Latest / Becker’s Healthcare Podcast / Building Systemness Without Creating More Red Tape with Aaron Chang

Transcript

Building Systemness Without Creating More Red Tape with Aaron Chang · Becker’s Healthcare Podcast

• 0:00
  - This is Laura Dierdahl with the Becker's Healthcare
• 0:02
  - podcast. I'm thrilled today to be joined by
• 0:04
  - Aaron Chang, executive vice president at Jefferson Health
• 0:07
  - and president of the East Region as well
• 0:09
  - as system perioperative services.
• 0:11
  - Aaron, it's a pleasure to have you on
• 0:12
  - the podcast today.
• 0:14
  - Thank you, Laura. It's a pleasure to be
• 0:15
  - here.
• 0:16
  - Excellent. Well, I'm excited for our conversation. I
• 0:19
  - know we're gonna dig into deep some of
• 0:21
  - the changes that have been happening at Jefferson
• 0:23
  - as well as with your role. So let's
• 0:24
  - start there. I know you currently have a
• 0:27
  - rather unusual dual role. You lead the region
• 0:29
  - while also helping develop a system wide perioperative
• 0:32
  - model. How do those responsibilities
• 0:34
  - fit together?
• 0:36
  - That's a great question, Laura.
• 0:38
  - It is a bit unusual, and I feel
• 0:40
  - like I've been explaining
• 0:42
  - kind of what I've been doing to friends,
• 0:44
  - colleagues, and folks that reach out for, a
• 0:46
  - little bit here. So it's exactly that, though.
• 0:49
  - You know? I have regional responsibilities
• 0:51
  - and system wide responsibilities,
• 0:54
  - and they fit together
• 0:56
  - more naturally than people might assume.
• 0:58
  - You know, as a regional president, I'm accountable
• 1:00
  - for what happens every day, patient access,
• 1:03
  - quality,
• 1:04
  - workforce,
• 1:05
  - financial performance,
• 1:06
  - physician relationships, and and overall the experience of
• 1:09
  - the communities we serve. And I love doing
• 1:12
  - that, and that's been
• 1:13
  - the,
• 1:14
  - main work that I've been doing for the
• 1:16
  - last fifteen years or so. But in my
• 1:18
  - system preoperative role,
• 1:21
  - I now have to step back and ask
• 1:23
  - a different set of questions.
• 1:25
  - How do we connect our regions?
• 1:27
  - Where would common standards improve performance?
• 1:31
  - What should be decided locally?
• 1:33
  - What should be decided regionally?
• 1:36
  - And what truly needs to be coordinated
• 1:39
  - across the system. And as you're keenly aware,
• 1:42
  - mergers and acquisitions have been happening
• 1:44
  - throughout, you know, the last five to ten
• 1:47
  - years.
• 1:48
  - And, you know, as part of that, it's
• 1:50
  - how do we integrate, come together.
• 1:52
  - So it's been fun from this end, in
• 1:54
  - fact, that, you know, we're forming something new,
• 1:58
  - and at the same time, making sure
• 2:00
  - that it's really hitting the mark in terms
• 2:02
  - of what we're trying to achieve and really
• 2:04
  - mutually beneficial from both the region perspective
• 2:07
  - and, you know, the system perspective.
• 2:10
  - I mean, again,
• 2:12
  - regional role keeps me grounded in operational reality,
• 2:15
  - and the assistant role really challenged me to
• 2:17
  - look beyond the performance of kind of what
• 2:19
  - I have here in New Jersey,
• 2:22
  - but really how we can grow
• 2:24
  - and,
• 2:25
  - you know, achieve the objectives of Jefferson as
• 2:27
  - a system.
• 2:28
  - And the combo is important because systemness,
• 2:31
  - as we've kind of described it,
• 2:34
  - can't really be designed,
• 2:35
  - you know, from the center. And I think
• 2:38
  - that's in part
• 2:39
  - why if you look across the board, their
• 2:41
  - regional presidents more recently
• 2:44
  - took on system level responsibilities.
• 2:47
  - It has to work for the people who
• 2:49
  - will care for the patients and operate hospitals
• 2:51
  - every day, and we're certainly,
• 2:53
  - you know, those individuals
• 2:54
  - leading those efforts. So, you know, that's kind
• 2:57
  - of a a snippet of what I'm what
• 2:59
  - I'm doing and, you know, the intent behind
• 3:01
  - it.
