Jenny's vision of global expansion, and helping nurses to overcome limiting beliefs and step into leadership.   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700  

High levels of government funding means that the value of healthcare fraud runs into billions of dollars annually. Attorney Jonathan Tycko discusses his role in representing whistleblowers, with Jim Cagliostro.    Episode Introduction  Jonathan explains why the value of healthcare related cases under the False Claims Act ($1.8 billion recovered in 2022) represents only a fraction of the real total, why most people are reluctant to become whistleblowers, and shares the universal mistake all health systems make. He also urges hospitals to focus on mission over money and explains why compliance isn't the enemy of healthcare.   Show Topics   Representing whistleblowers in qui tam lawsuits Understanding healthcare fraud Analyzing statistics in healthcare fraud  Whistleblowers share key characteristics The risks of becoming a whistleblower Compliance should not be seen as a problem Hospitals must focus on mission, not money   02:46 Representing whistleblowers in qui tam lawsuits Jonathan explained his move into the healthcare niche, and the meaning of ‘'qui tam.'' ‘'This particular practice that I'm in now where I represent whistleblowers for reasons we can get into as we go along here, tends to be very focused in the healthcare sector….about 15 years ago, I got a call from a person who was involved in one of these cases and he says, "I'm a relator in a qui tam lawsuit and I'm looking for a new lawyer to help me with an appeal." And I said, "I don't even know what those words mean." Even though I had been practicing law for about 15 years at that point I had never heard of these kinds of cases before. It is really a very niche practice, there are very few of them. But I took his case and through that really learned a little bit about the False Claims Act, which is the statute we operate under mostly. And just got really interested in it from that one case. And then slowly over time started to look for other opportunities to represent clients in that area. Did a little marketing and so forth and over time built up the practice. And now this is almost exclusively what I do as a lawyer, which is representing whistleblowers in what are called qui tam lawsuits, which is where a whistleblower is bringing a claim for some type of fraud, where the fraud is really committed on somebody else, usually the government or government programs. But it is brought by a private whistleblower that is specifically authorized by certain laws.''   06:03 Understanding healthcare fraud  Jonathan said any type of fraud in healthcare is likely to fall within the False Claims Act due to the extent of government funding.  ‘'Well, at a very high level of generality, it's just what it says. It's any type of fraud scheme that is impacting the healthcare system. What we're focused on a little bit more specifically is, like I said, there's this statute called the False Claims Act, which makes it illegal to basically commit fraud on the government or on programs that are funded with government dollars. And as you know, obviously a huge percentage of healthcare spending is funded through Medicare, Medicaid, Tricare, the VA system, and these are all programs that are covered by the False Claims Act. So any type of fraudulent conduct or unlawful conduct that is widespread and that impacts the healthcare industry is likely to cross paths with the False Claims Act because of all those government dollars that are used to fund our healthcare system. And so any sort of fraud... And I can run through a whole bunch of different categories and give you some sense of what the types of cases are, but pretty much any type of fraud that is ongoing in the healthcare industry is likely to also violate the False Claims Act. And so a whistleblower, somebody who has non-public information about that fraud, is a potential whistleblower under that statute.''   07:45 Analyzing statistics in healthcare fraud Jonathan said that the high levels of healthcare spend makes it difficult to provide accurate figures on fraud.  ‘'It's really hard. It's an interesting question. It's really hard to talk about fraud in a statistical sense because you only know about what gets reported. And so you never really know how much fraud is occurring that you don't know about. So what I can give you some sense of is what is reported by various government agencies that have access to some statistics. So what we know is that pretty much every study that's done of any government program where they're looking at what are the rates of what folks in the government call fraud, waste, and abuse. So it's not all just intentional fraud, but it's also just wasted money. They're looking at, "If we spend a billion dollars, how much of that is going to actually go to the program and how much of it is going to just get siphoned off through fraud, waste, and abuse? And they pretty much always conclude that it's about 10%, which is a shockingly high number, but that's usually what they conclude. And so what I can tell you is I can give you some more very, very specific statistics. So if we look at just this past year, 2022. The government reports statistics under the False Claims Act every year. So in 2022, the government recovered about 1.8 billion in healthcare related False Claims Act cases. And that's somewhere around 2 billion a year. Again, that's what they recover. So the actual amount of fraud is probably some multiple of that. And that's just the federal government, right? The state governments recover more on top of that if there are Medicaid dollars, because Medicaid is jointly funded by the federal government and by state governments. So that's even a little bit of an underestimate. My sense is probably the real number is about 5 billion a year in recoveries and maybe five X or 10 X more of that that isn't recovered. So it's a lot. And it's a lot because healthcare spending is so huge.''   12:44 Whistleblowers share key characteristics Jonathan said most people are reluctant to take action when it comes to whistleblowing.  ‘'….everybody, when you ask them in the abstract, "Well, if you saw your employer doing something illegal, would you turn them in?" I think most people would say, "Oh, yeah. Yeah. Of course I would." But then in practice, most people actually don't because we have these very, very strong instincts to want to get along with the people we know and work with. It turns out that most people, even most good people who would never themselves do something dishonest, won't blow the whistle when they see it happening in an employment setting. And what I've noticed is that the people who do, the people are willing to blow the whistle, tend to have some fairly unique personality types. They're people with a strong sense of self-identity. They're not necessarily people who are just going to go along to get along. They have a strong sense of right or wrong. Often they have a strong sense of patriotism because a lot of these cases have to do with injuries being done to the government and to taxpayer dollars. And so they have this sense of wanting to stick up for the country or for the community. And so they're often are motivated by some strong personality trait, and they tend to be very strong-willed people.''   13:36 The risks of becoming a whistleblower Jonathan said whistleblowers risk dismissal from their jobs for raising concerns with employers and play a key role in providing information.  ‘'And this goes to the question of what is the role of whistleblowers within organizations? Often by the time somebody has called me, they've already tried to solve the problem internally at the company or in the office or with their employer. And what they've run into is being told to keep their mouth shut, being dismissed, being told they're crazy, maybe being fired because the company doesn't want to deal with it. And so they've tried to fix the problem and they had been met with this stonewalling or evidence that the company isn't going to deal with it. And that's usually what's happened before they call me. Then the next question is, "Well, what role does the whistleblower actually play in one of these cases?" And what are called again, qui tam cases. These are cases brought under the False Claims Act by the whistleblower. The main role in that case is for the whistleblower to actually provide the information to the government.''   19:35 Compliance should not be seen as a problem  Jonathan said that healthcare's focus on the bottom line is an obstacle to compliance.  ‘'If they're in a rush to ramp up the company and they're trying to turn the company profitable and go public or sell it, trying to get to the next round of VC money or whatever it is, there's a strong pressure to focus very much on the bottom line. And sometimes compliance issues can at least not stop that, but can slow it down a little bit. And so often when the whistleblower raises his or her hand and says, "Well, wait a second. Isn't the way we're marketing this drug or isn't the way that we're billing for this procedure, whatever the issue is, isn't that maybe wrong?" There's often, in companies like that, a tendency to instinctively say, "We don't really want to hear about that." No. No. Because God forbid the answer be, "Yeah. It's wrong." Then we might have to change how we do things and we don't want to change how we do things. So there's that instinctual resistance to it. So again, that's a corporate culture thing. So what I would say is you can't, and particularly in healthcare where it's such a heavily regulated business, you can't just view compliance as a problem. You have to view it as just part of the business, right? That you have to deal with compliance. You can't have this negative view that compliance is just something to be minimized and dealt with. And so if a whistleblower within the company... They're not really a whistleblower at that point, they're just an employee who is raising an issue that they see in the company, right? They haven't become a whistleblower yet.''   30:06 Hospitals must focus on mission, not money Jonathan said the priority in healthcare has to be the service provided. ‘'But don't become obsessed with the money. It can't be about the money as the first priority, right?The first priority has to be, "Let's provide the service, provide the product, do it in a safe way, do it in an ethical way." And if you do that and you do it well, you will make your money. But if you go into the healthcare business and you think making the money is the thing, your chances of running into legal problems go way up because it is a regulated industry. It's a highly regulated industry. It's an industry that the government watches carefully. And people within the industry, a lot of them do know about these whistleblower rights. And so maybe you can make some money for a little while, but eventually you'll get caught. So just keep your eyes on the prize. And the prize should be, "Am I fulfilling whatever the mission of the company or my healthcare mission is?" Take compliance seriously. It's just part of the business. It's not something outside the business that you have to view as the enemy. You have to view compliance as just part of the business and take it seriously. So from my perspective, that's what I would say to somebody running a healthcare entity.''   