Latest / Becker’s Healthcare Podcast / Transforming Patient Flow and IT Quality at University Health with Ashley Schutz

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Transforming Patient Flow and IT Quality at University Health with Ashley Schutz · Becker’s Healthcare Podcast

• 0:00
  This is Scott Becker with the Beckers HealthCare
• 0:02
  podcast.
• 0:04
  We're thrilled today to be joined by a
• 0:05
  brilliant lifelong
• 0:07
  leader, our favorite type of leader. We're joined
• 0:10
  today by Ashley Schutz,
• 0:11
  and Ashley is the director of IT quality
• 0:14
  assurance at at University Health Texas in San
• 0:17
  Antonio.
• 0:18
  Ashley has done a tremendous job over seeing
• 0:20
  so many interesting efforts at University Health,
• 0:23
  whether Epic implementation,
• 0:25
  lean task implementation, and and so much more.
• 0:28
  We're gonna talk to her today about operating
• 0:30
  technologies,
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  and and just technologies in general and trying
• 0:33
  to implement them well and working with teams
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  to do so. Ashley, can you take a
• 0:38
  moment to introduce yourself and tell us a
• 0:40
  bit about yourself and your work in health
• 0:42
  care at University Health in San Antonio, Texas?
• 0:45
  Yeah. Thank you so much. First and foremost,
• 0:47
  thanks for having me.
• 0:49
  I'm really excited to share our story and,
• 0:51
  my thoughts on health care IT.
• 0:53
  But a little bit about me, I've actually
• 0:55
  worked for University Health for thirteen years.
• 0:58
  I started with them. It's kind of a
• 1:00
  long winding road, but I've started my career
• 1:02
  with them as a medical laboratory scientist in
• 1:04
  our microbiology
• 1:06
  department.
• 1:07
  But, basically, I latched on to anything related
• 1:09
  to process improvement
• 1:11
  and especially crossover with other departments.
• 1:14
  So
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  in 2018,
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  the opportunity came up to join the EPIC
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  team,
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  and I thought what better time to get
• 1:22
  more involved than the implementation of a system
• 1:24
  wide EHR system.
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  So that was like a big switch in
• 1:28
  my career from
• 1:29
  microbiology
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  into IT, but
• 1:32
  story for another day.
• 1:34
  We actually went live during the COVID pandemic,
• 1:38
  which was also,
• 1:40
  pretty exciting times.
• 1:42
  But pretty quickly after going live, I got
• 1:45
  back into that process improvement mindset where I
• 1:48
  saw a lot of opportunities
• 1:50
  where we could bridge the gap between operations
• 1:52
  and IT.
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  And basically,
• 1:55
  I moved into my current role, which is
• 1:58
  the IT director of quality assurance.
• 2:00
  And then a few years ago, I ended
• 2:02
  up going back to school. I got my
• 2:03
  master's in healthcare administration
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  just so I can pull the whole picture
• 2:07
  together.
• 2:08
  And basically over my career, I feel like
• 2:10
  I've kind of turned into this Swiss army
• 2:12
  blade.
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  I like to bridge the gap in between
• 2:15
  IT and operations. That's where I found my
• 2:17
  little niche area. And
• 2:19
  one year ago, I would say, we
• 2:21
  got the news that we were going to
• 2:23
  be partnering with LeanTos for our inpatient throughput.
• 2:27
  And our COO, who was our CIO at
• 2:29
  the time, actually asked me if I wanted
• 2:31
  to oversee the implementation.
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  So here we are a little over a
• 2:35
  year out from our discovery and kickoff call
• 2:38
  and, sharing our success story.
• 2:41
  Thank you. And what's fascinating is you're like
• 2:43
  the epitome of a lifelong
• 2:45
  learner,
• 2:46
  microbiologist
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  to IT,
• 2:48
  back to do a master's
• 2:50
  degree. I mean, it's it's such an impressive
• 2:53
  thing, and congratulations
• 2:54
  on a on a fantastic career.
• 2:56
  You you saw it bring a unique, expective
• 2:59
  perspective
• 3:00
  to someone who grew up in the health
• 3:01
  care IT world. When you look at health
• 3:03
  IT today, hospital IT teams
• 3:06
  adopting and implementing new technologies
• 3:08
  effectively,
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  what have you found most important? What works
• 3:12
  when people are getting things going or or
• 3:14
  starting new technologies? Because You've been on the
• 3:16
  EPIC team that the implementation there. You've worked
• 3:19
  on this, the the
• 3:20
  the IQ for inpatient flow team with link
• 3:23
  toss. Talk about what what's most important in
• 3:25
  implementing new technologies effectively.
