Episode 8 : Building Differentiated Experiences:

Smart from the Start_Sara Vaezy: Audio automatically transcribed by Sonix

Smart from the Start_Sara Vaezy: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro:
Welcome to Smart from the Start, presented by Care.ai, the Smart Care Facility platform company and leader in AI and ambient intelligence for healthcare. Join Steve Lieber, former CEO of HIMSS, as he interviews the brightest minds in the health provider space on truly transformative technologies that are modernizing healthcare.

Steve Lieber:
Hello, and welcome to Smart from the Start. I'm your host, Steve Lieber, and it is my pleasure to bring to you a series of conversations with some of the sharpest minds in health information technology. We'll discuss the smart directions healthcare companies and providers are pursuing to create smart care teams. Today, I'm joined by Sara Vaezy, executive vice president and chief strategy and digital officer for Providence. Sarah is responsible for system strategy and digital innovation for this integrated delivery network, which includes 52 hospitals and over 1000 clinics serving over 5 million unique patients. She brings deep experience to the organization in both digital and enterprise strategy development and lead systems strategy. The ongoing development and evolution of Providence's integrated strategic and financial plan. Her framework for building and maintaining deep organizational relationships with stakeholders across the industry has resulted in partnerships with over 150 health system, digital and innovation teams, venture capital organizations, industry analysts and influencers, and digital health organizations. Welcome, Sara.

Sara Vaezy:
Thank you so much for having me, Steve. I'm looking forward to the conversation.

Steve Lieber:
I am as well. You're well known across the healthcare digital world, and so the opportunity to spend some time with you today is quite a treat. So let's start out talking a little bit about your environment in Providence. Providence has a reputation for challenging its own establishment and its incumbency. So there are two sides to that. One, you can run into some resistance to change, and then, there's also benefits from it. Let's start out with the internal environment and what you encountered in the way of challenges, resistance and how you overcame that.

Sara Vaezy:
So I've been with Providence for seven and a half years, and the nature of the challenges, and the internal environment has actually changed quite a bit over that time period. Seven and a half years ago, when I joined the Digital Innovation Group, it was a much less mature market from an innovation standpoint, from a digital standpoint, and as such, the organization itself was a lot less mature, and there were, the environment was much more around like science projects and interesting things that we could do in digital and things that maybe wouldn't really pay off for several years and were fairly, I would say, expensive things to even develop, and I know we'll get to this in a little bit, but mostly in point solution land. Then, and the nature of those challenges was a lot of butting heads with our IT colleagues around, like how do you build in a sustainable architecture that's really focused on uptime and maintaining the EMR and sort of those core functions versus keeping innovation going? That was the nature of the sort of challenges at that stage. And then, as we progressed, and we honed our thesis around why we do digital and not just innovation, but digital innovation specifically, and in service to driving sustainable growth for the system, for our patients to get more patients and consumers within our system and retain them and serve them in the most effective way, those conversations changed into, okay, now you've got two different teams building and maintaining enterprise software. And so there was natural tension there because the interdependencies between the team grew and were, we were building everything on top of our core EMR platform and things like, Oh, we've got an upgrade coming up, and therefore you can't do innovation. It was just like constant clashing. Now we get to the COVID period, and I would say maybe most relevant is the sort of downward I don't, I wouldn't call it post-COVID quite yet, but this, like the tail end of COVID when the health system environment, internally for us, but also every single health system out there just economic the bottom fell out. And that actually became an opportunity for us from an IS and technology standpoint to stack hands and to really divide up like, what are we all respectively here for? And those, that, those historical challenges went away out of necessity. But what emerged in its place is a focus on needing to just double down on the core, on care delivery, and our recovery efforts, and that becomes very difficult to compete for attention with clinical and operational needs that are like very much keeping the lights on. And it's a hard kind of argument to make from my perspective, even, I'm like, I'm not asking for us to not go hire nurses or to ensure that our caregivers are safe and happy or that we are serving patients in our hospitals. And so that's the natural tension that has emerged, and over the course of the last 18 to 24 months or so. And now we're emerging out of that and beginning as an organization to lift our heads up and say, what do we need to do that's further out and knit together our enterprise strategy with our digital strategy? And so the internal environments becoming more responsive and receptive to that. But those challenges still remain where we're, we've got a massive workforce challenge ahead of us. It's actually, one of our executives in our workforce team reminds us, this is about as good as it's ever going to be in the future because it's actually going to get tougher and tougher. And so how we function in that environment, that's where those internal challenges are emerging. And it's the way that we've handled all of these situations and in particularly over the course of the last year, is constant engagement, constant kind of reminders about what we do, why we're here, why sustainable growth is important, how it works in service to and compliments all of these other things in the organization that are competing for attention and they should, and why they all build like a mutually reinforcing story together and just doing it over and over. So that's been our evolution from an internal environment standpoint, it's still very tough. And, but for, I would say it's tough, not for silly reasons. We've got a lot going on in healthcare, in health systems, and we're working on structural changes that are going to be meaningful into the future.