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Jonathan Tyko on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:    The niche nature of whistleblowing in healthcare: ‘'There are only about 600 of these cases that are filed nationwide every year. And just to give you some sense, that is out of about 400,000 cases that are filed every year in federal court. So this is tiny, it's one 10th of 1% of the lawsuits in the country.'' The potential rewards for whistleblowers in successful cases: ‘'In some of these cases the recoveries are quite large. Just in fiscal year 2022, the last reported fiscal year, the federal government paid $488 million to the whistleblowers in False Claims Act cases.'' Why not taking whistleblowers seriously is the universal mistake made by healthcare systems.  Why a feedback loop is essential in encouraging people to become whistleblowers. ‘'Sometimes the employee thinks the company is doing something illegal, but actually they're not. And so it's also important, I think, to have a feedback loop that goes back to the employee that says, "Yeah. We've heard you."  Understanding the process: Why litigation can take years. ‘'The process is slow. The government investigations often take months or years to complete. And then if you have to litigate on top of that, that's more months and years. And in some sense, the stronger cases take the longest because those are the ones that get investigated the hardest, that have the most dollars at stake.'' What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700  

US healthcare costs are the highest in the world, yet health outcomes lag behind other countries.  Preston Alexander shares his mission to prioritize patient care and clinicians over profit with Jim Cagliostro.    Episode Introduction  Preston explains that the principal issue with US healthcare is its profit-driven approach, why healthcare must be a forward-thinking Netflix, rather than an obsolete Blockbuster, and why the nursing shortage is the result of a broken system. He also emphasizes how understanding the line item hospital costs can significantly benefit clinicians, and the importance of an empathetic mindset.      Show Topics   The current path of healthcare is unsustainable  Turn the ship around or build a new one?  Clinicians need to understand the business of healthcare The ability to analyze financial statements is an invaluable skill Hospitals benefit from having clinicians in leadership roles Preparing clinicians for leadership       06:08 The current path of healthcare is unsustainable Preston said the profit driven nature of healthcare is leading to higher costs and poorer outcomes.  ‘'. .. I think the primary issue that I see is that, and you talk about systems level problems, is our healthcare system operates within a much broader context. The context being a system of capitalism. And it was created in a way, in more modern times, I suppose, if you want to look at it that way, to maximize profits. And all the systems we've designed have created a little bit of a bifurcated system whereby you have wealthy individuals who are covered by insurance and can afford all the out-of-pocket fees and charges they have to pay if they need healthcare. And then the rest of the population who's functionally uninsured or underinsured or doesn't have insurance at all, and then what they can access. So, if you wanted to just really take one big giant swath, like what's the problem in healthcare, is that it's fundamentally profit driven first, and healthcare fundamentally is a function that can't be delivered appropriately to everyone with profit being its primary driver and outcome. We see examples of it all over the place. You have insurers who are supposed to help you avoid catastrophic costs related to healthcare, who make... United Health Group, I think in 2022 profited $20 billion or something like that. So you're just talking about outrageous numbers. It made, I was just looking at their financials this morning actually, $340 billion in revenue. And it's like, what are we getting for it? More expensive treatments, more cost, worse outcomes, lower life expectancy, less access, more people left behind by financial design.''   09:51 Turn the ship around, or build a new one?  Preston said the broken healthcare system is the cause of the nursing shortage, but change is possible.  ‘'… I am still going to believe, and I'm probably wrong, but that we can turn the ship because systems are what drives everything.... It's what we see with all the nursing shortages right now. We don't really have a shortage of talent, but we have a brokenness of systems. Today, we're 300,000 nurses short. If I gave you 300,000 nurses tomorrow, we'd be short again within a year or two because the systems are broken. You can't just throw good people into a broken system. But people design systems, people can change systems. So with that sort of premise foundation, the ship could be turned. We could turn the Titanic, but it's going to take leadership, it's going to take people at the top, it's going to take bottoms-up approach. It's going to take a lot. It's not an easy thing to do, neither is building a new one. But that's the alternative. We can try our hardest and get our CEOs on board or the people in charge or mutiny so they have to listen to us or whatever the things are. Or you can say, we're going to just do something different, not to minimize it in any way, but we're going to make Blockbuster obsolete. We're going to be Netflix. We're going to create something totally different and not even disrupt the system because it's so useless to us. So we're just going to go over here and do something else…..So it's, what can you do to build something outside of that traditional healthcare system? And I think both ways can work. I honestly think building a new ship is probably the best solution at this point, although I don't totally want to believe it because there's a lot of meaningful infrastructure. But also once you build a new ship, everybody aboard the old one's going to want to come over there and you can really access a lot of that existing infrastructure in positive ways.