• 3:02
  - That's really helpful to understand and seems like
• 3:05
  - a great way for you to have that
• 3:07
  - global view of the entire enterprise as well
• 3:09
  - as make an impact across the board and
• 3:11
  - then continue leadership of of the region too.
• 3:14
  - And what does it mean from,
• 3:17
  - to make the move from being a hospital
• 3:19
  - operator to becoming an enterprise integrator? What are
• 3:22
  - the skill sets and things that you have
• 3:24
  - to do now in the larger role?
• 3:27
  - Yeah. You know, for much of my career,
• 3:29
  - the core responsibilities
• 3:31
  - was to make an individual organization or region
• 3:34
  - successful.
• 3:35
  - That certainly requires focus, discipline,
• 3:38
  - and local accountability.
• 3:41
  - But, you know, as I described, when our
• 3:42
  - organization
• 3:43
  - grows, leadership also has to evolve. And, you
• 3:46
  - know, with the scale, it creates opportunity,
• 3:49
  - but it's complex.
• 3:51
  - So, you know, with more sites, more leaders
• 3:53
  - Right. Clinical programs, and also multiple ways of
• 3:56
  - performing the same work.
• 3:58
  - All of these have to be aligned, and
• 4:01
  - they need to...
• 4:02
  - When I say align,
• 4:04
  - they need to make sense
• 4:05
  - given our strategic,
• 4:08
  - initiatives that we're driving
• 4:10
  - and the overall strategy of the organization.
• 4:13
  - So from a leadership standpoint, I mean, the
• 4:15
  - question becomes,
• 4:16
  - how do we move from a collection of
• 4:18
  - successful organizations
• 4:20
  - to a genuinely integrated system?
• 4:23
  - Joe, our system CEO, Bali, our Jefferson Health
• 4:26
  - clinical enterprise president always says this is, you
• 4:28
  - know, we are an academic integrated delivering finance
• 4:33
  - system. So it is
• 4:35
  - very important for us that we are all
• 4:38
  - working together as one whole, and
• 4:41
  - that is true enterprise integration. So a lot
• 4:44
  - of times, people confuse that with, you know,
• 4:46
  - it's pure centralization for the sake of centralization.
• 4:49
  - But to me, it's making sure
• 4:53
  - that I am of the,
• 4:55
  - you know, mindset that it's connecting the parts
• 4:58
  - of the organization so that the whole performance
• 5:00
  - doesn't.
• 5:02
  - I love it. I think that makes a
• 5:03
  - lot of sense, and what a great philosophy
• 5:05
  - to think through what it actually means to
• 5:09
  - have a centralized,
• 5:11
  - system is and how you can,
• 5:14
  - scale that, I guess, across the entire organization,
• 5:16
  - the culture, and everything else that you need
• 5:18
  - in order to be successful
• 5:20
  - as a,
• 5:21
  - larger system. Now I know
• 5:24
  - the title of this episode is we're looking
• 5:26
  - at is how do you create systemness without
• 5:28
  - creating more red tape.
• 5:30
  - What does that look like for you? How
• 5:31
  - are you thinking through that, and what does
• 5:34
  - that,
• 5:35
  - how does that show up at Jefferson?
• 5:37
  - That is a
• 5:39
  - a very
• 5:40
  - difficult, but, like you said, a very important
• 5:43
  - one because,
• 5:44
  - you know, I felt it in different instances.
• 5:46
  - And, because of my kinda career path, I've
• 5:49
  - gone through,
• 5:51
  - scenarios where we've
• 5:53
  - been integrated into a larger entity.
• 5:55
  - And, naturally, when you're at the ground level,
• 5:58
  - a lot of processes
• 5:59
  - just involve more steps and more people involved.
• 6:02
  - So I think the reality of it is
• 6:05
  - you're not gonna be able to avoid everything,
• 6:08
  - but there are ways to make it more
• 6:11
  - efficient.
• 6:12
  - And I think the things I'm about to
• 6:14
  - reference, you know, I think people hear it,
• 6:16
  - and they essentially picture the additional meetings and
• 6:20
  - more approvals and decisions moving farther away from
• 6:23
  - the people doing the work like I just
• 6:25
  - described.