• 3:28
  Yeah. That's a good question.
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  I from my perspective, I think the most
• 3:33
  important thing is
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  to really get in there, to know your
• 3:37
  end users, know their workflow, and then become
• 3:40
  as familiar as you can with the system
• 3:42
  architecture.
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  I think in today's world,
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  we are becoming so dependent on IT. I
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  mean, with increasing patient volumes and
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  it's impossible to keep up with the workload
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  if you are not keeping up with your
• 3:56
  technical systems.
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  And it's there to be a tool. It's
• 3:59
  not there to replace anything, but really it
• 4:02
  should be enhancing your work.
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  So if your IT team
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  can get to know
• 4:08
  what your needs are, and I'm not talking
• 4:10
  about your technical needs, but how do you
• 4:13
  serve your patients and how do we get
• 4:16
  your IT
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  processes to fit seamlessly?
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  We have this really nice
• 4:22
  marrying of the two different sides, and it
• 4:24
  helps everybody out.
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  So
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  going back,
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  I think my number one thing that I
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  would say is important
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  would be to
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  just immerse yourself in what you are doing
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  for your end users.
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  Ask the questions,
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  go in shadow if you can,
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  and try and figure out what the need
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  is,
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  not just what can the system do, but
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  how can we make the system work for
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  you.
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  But but that point on on being totally
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  connected to the end user,
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  the actual user of the technology,
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  whether it's EPIC, whether it's LeanTusk's technology,
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  the IQ for impatient flow, whatever it is,
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  that is so important because you see so
• 5:07
  many people who's just historically in IT
• 5:10
  that almost thought they were in a silo,
• 5:12
  and that silo is not meaningful unless it's
• 5:14
  really connected to the end user.
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  Can you take a moment, Ashley?
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  Is there a moment
• 5:19
  where where that really stood out, where that
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  concept being really end user connected,
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  really
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  showed showed importance?
• 5:29
  Yeah. For sure. We have seen this probably
• 5:32
  most prevalently in our implementation
• 5:34
  of lean toss.
• 5:36
  Toss. So,
• 5:37
  as we were doing discovery with my background
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  in IT and knowing the epic systems,
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  as we started meeting with our end users
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  to discuss
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  what were our biggest opportunities,
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  We had to tie that back because you
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  really you start becoming a translator for these
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  services. So you have one system that's connecting
• 5:56
  to another, you have data that's being ingested
• 5:59
  constantly, and you have to really know where
• 6:01
  it's coming from and you have to know
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  the workflows that drive
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  that documentation.
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  So
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  Epic is our source of truth system. That's
• 6:09
  where we do all the bulk of our
• 6:11
  documentation.
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  But LeanTos is wonderful in the fact that
• 6:14
  it surfaces all of that in a big
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  picture way. So it's great for your managers.
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  It's great for your clinical leaders that really
• 6:21
  need to think about that big picture.
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  And looking at the numbers was just one
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  piece of the puzzle.
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  So
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  whenever we started first getting that data over,
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  we started looking at it and say, well,
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  this doesn't make sense. We hear anecdotally about
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  all of these barriers that are occurring,
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  but we're not seeing anything in the data.
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  And it didn't really match what we were
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  expecting to see. And that's whenever we had
• 6:45
  to start kind of reverse engineering and say,
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  okay. Where is this data supposed to be
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  coming from? Go and check our source stem.
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  Okay. We went and checked the source system
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  and we said,
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  okay. Well, there's stuff that's populating.
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  And whenever it does populate, it comes over,
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  but why isn't it populating all the time?
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  And that's when we actually went several steps
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  back and we started shadowing and sitting with
• 7:09
  our end users and saying, hey.
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  I noticed that you didn't document this over
• 7:14
  here. You documented it in this place instead.
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  Can you talk me through that purpose?
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  So
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  by digging into that, we were able to
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  not just
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  validate the data
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  and really give us some meaningful metrics in
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  what it actually is tied to, but we
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  were able to discover opportunities within
• 7:33
  our workflows on our clinician side. We were
• 7:35
  able to discover opportunities to correct within our
• 7:38
  EHR system to say this would be an
• 7:40
  easier workflow.