Steve Lieber:
Yeah, you touched on something as you went through that timeline that was a new sort of thought to me in terms of the pandemic changing the way we looked at change and, maybe out of necessity, that we were faced with a lot of our workforce not being in the same place, we are all the time, patients not being in the institution and having to reach them. And so is that really a message there that we did change the way we looked at change because of the environmental necessity of having to work differently?

Sara Vaezy:
Absolutely. And that was most obvious at the very beginning of COVID when there was this massive, we didn't really know what was going on, and everybody had to stack hands, and we had to shut clinics down and stop doing certain services because folks were so worried about exposure. And so everybody had to work together to, in that more virtual environment, figure out how do we serve, how do we do things that would have taken a year and do it in 3 to 5 days? Like, we stood up our first home monitoring program in under a week, and that's like unheard of now. And so the way we think about change and our risk tolerance and the pace at which we embraced change was completely transformed. Now, in some ways, like the inertia from the past took back over, and so we've, in some ways, gone back to how we take that very thoughtful and like methodical approach. And we are very concerned about dotting all the I's and crossing all the T's from a risk integrity perspective, risk, we call it risk and integrity services, so like risk compliance, all that stuff. But when in the beginning, like it was just, it was a bit of a free-for-all, but it was also just a different way of working where it was like everyone swarmed the problems together. And so that definitely happened, but both things, one thing I think we took for granted was that momentum would continue, and it doesn't because people get tired, and it's really hard to work that way over the fullness of time. And you, and I don't even know if it's, I don't even think it's healthy, right? You get into a hero mentality as opposed to a, we got to build systems that allow for us to do this over the fullness of time, and we didn't have the bandwidth to be able to do that.

Steve Lieber:
You talk about being methodical and dotting I's, crossing T's, and that sort of thing, but from the outside, Providence has a reputation of being on the forward edge of things. The impression I have of the organization is, it's not a plodding organization. There's an aggressive mentality, and especially in your area, that drives strategy in the organization. Fair assessment?

Sara Vaezy:
I think it's a fair assessment, though there are places from a clinical in the clinical domains where we are very, I don't know if I would use the word plodding, but we definitely take our time because there is a much there's more at stake.

Steve Lieber:
Sure.

Sara Vaezy:
When we're talking about, for instance, like a lot of the work that I do around ensuring folks have a really great experience booking their appointments or getting access to their, all of their digital sort of solutions. And we have this concept of identity-driven engagement around a centralized platform, those things aren't life or death. We don't want to have bad experiences, right? But we also they're not life or death versus the clinical domain. So it depends on the part of the organization. But we are, we're very aggressive on certain things because we, that's a necessity unto itself. For instance, in the, anything that's in the consumer space, we're out there in the market with folks that are much more nimble, have much more capital, have much more, in some cases, connection to patients and consumers because of, because they might be a payer. So they've got the head element working for them. So we have to be, and so we really view all of these things in a, I would say, a relatively sophisticated way. What's the opportunity cost of not being aggressive? And in some cases, it's pretty high.

Steve Lieber:
Pretty high, yeah. You mentioned the Digital Innovation Group earlier, and you've architected evolution of that group, according to my notes, commercialized three incubated technologies into independent companies. Talk to us a little bit about that journey and how that works, both in terms of building those technologies and creating new companies, but also integrating that into Providence own systems and operations, which I assume is equally an objective of what we're trying to do here, not just create new solutions for other people.

Sara Vaezy:
It is equally an objective, and it's the harder part. So we have, yeah.

Steve Lieber:
And we're going to follow that up with, Okay, let's talk about the tension between innovation and operations, but let's start out with the group and how you got there, and then you can follow on into that area, or I'll ask the question again.

Sara Vaezy:
Sure. From an innovation standpoint, all, so this is less about the operationalization side of things. It's, especially when we come, we talk about the consumer-facing sides of an organization, it's absolutely essential to build differentiated experiences. Otherwise, we won't be able to maintain any sort of competitive advantage over these digital-first disruptors and companies that are coming into our space. And it's not like one company is going to deal a death blow, it's more chipping away little by little at our relationships with our patients and our consumers and the economics all up. So we build in that innovation context because we know that differentiation is so important. But we can't, we're not a technology company, we're a healthcare organization, we're a health company. And so we had to figure out a way throughout the evolution of our group to go from building cool technology to actually doing something. And that's why we started commercializing and launching these new companies, because we can still build the company, but then we can raise external capital and release these companies out into the market so that they can compete with that capital. They can serve other health systems, which we have this broader sort of objective to help others transform as well. It's not just about keeping it within Providence because we're just one among many. And in order to have a full transformation, we really need others to come along for the ride, if you will. And then we can redeploy our internal resources against the next set of problems. And so that's the way we think about why we do innovation. We get really deep on understanding our own problems as well as the problems of other health systems, and then we solve for them. We do extensive build-buy analysis, and then once we build with this sort of market-oriented, is there a market out there, and does it make sense for us to, do we have some sort of advantage in terms of how we're building? And often, the answer is no. But sometimes the answer is, look, we're a customer of, we're going to be a customer, we know that we have a sandbox, we've got the internal expertise, we've got the, from a clinical and operational standpoint, and we bring in this technology orientation. So we have this very unique vantage point relative to others simply by just because of this little, this interesting intersection of all these services.

