Sarah Roller (00:12):
From Advisory Board, we're bringing you a Radio Advisory, your weekly download on how to untangle health care's most pressing challenges. I'm Sarah Roller, managing director of physician and medical group research, longtime guest, first time host.

(00:30):
I recently went to an Advisory Board event all about what a sustainable future looks like for healthcare. We talked a lot about the growing pressures health systems are facing, challenges with reimbursement, volume shifts, workforce shortages, and skyrocketing costs. As part of that event, I hosted a panel on how to survive in such a harsh environment. Health systems have no choice but to double down on operational excellence. To quote one of our panelists, "That means working hard as hell every day." To help us dig deeper into what that hard work entails and how we can make it sustainable in the long term, I invited two healthcare leaders on stage. And now to you, our Radio Advisory listeners, who have personal experience in making operational excellence a strategic priority. Dr. Mary Jo Cagle, CEO of Cone Health, and Dr. Cynthia Horner, chief medical officer of Amwell and president of Amwell Medical Group.

(01:45):
We are here today to talk about operational excellence, and I think the reality is we are facing challenges with reimbursement, volume shift, workforce shortages, skyrocketing costs. And so what keeps coming up when we talk to providers across the country is this idea that what we need to do now is double down on operational excellence, really get it right this time. How do we sustain the changes that we're making in our operations right now? And Mary Jo, not to steal your words, but you described it to me as strategy leads to operations, which leads to tactics. And I know you do your strategic planning with that in mind. Can you tell us a little bit more about that process and the interconnectivity between strategy and ops?

Dr. Mary Jo Cagle (02:30):
I think it's so important to have strategy drive everything that you do. And I think we must always start with what is the strategy to get where it is that we're wanting to go? Strategy is what gives an organization its competitive advantage. And so when you start with what is your strategy, where is it that you want to go? Then you give everyone in operations the idea of how do we attach operations to strategy? Everything we do at operations ought to be attached to some pillar in your strategy.

Sarah Roller (03:08):
Can you give me an example of something you've done that connects those two? Not to put you on the spot.

Dr. Mary Jo Cagle (03:11):
You're not putting me on the spot because this is what I live and breathe every day. So let's talk about healthy communities.

Sarah Roller (03:20):
Okay.

Dr. Mary Jo Cagle (03:21):
So part of one of our big strategies is to develop healthy communities. And so all of us are required to do at least every three years, a survey of our communities and understand the health needs of our communities. And so as we did this, we said, "North Carolina is not known for healthy communities and our segment of North Carolina in particular is not." So that's one of our strategies is to increase the health of our communities and we have segmented it to understand that. And so as we did that, we said, "Well, that ties to what we're trying to do with value-based care. If we move the care upstream to our primary care physicians and work to make certain that each segment of our population had a primary care physician, then we tie them to our risk-based care." And we believe we've got it down to how much it would decrease ED visits, how it might decrease hospital visits, but how much access then we would have to build in our primary care.

(04:30):
So then how does that tie to operations? Then that tells us how many primary care docs do we need to recruit? We have to look at access of our existing primary care doctors. It tells us how many visits, how many new patient slots. Oh, is that operations? Yes. One of our KPIs is tracking visits, tracking recruits. It's tracking ED visits. What does that lead to? That leads to tactics, so it goes to tactics for our medical group about looking at how do they create access. So it's a lovely waterfall of the healthy community strategy down to operations of how are we looking at visits and access in our primary care and then the tactics of how you get there.

Sarah Roller (05:20):
And it sounds like the metrics and measurements as well. How do you incentivize that performance?

Dr. Mary Jo Cagle (05:26):
You can't have operational excellence without metrics and incentives.

Dr. Cynthia Horner (05:30):
That's exactly it. And I'm delighted to hear about how so much of this is data-driven specifically, but you have to pick the right metrics. You have to understand what are really those metrics that are going to drive those outcomes. And the good news is there are subject matter experts out there and various groups, like Advisory Board, that help us understand the relationship between metrics, outcomes, and which ones seem to have the most power.

Sarah Roller (05:57):
And talk to me a little bit more about this idea of strategy is not just looking ahead one year. It's looking ahead one year, I know each of you think about it in one year, five year, 10-year plans. How do you think about that, especially with evolving technology, which is sometimes hard to predict that far out?