• 6:26
  - But, you know, I think
• 6:28
  - having governance and good governance
• 6:31
  - should make the organization faster, not slower.
• 6:35
  - But, you know, you really have to kind
• 6:36
  - of prime it. And the thing... Four basic
• 6:38
  - things that you have to make sure that's
• 6:40
  - answered is who owns the decision,
• 6:44
  - who needs to provide input, and that's an
• 6:46
  - important one because,
• 6:47
  - when you talk about red tape and bureaucracy,
• 6:50
  - you know, how many people need to be
• 6:51
  - involved in that, how big of this group
• 6:55
  - needs to be to meet on this specific
• 6:57
  - issues. And, you know, I'm,
• 6:59
  - a big... You know, I'm in... I'm high
• 7:01
  - opposition of, you know, a thirty, forty people
• 7:05
  - meeting because you can't really get stuff done.
• 7:07
  - It's not a working meeting at that point.
• 7:10
  - So the third thing is who needs to
• 7:11
  - agree, and fourth thing is who's responsible for
• 7:14
  - the execution.
• 7:15
  - Luckily,
• 7:16
  - you know, we have a great consulting group
• 7:19
  - at Vynamic helping us kinda work through that.
• 7:21
  - And one of the models that, is new
• 7:24
  - to me,
• 7:25
  - and it's similar to the RACI model that
• 7:27
  - a lot of people use, but, you know,
• 7:29
  - it's it's helping us clarify the, those roles
• 7:32
  - and and really
• 7:34
  - some of the decision points on the four
• 7:36
  - items that I touched on. And, you know,
• 7:38
  - again, overall, the purpose is that not add
• 7:41
  - process. The purpose
• 7:43
  - is to eliminate,
• 7:44
  - you know, some of the ambiguity
• 7:46
  - that goes on. And everybody now,
• 7:49
  - is in a matrix
• 7:50
  - organization
• 7:51
  - is how do we get more fluent in
• 7:53
  - in that environment, I think, is key.
• 7:56
  - That's helpful to understand. And, you know, what
• 7:59
  - a great way to kind of tackle that
• 8:01
  - question and figure out how you can most,
• 8:04
  - beneficially think about your role and and how
• 8:07
  - it interacts with everybody else in in the
• 8:09
  - system overall.
• 8:10
  - Now does holding both a regional and system
• 8:12
  - role give you a different perspective on this
• 8:14
  - work?
• 8:15
  - Oh, absolutely.
• 8:16
  - It really forces me to see both sides
• 8:18
  - of
• 8:19
  - every decision. So, you know, when I'm thinking
• 8:21
  - as a system leader,
• 8:22
  - I can see the benefit of common standards,
• 8:25
  - shared data, or platforms for which we all
• 8:28
  - use from
• 8:29
  - coordinated capital planning. That's a huge one and,
• 8:33
  - one that...
• 8:34
  - In terms of, like, a process,
• 8:36
  - I've not seen, you know, a organization I've
• 8:39
  - been part of do it really, really well.
• 8:41
  - So we're certainly trying to,
• 8:43
  - improve that. And then just consistent operating practices.
• 8:47
  - Right? I think there is,
• 8:49
  - magic there because
• 8:51
  - we provide
• 8:52
  - excellent clinical care,
• 8:54
  - and it's no different than if you get
• 8:57
  - outside of the health care sector, whether it's
• 8:59
  - retail or wherever else. You want the same
• 9:01
  - experience the same. So whether you're going into
• 9:05
  - a facility
• 9:07
  - in Northern Pennsylvania
• 9:09
  - or step into the doors at one of
• 9:12
  - my facilities in South Jersey,
• 9:14
  - you know, it should be the same from
• 9:16
  - patient satisfaction,
• 9:17
  - quality,
• 9:18
  - and,
• 9:19
  - business operation standpoint. Right?
• 9:22
  - But in general, you know, I think when
• 9:24
  - you look at the region system stuff and
• 9:26
  - what I've talked about,
• 9:28
  - the perspective piece is huge. And I... I've
• 9:30
  - always been, you know, I think
• 9:33
  - a advocate of having healthy tension.