‘'    14:18 Clinicians need to understand the business of healthcare Preston emphasized the need to prioritize patient care and clinicians above profit.  ‘'We have this big underserved population. And this hospital was dragging down the bottom line of a big not-for-profit health system that makes plenty of profit, believe you me. And so they closed the hospital. And that hospital had a lot of problems. It was under-invested in for a long time. It has a troubling financial population, but they approached it the wrong way. It was finance only, right? Like, "Let's just bottom line, little investment, and then let's get out of this and not take the black eye." But you can do the right things, but also understand the economic realities, like how do you invest in a new parking deck? Which they needed, because they had a condemned parking deck. You know what I mean? So bridging that gap, I think really helps everybody. So in the first way, it's just to get on the same page. We need to do the right things for patients. We need to do the right things for clinicians, deliver the best care, highest quality, all that stuff, first and foremost, absolutely. But then how are we going to cover it and pay for it and actually deliver it and pay people well and pay people fairly? Those are just the economic realities of the broader systems that we live and operate in. And so people always talk in a way that's like, it's either or. And I think it can be both. And I also firmly believe that if you do the former, which is start with patient care in mind, quality, safety, take care of your clinicians, the profit and the money takes care of itself on the backside. And I mean, we've seen examples of this before.''     19:55 The ability to analyze financial statements is an invaluable skill Preston said understanding financials gives clinicians insight into what's really happening versus ‘'red herrings.''   ‘'But then more applicable to our conversation, I just think it's really beneficial, again, to my previous point, of knowing what goes into and what's required to operate a large organization. When we look at hospital financials, you see line items, and I think staffing costs are the biggest line item of any hospital. And you see that it's, I don't know, $13 billion. You're like, "Oh, whoa, wait a sec, I didn't realize that. What goes into all that?" Or you see supply costs $20 billion, and you're like, "Man." But in the same breath, you see revenue, $150 billion. Not for a hospital, it wouldn't be that much, but whatever it is. $14 billion or something. It starts to shift your perspective a little bit and you start to see, wow, these are really big, a lot of moving parts and pieces. Here's what goes into it. It's also a way to see the red herring where it exists, because in healthcare we have a lot of issues and then everyone's going to spin it in their own particular way.''    24:53 Hospitals benefit from having clinicians in leadership roles Preston said clinicians can help hospitals to make better decisions on costs.  ‘'Some really great, awesome tech wizard, hoodie-wearing guru comes in and sells this awesome vision and then the C-suite says like, " We're going to make this extra money. We're going to reduce costs here," And then you go to implement this $5 billion whatever thing you just signed up for. And then all of your clinicians are prepared to mutiny because you just jacked their workflows in an incredible way. And they're just like, "How much more work do you expect me to do to realize this sort of pipe dream that somebody sold you? And had you just had the previous chair of surgery now working in a nonclinical leadership role, who could have been in on those conversations?" Not to say that every hospital leaves clinicians out of the discussion, but I mean, they're a minor part. But when you can be at the table and say, "This is a terrible idea. Do you know what this is going to do to our workflows? This is not a good investment." So it can help really dictate not only don't cut this cost or don't cut this cost, it can really propel the financial health of an organization forward in meaningful ways too, to say, "We have these resources. This is where they'd probably be best allocated for patient care, for patient experience." And it's like, "And here are the returns that you can get from that improvement in patient care and experience." Because I think that's just such a big piece that's missing is the short-sighted financial management to lower expenses and maximized revenue.''   27:19 Preparing clinicians for leadership   Preston said building relationships with people in nonclinical positions can empower clinicians for leadership roles.  ‘'.. I think the one thing that is super powerful and helpful is just to make friends with people who are in nonclinical positions. So I talk to people sometimes who wanted to make that jump in administration or something, and I say, "Well, go spend time in the purchasing department with supply chain, go set up internal meetings." I used to do this all the time in my previous companies. And I mean, listen, I get it. Everyone's super busy. And when you're on shift, bless you if you can find a bathroom break time. It's hard. You know what I mean? I totally understand that. But it can be very, very meaningful and helpful not only from a political want to move around in an organization perspective, but from a learning perspective is when you can make those relationships and talk with the director of accounting, VP of finance, chief of investments, whomever those people are who are close to the money, the revenue cycle management folks to build those relationships. And more often than not, I know people are strapped, I get it, but you can forge some relationships and start learning that business aspect coming from the angle of what is it that you do? Help me understand. I want to be a better X, Y, Z. So I just really would love to understand what are you dealing with all day every day? What are the practicalities? What would make your job easier? What makes it super hard? What's the most important thing to be successful in this type of position? And then you can really start to learn those fundamentals and the mechanics and the big drivers of that type of thing. ‘'     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Preston Alexander on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:    Preston's career journey and his motivation to understand the business side of healthcare.  ‘'I would have people write to me saying that they had stage four cancer, they couldn't afford our products, but they're the only things that helped them. ….So never really sat right with me and I just didn't understand what was going on. So I launched myself into understanding more about healthcare from a business perspective.''   Living with economic realities, but moving away from a ‘'finance only'' approach.  ‘'The famous phrase was like "no margin, no mission" coined by a nun way back in the day with one of the Catholic nonprofit health systems. And people say that a lot, but they just mean it to justify profitability…. But you can do the right things, but also understand the economic realities.''   "That'll be $10,000. Cost of a hammer, $5, knowing where to bang the hammer….'' How an engineering anecdote encapsulates the need for clinicians to understand hospital line item costs.    Why it all comes down to ‘'infusing more empathy in everything we do.''   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700  

Giving nurses a voice in healthcare is the mission of Rebecca Love, Chief Clinical Officer at IntelyCare & President of SONSIEL. Here she explains why to Jim Cagliostro, and how a hackathon changed her life.     Episode Introduction  In a powerful conversation, Rebecca discusses the impact of the Woodhull study, plummeting post-Covid retention rates in nursing, and how the perception of nursing as ‘'cost'' is damaging to healthcare. She also reveals the imminent launch of the Commission for Reimbursement, why every hospital should run a hackathon, and how encouraging others raises the voices of the entire nursing profession.      Show Topics How a hackathon changed Rebecca's life Nurses as innovators: changing the perception  The findings of the Woodhull study  The real reason nurse retention levels are falling  Gaining a voice during the pandemic Advice for the C-Suite: Run a hackathon  Encouraging nurses into leadership      04:25 How a hackathon changed Rebecca's life  Rebecca described her experience of being a nurse in a room full of decision makers.  ‘'… It was at a hospital in Boston. I'll never forget crossing into it being the nurse, not knowing anybody there. And everybody in Boston was there. All of the major tech startup CEOs, the CEO of the hospital, all the doctors, engineers, scientists, everybody was in this room, hundreds of people. And that's when I walked around and I realized there were no other nurses in that room, James. I was like, "Oh my God, I'm not supposed to be here as a nurse, this is where the decision-makers are." We feel this way constantly as nurses, we know everybody that makes all the decisions are in rooms that we're not in. But nobody asked me to leave that weekend, James, and I ended up joining a team, and that's when my whole life changed because we were sitting in these rooms where we were hashing out. I had a doctor and my team, I had an engineer and an occupational therapist. I had a scientist, were all in there. And in walked the CEO of the hospital and he literally sat down next to me and he said, "So, tell us what is your problem and what's your solution that you're fixing?" And this gentleman, our physician starts talking like, "Well, here's the problem and here's how we're going to solve it on the floor."  And I'm squirming, right. Because I'm hearing this doctor explain a solution that's not going to work. So, I finally speak up and I say, "That's not how it's done on the hospital floor. If we do it that way, it's just going to create more work for the nurses." And they looked at each other and the CEO looks at me and goes, "Well, how did I not know that's not how it worked on the floor of the hospital?" And I said, "Well, did you ever ask a nurse?" And they started laughing. So then, I started laughing because I didn't really know what was funny. And then, I realized they thought it was funny to have ever thought about asking a nurse how they should solve these problems.''   