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  Let's clean this up a little bit. And
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  so now we have
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  a great representation
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  of what is actually occurring on the floor.
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  And all of that is tying together, and
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  now as leaders, we're able to look at
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  that data
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  and make actionable decisions
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  that are impacted
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  directly by what we are doing. It's very
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  correlated,
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  and that was to me the biggest thing
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  that we have been able to accomplish
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  by having this
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  collaboration between our IT operations and clinical folk.
• 8:16
  Thank you. And that's just a great example
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  of where things can go very right
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  if you get that integration correct and where
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  they could really struggle if they don't. So
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  I think that is so important, and I
• 8:27
  love that.
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  Talk for a second. University Health is in
• 8:30
  it is in its first year
• 8:32
  since going live with IQ for inpatient flow.
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  What have you learned about improving patient flow
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  now that your past go live?
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  And what parts have been transformative so far
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  or the most transformative? What have you had
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  the biggest impact so far?
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  Well,
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  I would say our biggest impact would probably
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  be
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  just in the transparency
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  that Wing Tsots has been able to provide
• 8:55
  our group.
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  As we mentioned before,
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  documentation
• 8:59
  is happening in Epic, but that is I
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  think of Epic as more of a a
• 9:02
  tool where people are doing the documentation that
• 9:05
  are taking care of the patient directly.
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  If you need to start making decisions and
• 9:10
  actions and looking at how all of these
• 9:12
  things tie together,
• 9:14
  LeanTos
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  is fantastic
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  at taking all of that data, putting it
• 9:18
  in a way that puts your most important
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  pieces in the forefront.
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  And by that, I mean, they're surfacing those
• 9:25
  barriers that we are encountering
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  in real time. They're surfacing
• 9:30
  the expected data discharge so that we can
• 9:33
  plan more proactively. It's
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  identifying
• 9:36
  patients that maybe could take an alternative route
• 9:39
  for discharge and they're going to our transitional
• 9:41
  care center, which is our discharge lounge. And
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  we're saving bed minutes even if it's only
• 9:47
  an hour here or there,
• 9:49
  but ultimately,
• 9:50
  just the transparency
• 9:52
  and now being able to
• 9:54
  see everything that is going on as it
• 9:56
  relates to throughput
• 9:58
  has been eye opening.
• 10:00
  We have people talking.
• 10:02
  We have a push instead of a pull
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  method. Now our house supervisors are calling proactively
• 10:08
  to say, hey. It looks like we're running
• 10:10
  into some issues over here. What can we
• 10:12
  do to help clear them up? Our EVS
• 10:15
  team has actually,
• 10:18
  really
• 10:19
  been excited because now they're also able to
• 10:22
  get into it and you wouldn't think so
• 10:23
  much. It's usually direct patient care
• 10:26
  that you think about having that impact. But
• 10:29
  the EVS team, something as simple as getting
• 10:32
  real time information
• 10:34
  in advance to them to say, hey. On
• 10:36
  this unit, it looks like we're gonna have
• 10:37
  quite a few discharges. Can we make sure
• 10:39
  that we have extra support to make those
• 10:41
  go smoothly? Can we get transporters involved so
• 10:44
  that they're ready to go and move our
• 10:46
  patients from the ED up to that floor
• 10:48
  as soon as possible?
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  So
• 10:51
  summary of all the things that I just
• 10:53
  said is the transparency that it's able to
• 10:56
  provide us so that we can enhance our
• 10:58
  communication
• 10:59
  has really had the biggest impact.
• 11:02
  Thank you. And and and so critical
• 11:05
  for people to understand where there's openings, where
• 11:06
  there's not, how we move things along better,
• 11:08
  how logistics work better,
• 11:10
  and and just leads to a ton more
• 11:12
  efficiency, that transparency,
• 11:14
  and the ability to to, quite frankly, generate
• 11:16
  more revenues because there's better usage of operating
• 11:19
  rooms and procedure rooms and everything else.
• 11:22
  Talk for a second about sort of where
• 11:24
  have real time insights or predictive tools made
• 11:27
  the biggest difference in daily operations? Where do
• 11:30
  you see that biggest difference?
• 11:32
  So
• 11:33
  going back to the barriers, I think was
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  the first huge win that we had whenever
• 11:38
  we went live in April.