Steve Lieber:
What you're talking about, you have the problem, you're experiencing the problem, and you're also coming up with the solution for it.

Sara Vaezy:
Exactly. And the problem is they're all wrapped up together. The operational problems, the technology platform problems, and the operational problems, they're all together. And so we are, we live it every day, and therefore, we're best positioned to solve for it. So we've done this three cycles, each with a different model. Our first instance was a company called Zell's, which was an EIR, entrepreneur-in-residence-driven model where we had a great team of formerly mobile entrepreneurs come in and build an enterprise solution for driving digital prescriptions. That company is run by a gentleman named Mike McSherry, who is awesome, and we are still partners with them. The second time we did it, we actually had built a platform for women's health personalization that was acquired by Wildflower Health, which is a women's health platform, and they're moving more and more into risk-based maternity care. And then the third cycle was a company called Dex Care that we did, that we built, and it's led by Derek Street and Sean O'Connor, again, two entrepreneurs. They were in the sort of surgical education, and they worked intuitive surgical kind of space. And then they came in and brought this thinking to platforms as a service for driving, essentially load balancing and access optimization. So in each of these instances, very different. In the Dex Care case, like we founded a lot of that, we built it internally and then brought Derek and Sean in to do that work. And, but the similarities were we had an MVP internally, and then we scaled it across our organization. Then we commercialized to other health systems had or brought in external leaders to be able to continue to lead these things, not just converting internal operators into leaders of startups, and then, we raised external venture capital. So we have three points of external validation. So that's how we thought about our model. And then, in each case, we redeployed resources to the next set of problems. We've got a list of 99 problems and ever-growing and continuously being refreshed. Then the question you asked around operationalization.

Steve Lieber:
Yeah.

Sara Vaezy:
That's a really tough one. And in particular with our, that we're now on our fourth cycle of building a company. We've been emphasizing that quite a bit. Who is our internal buyer? What problems are they trying to solve that they are willing to pay for is something that we are much more, much more focused on this time around. And then what are the capabilities that we need that will allow us to catch that technology to make it scale successfully? So that's what we're really focused on this time around, and we're getting really dialed in on it.

Steve Lieber:
Cool. I want to pivot a little bit and talk about platforms and point solutions, we came up in the conversation a little while ago, come back to it now. So over the last 20 years, we've seen a couple of cycles back in the early part of the millennium, very focused on EHR platforms. All of us were really driving that, digitizing healthcare, and that's the way we figured out how to do it. Then came along an era of applications. Everybody had a solution for a single problem point solution type of approach. So talk a little bit about where you see where we are today, advantages and disadvantages. From my perspective, you solve one problem with point solution. Usually, problems are not isolated. There are other activities related to that function. And if you just have a technology that addresses a piece, now you've got dozens related to the same care process, to use that term. So talk a little bit about your experience platforms versus point solutions where you see us going.

Sara Vaezy:
I think we're swinging back in the direction of more platforms. That's the short answer and the reason for that being, as you described, right? Point solutions, one, there are other kind of related problems. It creates, if we only live in application land, it creates a huge amount of integration challenges for IT, and then there's the question of like, how do these things interact with one another in order to actually drive outcomes? In many cases, from an information data transfer perspective, like they live in silos. And so these sort of the, they don't talk to one another, they don't really work collaboratively in service to some sort of outcome, whether it be for a patient or a consumer. And so we're swinging back, I think, in the direction of platforms, and that's been one of our theses when it comes to build, is that there was a huge amount of emphasis as you articulated, around the EMR during the meaningful use era. That's fine, but those have very specific kind of things that they're good for and it's very oriented around like the clinical transaction as opposed to a more longitudinal or continuum of view.

Steve Lieber:
And more of the collection of data versus doing something with it.