07:22 Nurses as innovators: changing the perception  Rebecca explained how SONSIEL (Society of Nurse Scientists, Innovators, Entrepreneurs and Leaders) evolved out of her first nurse hackathon. ‘'And that's when I hypothesized, oh my God, if we had nurse hackathons, we could change the future of healthcare because nurses have the practical knowledge and experience that they are closest to the problem. That if they were given the opportunity a team to be heard and seen and built towards the solution, we could solve all of the insanity that we live every day as nurses that we could fix healthcare. So, I went on, and that was the story. We finally, after 200 phone calls connected with the dean at Northeastern, Nancy Hanrahan didn't hang up the phone on me and she said, "Next summer, Rebecca, I'm running a conference on innovation entrepreneurship. Why don't you run a hackathon?" …. And I said, "Sure, I've been through a hackathon. I'll run one for you." And just jumped in. And that event, that nurse hackathon at Northeastern that we built to which nobody talked about innovation or entrepreneurship as nurses back, if you look in 2015, there was like a handful of articles that mentored those words, but none of them in the same sentence. Like nobody believed nurses could be innovators. And we built to that event in 2016 that ended up changing my life and ended up changing the idea that nurses could be innovators and entrepreneurs because we built the first nurse innovation and entrepreneurship program out of Northeastern for two years and then spun that out into SONSIEL. So, James, that was a very long story about one of the things that we didn't talk about, but change the credit, and I'd say this to nurses all the time, A hackathon is going to change your life because it empowers you to take ownerships of the problems you want to solve.''   10:35 The findings of the Woodhull study  Rebecca said the study revealed how the views of nurses were overlooked during important discussions around healthcare. ‘'... It was founded by Nancy Woodhull, who was the editor of USA Today, who in 1998 wanted to understand why nurses were missing from so many media stories in the mainstream media when they represented at the time 3.5 million in the entire country, the largest healthcare workforce like it is today. But they were absent from many of the conversations that they would've been centered to germane to the story as she said. So, they found in 1998 that 4% of all media stories were nurses would've been relevant. That is all they were quoted of the 100% of our only 4% of news stories mentioned or quoted nurses at that time. So, they reran the study in 2018, co-sponsored by woman under the name of Barbara Glickstein. Now in 2018, did we expect that number would've gone up or down?You would hope up, except the study showed not only had it not gone up, it had gone down by half. Nurses in 2018, were now sourced, incited less than 2% in all major media stories and absolutely devastating one. So, nurses have abdicated their voice to everybody else except ourselves to speak on our behalf. ‘'   16:37 The real reason nurse retention levels are falling Rebecca said the view of nurses as a ‘'cost'' is causing nurses to leave the healthcare sector.  ‘'There is a shortage of nurses willing to work in the healthcare environments again, that they are today. And the numbers showed out even before COVID, 57% of new grads left the bedside within two years of practice. Nobody wanted to address that, right? They're like, "We're just going to produce more nurses." And a lot of the conversations I'm hearing at the federal level are saying, "We're just going to produce more nurses." We produce plenty of nurses. What we don't do is we don't retain them. Do you know that since COVID, before COVID, the average length of an experience on a 12-hour shift was six years of experience. Today, it's 2.7 years of experience of a nurse. That is your average nurse length of experience. That's still a novice nurse, but it dropped almost three years from length of experience on being on 12-hours shift. So, here's the reality. Why is this existing? The reason exists today is because nurses are cost to healthcare system, James, and because they are cost, we deinvest in that there is always an argument to say, "We need more nurses," and hospital systems will say, "Well, we can't afford more nurses now," but they always can afford more physical therapists or occupational therapists or doctors, right? They're not a cost to healthcare systems. They have a reimbursable service that pays for them. But as nurses, we only are cost. ‘'   26:43 Gaining a voice during the pandemic  Rebecca gave examples of how nurses are gradually becoming more involved in the decision-making process.  ‘'… I still think that there's barriers, but I think even in COVID, we saw that nurses really were able to take charge of a lot of their systems and supply chains failed, GPOs, group purchasing organizations and vendor management platforms. They all failed in the name of code and allow nurses to get really savvy about getting what they needed into hospital systems. Now, you have people like Hiyam Nadel, the first director of Innovations at Massachusetts General Hospital nurse appointed over to really recognizing, "Hey, what products would help us work better for our nursing workforce?" We saw a rollback of the role of the chief nursing informatics officers after EHR's rolled back, but now we're seeing a resurgence of those chief nurse informatics officers who are being employed by hospital and healthcare systems to basically validate the technology from the nursing perspective. So, this has been a really exciting thing. So, you just saw Becky Fox just be chain, the chief clinical informatics officer for all of Intermountain, for example, you have Brian Weirich, he's the chief nurse information executive for all of Banner Healthcare. These are newer roles that are helping hospitals shape, you know what? Okay, we're going to roll out this product. We better have our nurse informaticist officer check to make sure that it's going to work out. That is super exciting, and I think the best hospitals are starting to see that this is going to happen. And so, there is the American Nurse Association of Informatics, really cool group of rockstar nurses who are pioneering this space and demanding that their voices are heard.''   