• 9:36
  - It keeps us from designing a system model
• 9:39
  - that looks, you know, great on paper but
• 9:41
  - is a work in practice. So whenever we
• 9:43
  - consider moving a responsibility to a system level
• 9:46
  - or, you know, have those type of conversation
• 9:48
  - or think about initiatives that would, you know,
• 9:51
  - encourage that,
• 9:52
  - the the one question that I always think
• 9:54
  - is
• 9:55
  - important that everybody should ask is what value
• 9:58
  - does this system provide in return? And I
• 10:01
  - always go back to, you know, what Valley
• 10:03
  - and others have said before.
• 10:05
  - You know, we need to standardize where possible,
• 10:08
  - but we also need to make sure, where
• 10:11
  - necessary, we differentiate ourselves because, look, the reality
• 10:14
  - of it is each market is different. Each
• 10:16
  - hospital are gonna provide different services, and there's
• 10:19
  - gonna be some nuances and some dynamics there
• 10:22
  - that need some level of flexibility.
• 10:24
  - So it can't be a hard and fast
• 10:26
  - rule. It can't be very black and white.
• 10:28
  - But, you know, even as I'm talking, you're
• 10:30
  - seeing, you know, I think a little bit
• 10:33
  - of me arguing myself. Right? And that's the
• 10:35
  - the beauty of having both the regional and
• 10:37
  - system perspective.
• 10:39
  - I love it. I I think it's so
• 10:41
  - critical to have both of those points of
• 10:43
  - view and then being able to,
• 10:45
  - really make the best decision possible given both
• 10:48
  - perspectives.
• 10:49
  - You've described having the perioperative services as one
• 10:52
  - of the major remaining opportunities for health system
• 10:54
  - integration.
• 10:55
  - Why? Can you tell us more about that?
• 10:58
  - Yeah. I mean, I think, first, if you
• 11:01
  - look at a lot of the mergers and
• 11:03
  - acquisition, a lot of the impetus is just,
• 11:06
  - you know, making sure that,
• 11:08
  - we could capitalize
• 11:10
  - on, you know, the back office functions and
• 11:12
  - making sure that we become kind of one
• 11:15
  - centralized service from there. So when I think
• 11:17
  - about that, I think about finance,
• 11:19
  - human resources,
• 11:20
  - you know, and, of course, in supply chain.
• 11:22
  - And, you know, I think many systems have
• 11:24
  - done that.
• 11:25
  - There's a select few systems that have really
• 11:27
  - focused on clinical operations.
• 11:30
  - And, certainly, a lot of folks have tried,
• 11:32
  - and it's not for lack of trying. It's
• 11:34
  - it's just challenging. So when you look at
• 11:36
  - perioperative services,
• 11:38
  - you know, it being the major revenue generating
• 11:41
  - scenario,
• 11:43
  - it's it's at the intersection of almost everything
• 11:47
  - in a health system.
• 11:48
  - Physicians,
• 11:50
  - nursing,
• 11:51
  - anesthesia,
• 11:52
  - general ops, scheduling,
• 11:55
  - sterile processing, supply chain, capital, analytics,
• 11:59
  - certainly quality,
• 12:00
  - patient flow, and
• 12:02
  - and, overall, to my earlier point, financial performance.
• 12:06
  - So that is what makes
• 12:08
  - perioperative services so complex,
• 12:10
  - but it's also the reason why it makes
• 12:12
  - the opportunity so significant.
• 12:14
  - So, you know, you can't improve perioperative
• 12:18
  - perioperative performance through one department or one initiative.
• 12:22
  - You need that integration. You need the integrated
• 12:24
  - framework.
• 12:25
  - And
• 12:26
  - through key initiatives,
• 12:28
  - like Jefferson's
• 12:29
  - path forward work, you know, we're bringing to
• 12:32
  - light, you know, I've seen some key areas
• 12:34
  - in terms of procedural variation,
• 12:37
  - site of care optimization where we're looking at
• 12:40
  - and evaluating, you know, where certain people cases
• 12:42
  - need to be, what type of centers they
• 12:44
  - need to go, same day cancellation reductions, which
• 12:47
  - I would categorize as kind of the day
• 12:49
  - to day blocking tackling. But when you look
• 12:51
  - at it from a system scale, there are
• 12:53
  - huge implications,
• 12:54
  - huge reasons as to why
• 12:56
  - those things are happening,
• 12:58
  - you know, and generally physician engagement analytics,
• 13:01
  - and a whole slew of other items. But,
• 13:04
  - you know, I think the governance
• 13:06
  - also connect physician ownership to the data transparency,
• 13:09
  - quality, financial stewardship, and supply standardization.