• 11:40
  Before going live,
• 11:42
  we looked at our data, and I think
• 11:44
  even though we knew that there were barriers
• 11:46
  to discharge,
• 11:48
  they weren't being documented in a way that
• 11:50
  was visible to everybody that needed to be
• 11:52
  involved,
• 11:53
  and they were often just communicated verbally. So
• 11:56
  we knew, hey. This patient is waiting on
• 11:58
  a walker before they can go home, but
• 12:00
  that really wasn't documented in a way that
• 12:03
  other people could step in and help.
• 12:05
  So
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  I think we went from documenting one to
• 12:09
  two barriers a week to over 500
• 12:11
  a week just in the first month.
• 12:14
  And talk about eye opening.
• 12:16
  I think immediately
• 12:18
  as we went through our daily huddle at
• 12:20
  09:30, we could start talking through those barriers
• 12:23
  and actually having ownership conversations.
• 12:26
  So,
• 12:27
  we could say, hey. This has a barrier.
• 12:30
  Maybe the the physician hasn't had a chance
• 12:32
  to do their med rec because they're waiting
• 12:34
  on something.
• 12:35
  We were able to assign ownership to say,
• 12:38
  you
• 12:39
  need to call the physician and find out
• 12:41
  when that's going to be done.
• 12:43
  If we needed to coordinate,
• 12:45
  with PT and OT to do a final
• 12:47
  eval for some reason,
• 12:49
  we could do that. If we are waiting
• 12:51
  on an MRI read,
• 12:54
  we could reach out. We had all the
• 12:56
  stakeholders involved to be able to say, we
• 12:58
  have it documented. This is what we're waiting
• 13:01
  on. What can you do to help us
• 13:02
  in your area to move this along?
• 13:06
  So having the documentation
• 13:07
  there
• 13:08
  was great. And then
• 13:10
  I will also touch on that transitional care
• 13:13
  center,
• 13:14
  that discharge lounge.
• 13:16
  We were, for the first time, able to
• 13:18
  actually
• 13:19
  have criteria
• 13:21
  built into the system
• 13:22
  to where we could predict which patients would
• 13:24
  be most likely to go to the transitional
• 13:27
  care center. And we've increased our volume.
• 13:31
  That being said, there's always room for improvement.
• 13:33
  So that's one of the big things that
• 13:35
  we're looking into next is how do we
• 13:37
  use this system
• 13:38
  to now incorporate a new standard of practice?
• 13:41
  How do we transform into being reactive into,
• 13:45
  okay, now that we know this ahead of
• 13:47
  time, what can we do to plan? What
• 13:49
  can we do to
• 13:50
  prepare patients for
• 13:52
  the TCC?
• 13:54
  There have been so many benefits to having
• 13:57
  the real time insights.
• 13:59
  It's transformed us from being able to fight
• 14:02
  fires every day to go to the source
• 14:04
  of the fire and put it out because,
• 14:06
  before it becomes a fire.
• 14:09
  No. And and I love that. And and
• 14:10
  pretty soon, we'll ask you, what's coming next
• 14:12
  for University Health? And and where do you
• 14:14
  see the partnership with lean test evolving to
• 14:16
  in your needs and and and as your
• 14:18
  needs
• 14:19
  continue to scale and continue to get larger
• 14:21
  and larger?
• 14:22
  Before I ask you that, you also opened
• 14:24
  a new command center in November.
• 14:27
  How is this command center what does that
• 14:29
  command center look like, and how has that
• 14:31
  shifted the way that teams coordinate?
• 14:34
  And what has helped strengthen sort of cross
• 14:36
  functional buy in
• 14:37
  to to use of some of these operational
• 14:39
  changes and the use of the command center?
• 14:41
  What does that look like? And how is
• 14:43
  that shifted how teams coordinate?
• 14:45
  Yeah. The so the command center, it's kind
• 14:48
  of like a Cinderella story if I could
• 14:51
  if I could speak frankly.
• 14:53
  We actually
• 14:54
  I believe three years ago now, we opened
• 14:57
  up our women and children's tower. So
• 14:59
  we moved all of our previous women and
• 15:01
  children's units.
• 15:03
  So
• 15:04
  what we did was we took our 5th
• 15:07
  Floor NICU in one of our towers
• 15:09
  and we gutted it to basically,
• 15:13
  turn it into a command center. We had
• 15:15
  to run all new data.
• 15:17
  We had to get it ready. We had
• 15:18
  to put carpet in. We had gas lines
• 15:20
  that we had to cap all the way
• 15:22
  back to the wall. So it was a
• 15:23
  major
• 15:24
  construction
• 15:25
  process,
• 15:26
  and now we have this beautiful command center.