36:10 Advice for the C-Suite: Run a hackathon Rebecca said a hackathon can offer health systems the opportunity to value nurses and deliver vital solutions.  ‘'... I feel the stress that our leadership is under in these executive positions because they're caught in some really difficult positions. That being said, we know that healthcare does not function without nurses. And for a very long time, we have not given nurses a seat at the table to drive the changes they have. So here's my advice, instead of spending the millions of dollars that you are on your consultants, you have a problem you want to solve with falls, readmissions, bed throughput, run a hackathon with your healthcare system and ask the nurses to solve it. I guarantee those answers that you get for the small amount of dollars you spend are the answers that you have been looking for to solve those problems. Not only then do you solve two issues you solve, basically solving a problem for your institution, but suddenly you made that nursing workforce feel, seen, heard, and valued by one single event. So, here's my answer to you. Start looking at your workforce, not as the competition or as the enemy, but as the solution. And if you feel like this is something that you need to tackle head on, one thing that we know today is what we've been doing has not been working. So, it is the time for radical change, and that is hard. But find those people who want to own it, empower them to do it, and you're going to get back tenfold from anything that you do to empower your frontline. That's not pizza parties, and that's not a banana for nurses' week. It's a hackathon that makes them identify the problems they want to solve and actually drive your healthcare system forward together. So, that would be my advice.''   38:24 Encouraging nurses into leadership  Rebecca said championing colleagues and rising together as a profession can help to empower all nurses.  ‘'Stop being hidden, get out on social, and if you don't feel comfortable making a post, start commenting on the posts or liking the posts of those nurses who are being brave enough to do so. The truth is, it's time for us as one profession to come together and control the narrative that everybody else has controlled for us for a very long time. So, if you don't see yourself as that leader, be the champions of the others who do, I'm a big believer that a rising tide raises all boats and more nurses that have success in this world. The more nurses who start companies and are successful and are financially successful, more nurses who are getting airtime in the media, the more nurses who are getting senior leadership positions in untraditional nursing roles like chief clinical officers or CEOs, we want to amplify them because the more that we can get up high levels, the entire profession is going to rise with them. So, champion every nurses forward, if you are one of those nursing leaders, reach back through and pull up that next one for tomorrow too long. As nurses, we have been threatened by other success, and I am telling you that mindset has kept our profession down. So, if you want to do something great, stand up and applaud every single amazing nurse around you. And let me tell you, it is going to come back to you, not tenfold, but a hundredfold because the energy you put out there, helping other people to be successful comes back to you in ways that you don't even realize today. And I think that in all honesty, is the only reason I am here today is because I realized if I can help other people be successful, I didn't care.‘'     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Rebecca Love on LinkedIn   Check out VIE Healthcare and SpendMend    You'll also hear:    Finding soul sisters and soul brothers in nursing: ‘'..every day ..they give you hope for a better future. And I think that's what's so incredibly powerful on nursing is that the reason that we do our jobs, it's not because it was ever about the money… it's about everything that we do is about making the world better.''    Lessons from a hackathon: ‘'I learned more in the course of that weekend about the business of healthcare than I had ever learned in my life of trying to build a company.''   Reversing the trend and empowering nurses: How Rebecca uses LinkedIn to reclaim the voice of nursing.    Changing the status quo in healthcare: ‘'The status quo of healthcare doesn't speak for nurses anymore because the truth is we've allowed you to do that, and you haven't listened. And because of it, our entire profession is crumbling because the status quo has failed nursing, and it's time we change it.''   Launching the Commission for Nurse Reimbursement: ‘'.. Until we fix the reimbursement and financial model around nursing, we will not be able to fix the nursing crisis because healthcare can no longer afford nursing as it is structured today.''      What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700