• 13:12
  - I mean, if I was gonna wrap this
• 13:14
  - up in, you know, one kind of sound
• 13:16
  - bite here,
• 13:18
  - it's...
• 13:19
  - You know, many systems have certainly integrated their
• 13:22
  - administrative functions,
• 13:24
  - but per op... Perioperative services
• 13:27
  - still presents an opportunity and one that health
• 13:31
  - systems have to look at, especially what's coming
• 13:33
  - in the next few years with a big
• 13:35
  - beautiful bill and the financial headwinds that we're
• 13:38
  - facing.
• 13:40
  - Absolutely. I know that's top of mind for
• 13:42
  - many hospital health system executives and leaders across
• 13:45
  - the country is thinking about how some of
• 13:47
  - those changes on the national level,
• 13:49
  - will really impact them and how can they
• 13:51
  - can put themselves in the best position possible,
• 13:54
  - to be successful regardless.
• 13:56
  - Now
• 13:57
  - I really appreciate what you're talking about there
• 13:59
  - and,
• 14:00
  - the integration side of it. So can you
• 14:02
  - give an example of what, that integration actually
• 14:05
  - looks like? I think that'd be really helpful
• 14:07
  - for leaders who are, facing a similar situation
• 14:10
  - or looking to do so down the road.
• 14:13
  - Yeah. I think a strong example would be
• 14:16
  - the work we've done to create a common
• 14:17
  - perioperative operating model across the hospitals.
• 14:21
  - So, historically,
• 14:23
  - the individual
• 14:24
  - facilities
• 14:25
  - would define and measure
• 14:27
  - the same activity as we're finding out a
• 14:29
  - bit differently.
• 14:31
  - But through our path forward work,
• 14:33
  - we really took a stab at standardizing the
• 14:36
  - definitions for first case on time starts and
• 14:38
  - room turnover
• 14:40
  - and aligned
• 14:41
  - the case delay reasons
• 14:43
  - and developed a common metric
• 14:46
  - optimization template
• 14:47
  - and began standardizing a lot of the procedural
• 14:49
  - leveling for the surgical charges.
• 14:51
  - I mean, really, in a nutshell,
• 14:53
  - that gives every hospital a shared language, and
• 14:56
  - it allows us to compare performance,
• 15:00
  - identify, you know, where the variations lie, and
• 15:03
  - then spread best practices
• 15:05
  - more consistently
• 15:07
  - across the system, which is,
• 15:10
  - key, you know, in a lot of the
• 15:11
  - work that we're we're doing. I mean, an
• 15:14
  - example would be, you know, when you look
• 15:16
  - at airlines,
• 15:18
  - every airport's different, you know, Philly, Chicago, Los
• 15:21
  - Angeles,
• 15:23
  - and they all have different runway layouts,
• 15:25
  - passenger volumes, and just different operating environments. But
• 15:29
  - when we measure...
• 15:30
  - When airlines measure on time departure time or
• 15:33
  - arrivals,
• 15:34
  - those definitions have to be standardized. Right? Because
• 15:36
  - those are universal
• 15:38
  - across the board. And if everybody speaks the
• 15:40
  - same
• 15:41
  - language, the leaders there can identify which airports
• 15:44
  - are truly performing well and what processes need
• 15:47
  - to be, you know, replicated elsewhere and and
• 15:50
  - quite frankly,
• 15:51
  - where the customers aren't aren't happy.
• 15:53
  - As I think through... Maybe another example would
• 15:55
  - be
• 15:56
  - moving from just individual
• 15:59
  - hospital initiatives
• 16:00
  - to a more enterprise,
• 16:03
  - perioperative governance
• 16:04
  - and technology model. So in f y twenty
• 16:07
  - seven, we're bringing leaders together around
• 16:10
  - three shared priorities,
• 16:12
  - side of care optimization,
• 16:14
  - reducing procedural variation, and improving day of surgery
• 16:18
  - cancellations
• 16:19
  - by streamlining preadmission testing.