Sara Vaezy:
That's exactly right. Exactly. They're not workflow tools. And when it comes to consumer, like if we think about the consumer lens, it's certainly not a consumer experience, commercial grade experience. It is a very clunky sort of lots of menus with dropdowns and all kinds of stuff like that. And our thesis has been like there, the EMR has its place, but the platforms, but the systems on top are really important in order to bring up the platforms to the level of consumer expectation or clinician expectation around how they actually manage their workflow. And so I think we're swinging in that direction and it's the right thing to do, but -I don't really, when we talk about point solutions and people bash point solutions, they have their place. And if we are able to create an environment, a technical environment where we can actually like, for instance, again on the consumer side, have a single sign-on protocol to knit things together, point solutions can actually be really powerful and they will, we get like that best-of-breed approach to solving a very specific problem, but within the context of an ecosystem that's connected around an identity of an individual. So that's like the kinds of things, I think we're, now the puzzle pieces are coming together more, and so that instead of being focused just on like data infrastructure, which is what the EMR did, or getting these isolated little things done, we're knitting, we're connecting the dots and orchestrating experiences, and that's what modern-day platforms are more for.

Steve Lieber:
So if I'm hearing you correctly, there's an evolution here. We needed what we did 20 years ago to get to the point where we are today and for the things that we can do in the future. Again, key variables here are, you use term knitting together, so interoperability, they got to talk to one another. And certainly, we've got to be focused on ease of use at the clinician point of connection to our systems as well, because I'm still hearing that, although not like in the beginning, we still got some clinical resistance in terms of changing workflow, introducing new tools and all. And we really do need to listen to that and make sure we're not creating more clicks and taking away from care, so to speak.

Sara Vaezy:
Absolutely. There's no reason for us to make the clinicians' life harder, just like we don't want to make the consumer or patient's life harder. Like one of the things we remind folks is, it's really great, it's really important to have a 1 to 2-click scheduling experience. For every other additional click, you're losing folks throughout the process, right? When you're adding friction, you're losing, you're adding effort, and you're losing people along the way, and clinicians, same thing. We, one of the things that we've noticed actually is that we brought a bunch of folks online during the height of COVID because folks had to engage in telehealth and other types of things, but then we created this, there was an unintended consequence around like driving a huge volume of in-basket messages to providers because folks got trained up on like, how do I use these things? And we're now putting in place some platforms to actually support a message being sent, in some cases is a defect because that means that the person could have gotten, perhaps could have gotten their task completed with, if they had been able to find the information they needed or been able to complete the task but they couldn't. And so how about we navigate them through that and prevent a message from being generated in the first place? So we've got, we've done some work there and noticed already upwards of 20% reduction in administrative messages. So it's a really important thing to keep in mind.

Steve Lieber:
Yeah, that's a great takeaway in terms of recognizing that a decrease in messages is actually an improvement because the idea is self-service. You get your answer, you get your information, you transact your activity, versus I can get started, I can get to a point, then I have to send a message. That's a great metric. I really do like that. Okay, wrapping up here, our listeners are all kinds of digital health leaders, CIOs, CMIOs, CNIOs, and others. A takeaway for them. You've been through a lot here in just the last seven and a half years, plus a longer career period here. Take away a message.

Sara Vaezy:
To go back to our previous theme, the sense of urgency is something that it's not a technical thing to take away, but it is a, the sense of urgency around bringing together clinical, operational, and technology to meaningfully, especially solve consumer problems is something that can't be ignored and it can't be relegated exclusively to an infrastructure layer around the electronic medical record. It's not going to serve their needs because customers expect differently, and especially in this new era, our customer expectations are often set by retail and tech. They're so pervasive. That's what governs how we, what we want from everywhere else in our lives. And so it's not like, I'm not trying to be a technocrat. What I'm trying to say is that's the reality is that...

Steve Lieber:
You've got to respect your customer and what their expectations are.

Sara Vaezy:
Yeah, exactly. And so we need to lean in with urgency around understanding that it's not just about infrastructure and like putting all your data somewhere. It has to be usable and it has to make sense for driving a specific experience that people expect. So lean into it, don't expect your EMR to do everything.

Steve Lieber:
Yeah, and I'd add to that, clinicians are customers too, and thinking about them and their expectations of convenience as well as the patient. In a sense, they are the same set of expectations.

Sara Vaezy:
For sure, they are people too.

Steve Lieber:
They are. So this has been a great conversation. I really do appreciate your time today. It's been a fantastic few minutes here of visiting with you.

Sara Vaezy:
Thank you so much for having me. I really enjoyed it.

Steve Lieber:
Excellent. Thank you again. And to our listeners, thank you for joining us. I hope this series helps you make healthcare smarter and move at the speed of tech. Be well.

Intro:
Thanks for listening to Smart from the Start. For best practices in AI, in ambient intelligence, and ways your organization can help lead the era of smart hospitals, visit us at SmartHospital.ai, and for information on the leading Smart Care Facility platform, visit Care.ai.

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