• 15:30
  And within that command center, we have a
• 15:32
  core area that houses our bed planners, our
• 15:35
  house supervisors.
• 15:36
  We have
• 15:37
  representatives from EVS and transport that are involved.
• 15:40
  We're working on getting, a physician of the
• 15:43
  day role to step in.
• 15:45
  We also have our transfer center, our patient
• 15:48
  placement area
• 15:49
  off to one side of that. So it's
• 15:51
  an open it's a big open area, so
• 15:53
  we can easily get back and forth to
• 15:55
  them if we need to communicate quickly.
• 15:57
  We are also working on, our stars as
• 16:00
  our float pool nurses,
• 16:02
  and their staffing office has moved up there
• 16:04
  so we can start to balance our resources.
• 16:08
  And in that command center, the main area
• 16:11
  has 10 full screen monitors that are constantly
• 16:14
  displaying
• 16:15
  current real time status of what's going on
• 16:18
  in our system.
• 16:20
  We opened
• 16:21
  yes. Just it feels like it was yesterday,
• 16:23
  but honestly, it's probably been about three weeks.
• 16:25
  It's been,
• 16:27
  a very fast paced implementation of that.
• 16:30
  Biggest thing right off the bat, once again,
• 16:32
  is EVS.
• 16:33
  Having them there, I believe they told me
• 16:36
  preliminarily that they've already carved ten to fifteen
• 16:39
  minutes off of their average turnaround time for
• 16:42
  bed cleans.
• 16:43
  Still gotta validate that data, but it the
• 16:46
  fact that people can feel it is really
• 16:48
  what makes a difference.
• 16:50
  Our,
• 16:51
  how supervisors now have several reports that they
• 16:54
  look at every day,
• 16:55
  to kind of go over our quick wins.
• 16:58
  If we had to make capacity at the
• 16:59
  drop of a at the drop of a
• 17:01
  hat, where would our biggest opportunities be? And
• 17:04
  having that command center allows
• 17:06
  everybody to communicate those needs
• 17:09
  and has a central point of contact to
• 17:11
  kind of it really is like an air
• 17:13
  traffic control area that allows somebody with a
• 17:16
  big picture to step in and help make
• 17:19
  decisions to control the whole house.
• 17:21
  I mean, that's really amazing, the positives so
• 17:24
  far in that, and you could really see
• 17:26
  the changes. And I think it's really important
• 17:28
  for your operational teams, your clinical teams to
• 17:30
  see those changes to continue to buy in,
• 17:32
  and it becomes like a flywheel if it's
• 17:34
  going well where people see the changes and
• 17:36
  see the positive, then they're more vested in
• 17:38
  it and and more positive about the whole
• 17:40
  thing, I take it.
• 17:42
  Yes.
• 17:42
  We talk about this a lot of times,
• 17:45
  in our, like, leadership groups about
• 17:48
  it's very easy to become so metric focused.
• 17:51
  Whenever you throw numbers up on a screen,
• 17:54
  especially a lot of times they're color coded,
• 17:56
  so green means good, red means bad.
• 17:58
  And
• 17:59
  I think a lot of people, whenever you
• 18:01
  start putting those numbers in a spotlight, get
• 18:04
  really focused on the numbers and just making
• 18:07
  them go green.
• 18:08
  But it's a lot more than that.
• 18:11
  We could have a green metric
• 18:13
  or a good metric, I should say. But
• 18:15
  if your staff aren't feeling that and if
• 18:18
  they can't tie back
• 18:20
  what the data says to how they're feeling,
• 18:23
  it becomes really difficult to get that buy
• 18:25
  in or to continue that momentum.
• 18:28
  With Lane Tas, I think one of the
• 18:30
  first things that
• 18:33
  for me personally at least gave me this
• 18:35
  sense of, okay, we are actually impacting things,
• 18:38
  we are making a difference
• 18:40
  was whenever I talked to the head of
• 18:42
  our emergency department.
• 18:44
  And we were seeing that there was better
• 18:46
  movement,
• 18:48
  but what she told me, she goes, Ashley,
• 18:50
  I am so excited because we are actually
• 18:53
  starting to function like an ED again.
• 18:56
  They could feel it down in the EDU.
• 18:59
  As we were creating more movement up on
• 19:01
  the units, they could move their boarding patients
• 19:03
  up a lot faster,
• 19:05
  and it allowed them to breathe a little
• 19:08
  bit, honestly.