• 16:22
  - So we're supporting that work with the enterprise
• 16:24
  - dashboard that, has gone live,
• 16:27
  - a common master dictionary grounded in the ARN
• 16:31
  - definitions
• 16:32
  - and a system electronic platform.
• 16:35
  - So the goal is to not make every
• 16:36
  - hospital identical, but to the earlier points made,
• 16:40
  - to create consistency around standards,
• 16:43
  - visibility,
• 16:44
  - and governance,
• 16:45
  - all while allowing the care
• 16:47
  - to be delivered,
• 16:49
  - best. In a setting, it's best suited to
• 16:51
  - each inpatient and procedure. But those are the
• 16:53
  - examples that come to mind.
• 16:55
  - I love it. And I think that makes
• 16:57
  - a lot of sense and sounds like a
• 16:58
  - really smart way to approach things and,
• 17:00
  - make sure you've got the leaders in the
• 17:02
  - right place to make the biggest impact.
• 17:04
  - Now,
• 17:06
  - from your perspective, as you're thinking,
• 17:08
  - at the enterprise level as well as the
• 17:09
  - regional level, how do you decide what to
• 17:11
  - standardize and where to preserve some of that
• 17:13
  - local flexibility?
• 17:15
  - I guess the simple principle is
• 17:17
  - standardize
• 17:18
  - the what
• 17:19
  - when it creates
• 17:21
  - the value, but also allow flexibility in how
• 17:24
  - when, you know, the local dynamics or conditions
• 17:27
  - matter.
• 17:28
  - So, I mean, one that you're not gonna
• 17:31
  - get too much argument on and where we
• 17:33
  - should have, you know, common expectations are in
• 17:35
  - the areas of quality,
• 17:37
  - safety,
• 17:37
  - access,
• 17:38
  - data definitions, and accountability.
• 17:41
  - But the way a hospital achieves those outcomes
• 17:44
  - may differ based on its patient population,
• 17:48
  - the workforce,
• 17:49
  - physical capacity,
• 17:51
  - physician composition, and and roles
• 17:54
  - within,
• 17:55
  - each of the regions. Right? There are just
• 17:57
  - some naturally...
• 17:58
  - Some differences there. So we're not trying to
• 18:02
  - erase local identity by any means. Local relationships
• 18:05
  - and knowledge
• 18:06
  - are tremendously
• 18:08
  - valuable,
• 18:09
  - and it's what, in in many cases, is
• 18:11
  - the glue that holds people together and is
• 18:14
  - the gas that fuels the car. Right?
• 18:17
  - So the objective is to reduce
• 18:20
  - a lot of the unnecessary
• 18:21
  - variation
• 18:22
  - while holding on to,
• 18:24
  - you know, or preserving the professional judgment
• 18:27
  - and local adaptability. So that allow, you know,
• 18:30
  - people to serve their communities in a way
• 18:32
  - that makes the most sense,
• 18:34
  - and what the market expects.
• 18:37
  - That... And I I think it's critical to
• 18:39
  - have that type of judgment. And, I I
• 18:42
  - love the way you laid out so clearly,
• 18:44
  - the justification for both sides and being able
• 18:46
  - to keep that local,
• 18:49
  - feel alive while also being as efficient and
• 18:51
  - effective as a entire system and organization.
• 18:54
  - Before we wrap up here, I just have
• 18:56
  - one more question.
• 18:57
  - What has this work taught you about leadership?
• 19:01
  - My knee jerk response is,
• 19:03
  - you know, be careful what you sign up
• 19:05
  - for when you step into these roles because
• 19:07
  - it's a lot. You know? I definitely...
• 19:09
  - It's been a great learning experience in terms
• 19:12
  - of, you know, having that systems
• 19:15
  - role and having that different perspective there. And,
• 19:19
  - it definitely gives me appreciation
• 19:21
  - for
• 19:23
  - the differences
• 19:24
  - and the ability to move things at scale
• 19:27
  - as opposed to maybe, you know, something you
• 19:30
  - could do, you know, in a regional level
• 19:31
  - or maybe at one hospital level. You know,
• 19:34
  - systems thinking,
• 19:35
  - in in general,
• 19:37
  - requires people to,
• 19:38
  - you know, resist kind of the the local
• 19:41
  - optimization
• 19:42
  - and, in my case, the things I've been
• 19:44
  - using for quite some time. So, you know,
• 19:46
  - decision can be good in many a time
• 19:49
  - when we're thinking about it from a system
• 19:50
  - perspective for one hospital,
• 19:52
  - but really suboptimal
• 19:54
  - for, like, the organization as a whole. So
• 19:57
  - I've really taken from it that
• 20:00
  - I have to ask myself, does this improve
• 20:02
  - my area, but, also,
• 20:04
  - what does the student patient access capacity
• 20:08
  - cost
• 20:09
  - and performance
• 20:10
  - across the whole entire system?
• 20:13
  - And the second thing
• 20:15
  - that I take away from that is, you
• 20:17
  - know, leadership in an integrated organization
• 20:20
  - depends more on
• 20:22
  - influence than authority. Right?
• 20:24
  - I talked about,
• 20:26
  - a lot of the organizations being, you know,
• 20:28
  - in very much a matrix environment,
• 20:31
  - and we have so much studies going back
• 20:33
  - the last twenty years of the the negative
• 20:36
  - impact of kind of top down decision making.
• 20:39
  - So, you know, you can't
• 20:41
  - mandate authentic alignment.
• 20:44
  - You have to really
• 20:45
  - build trust,
• 20:47
  - involve people early,
• 20:50
  - and make that value proposition
• 20:52
  - clear and create share and ownership.
• 20:55
  - And I say this all the time.
• 20:57
  - You know, we're in the people business. So
• 21:00
  - relationships
• 21:01
  - are huge, and the ability to do that
• 21:02
  - is huge.
• 21:03
  - And so it's reinforced
• 21:05
  - that by kinda stepping into to this arena.
• 21:08
  - So,
• 21:09
  - maybe the last thing would be... And this
• 21:11
  - sounds kind of counterintuitive
• 21:13
  - or,
• 21:15
  - you know, not as
• 21:17
  - easy of a thought to kind of arrive
• 21:19
  - to unless you're kind of in it, is
• 21:22
  - complexity
• 21:23
  - requires simplicity.
• 21:24
  - Right? And I think about the work that
• 21:26
  - I'm doing now,
• 21:28
  - even just from a thought process standpoint, when
• 21:30
  - I encounter a very difficult
• 21:33
  - complex issue,
• 21:34
  - I try to distill it down to, you
• 21:37
  - know, one to two things that I need
• 21:39
  - to focus on. Or even from a solution
• 21:42
  - standpoint,
• 21:43
  - you know, how do we make it easy
• 21:44
  - enough to to really throw one or two
• 21:46
  - things to to yield the biggest impact?
• 21:49
  - And I think
• 21:51
  - that's what allows you, a,
• 21:53
  - to make it easier to tackle in terms
• 21:55
  - of the issue because it is daunting at
• 21:57
  - times,
• 21:58
  - if you think about all the things I've
• 21:59
  - said a little bit earlier. But it also,
• 22:02
  - you know, allows folks to come along for
• 22:04
  - the ride when they know
• 22:06
  - that it's an achievable goal or something that
• 22:10
  - isn't insurmountable
• 22:11
  - in terms of, you know, the the issues
• 22:13
  - that we're tackling together.
• 22:15
  - Love it. That is... It makes so much
• 22:17
  - sense and, you know, it's credible to hear
• 22:19
  - this journey that you've been on and how
• 22:21
  - you're thinking about the future and leadership and
• 22:23
  - more. Erin, thank you so much for joining
• 22:24
  - us on the podcast today. This has been
• 22:27
  - a really great conversation. I I learned a
• 22:29
  - ton, and I'm really cool to hear about
• 22:31
  - everything you're doing at Jefferson. I look forward
• 22:33
  - to seeing you as well at the CEO
• 22:35
  - CFO roundtable. I know you'll be speaking on
• 22:37
  - a panel, and we'll dig deeper into some
• 22:38
  - of the things we talked about today.
• 22:41
  - Absolutely. Thank you for having me, and really
• 22:43
  - enjoy our time together. And, look forward to
• 22:45
  - seeing you at the conference.