• 19:09
  And our median ED boarding time is kind
• 19:12
  of indirectly related
• 19:14
  to all the patient movement on the floor,
• 19:17
  but it was one of the biggest
• 19:19
  things that we saw
• 19:21
  right
• 19:21
  away.
• 19:22
  And not just saw it in the numbers,
• 19:25
  but to see it in how the staff
• 19:27
  are feeling and to have that relayed really
• 19:29
  tied it in and reinforce that what we're
• 19:32
  doing is
• 19:33
  first and foremost for our patients and then
• 19:36
  helping our staff feel that they can do
• 19:38
  their jobs more effectively and provide good patient
• 19:41
  care.
• 19:43
  That's fantastic. Literally fantastic.
• 19:45
  And, Ashley, take a moment. University Health at
• 19:48
  San Antonio
• 19:50
  is going through a growth phase. The system
• 19:52
  continues to grow.
• 19:54
  What's coming next for University Health, and how
• 19:56
  do you see your partnership with lean toss
• 19:59
  evolving as your needs and scale continue to
• 20:01
  grow and expand?
• 20:03
  We are on a path for growth, and
• 20:06
  it is coming at us fast. And we've
• 20:09
  known about it for a while, and I
• 20:11
  can tell you from an IT perspective, everybody's
• 20:13
  kind of like, oh my gosh. How are
• 20:14
  we going to do all of this in
• 20:15
  such a short amount of time? But
• 20:18
  I I feel confident that we'll we will
• 20:20
  be able to. So
• 20:22
  growth plans, we currently our main hospital, including
• 20:25
  our women children's tower,
• 20:27
  is a little less than a thousand beds.
• 20:30
  And then over the next two to three
• 20:32
  years, I say by the 2027,
• 20:34
  we are on track to have three other
• 20:37
  hospitals within the San Antonio area.
• 20:39
  These will be community hospitals.
• 20:41
  One of, the big things in our mission
• 20:43
  is always serving our community. So expanding our
• 20:46
  growth out
• 20:48
  to other areas within San Antonio because we're
• 20:50
  a pretty big
• 20:52
  physical city,
• 20:53
  so that more people have access.
• 20:55
  So we have those three new community hospitals,
• 20:58
  and with those, we'll probably be adding close
• 21:00
  to 600 beds.
• 21:02
  We are looking at this is the first
• 21:04
  time that we've ever had another hospital within
• 21:07
  our own system that we might have the
• 21:08
  ability to kind of move patients in between
• 21:11
  or more appropriately
• 21:13
  based off of acuity, put patients where the
• 21:16
  best
• 21:16
  care is possible or maybe closer to their
• 21:19
  families.
• 21:20
  So we are looking at all of that
• 21:22
  in relation to lean task. We're starting to
• 21:24
  work through
• 21:25
  our capacity protocols. We're starting to look at
• 21:28
  how are we going to connect all of
• 21:29
  these areas together. What is our escalation policy?
• 21:33
  What are our thresholds?
• 21:34
  And within all of that, we're also looking
• 21:36
  at all of our other IT systems to
• 21:38
  say, how are we going to grow this
• 21:41
  to where everything still talks really well to
• 21:43
  one another
• 21:45
  and supports each other so that we aren't
• 21:48
  building out silos of, well, this community hospital
• 21:51
  does it this way and our main hospital
• 21:53
  does it this way. We really wanna try
• 21:56
  and standardize as much as we can so
• 21:58
  that no matter where you go within our
• 22:00
  system,
• 22:01
  you can still expect the same level of
• 22:03
  care or quality level of care that you
• 22:06
  would get at our main hospital.
• 22:09
  Absolutely. Sounds like an amazing journey that University
• 22:12
  Health San Antonio is on. Simply remarkable. I
• 22:15
  I love your take on it. I love
• 22:17
  your constant ability
• 22:19
  to be a lifelong learner and connect dots,
• 22:22
  connect the IT to the users, the clinical
• 22:25
  staff,
• 22:26
  to procedure management, to predictive analytics, to the
• 22:29
  operating rooms. It's really remarkable leadership.
• 22:31
  Thank you so much for taking the time
• 22:33
  to join us today, in the Becker's Healthcare
• 22:35
  podcast. What a pleasure to visit with you.
• 22:37
  Thank you so much.
• 22:39
  Thank you. I really appreciate it. This has
• 22:41
  been great.