Dr. Cynthia Horner (06:14):
It is. In fact, I would say it typically takes about one to one and a half years on the short end, and that's being optimistic, to realize the benefits of a significant technology investment. There are smaller investments that one might have that you can start to see some of the benefits within a year. But typically, you need to plan out and plan for gains over a period of time. And especially if you're doing risk-based workflow changes and contracting that's driving those workflow changes, even changes to your staffing, you're not going to have the benefits within the first 12 months typically, it's going to be several years before you start to realize some of that.

(06:54):
From a technology standpoint, thankfully, you probably don't want to plan longer than three years because the technology is going to change. You need to keep your goals in mind. And so you always start with, what problem am I trying to solve? Because you can't boil the ocean. There are every one of the clients that we will speak to has several different initiatives that they would like to invest in. So figuring out where is your strongest pain point and how do you leverage existing technology that you have to address that? But you have it and it's not working, so why is it not working? Is it an issue of workflow that needs to change? Is it an issue that the technology is just not quite right or it's outdated? And so you now have regulatory changes that you need to improve.

(07:39):
So if you decide on, where are my pain points? Do I have technology that I can augment? And then invest in either workflow changes or new technology that will work together with your existing, because that's the second piece, because technology, as I referred to earlier, is evolving so rapidly, you need a flexible technology and you need to have one that can evolve either as you achieve the strategic goals that you have and move to new ones or as you find that your community is changing and the problem is changing.

Sarah Roller (08:12):
Mary Jo, what's your horizon look like for your strategic planning?

Dr. Mary Jo Cagle (08:15):
Yeah. Right now, we're updating it. We're working on Vision 2030, so six years, and we started last year. Now, I believe that a strategy has to be a living breathing document that you pick up regularly and you may need to refresh it because when you're creating a strategy, you're using the best known information you have at the time. You reach out to your advisory boards, you're looking at your census from your state, you're talking to your stakeholders in your community, your docs, your board, your community leaders. You're going to every source of data you can get.

(09:03):
And so if you're doing a good strategy, you're being as forward-looking as you can be and doing the best job you can to look out into the future. And you can't predict everything. So it's a living, breathing document that you're looking at regularly and you're saying, "Where do I need to adjust?" It has to be flexible, like you said, Cynthia, because a curveball might happen, COVID might happen. And so it's got to be strong enough that it can lead you forward and flexible enough that you can adjust it.

Dr. Cynthia Horner (09:48):
Or you might find that your solutions aren't netting the results that you thought. We have had clients in the past, one in particular that I'm thinking of, that instituted an automated care program specifically to address surgical downtime, surgical suite downtime for colonoscopies. And they had outreach specifically through an automated care program to ensure that appointments were confirmed and instructions were handled appropriately and patients understood. And their first round of this in the first three months wasn't really successful. And so they had to go back and retool some of their workflows and say, one of the things that they realized is that they were reaching out with the wrong timing. And so figuring out, it wasn't that the messages were wrong, it wasn't that their goal wasn't right, but they had to take their operational plan and their tactics and say, "We need to redo this because in three months we're not seeing the return on our investment."

Sarah Roller (10:50):
Yeah. You're getting us down a level almost to how do we do the operations, right? We were talking about the big picture, how do we interconnect strategy and operations? Why is it important and different? But so much of operational excellence and success is what are you doing? How do you do it and how do you bring people along with it?

(11:11):
Before we jump into that change management piece, which I know is something we're all passionate about, I want to understand a little bit about the decision-making process. How do you decide which operational initiatives are the most important, the ones you want to bet on, and who do you need in the room when you're making those decisions?

Dr. Cynthia Horner (11:32):
I feel very strongly about this. So I think as I mentioned before, you need to start with what are your highest and strongest pain points? But you also need your question, Sarah, about who do you need in the room? Is really critical because everybody has seen times in any kind of healthcare system where you may have the best ideas, it may be the right idea, it may be the right strategy, and you may have picked the right pain point, but if you don't have your vested parties involved, the people that are going to have to execute on this, or separately people that are individuals or constituencies that are going to be impacted by this, then you're not going to have as thorough and robust a solution.

(12:15):
And so I'm sure, Mary Jo, and one of the things that you spoke about was reaching out to your community to understand what are the community needs? I mean we certainly experienced that throughout my career and particularly in Sierra Leone, you need to let the end users, the beneficiaries have input into the process and you need to control that to some extent, but you have to have your advocates and you actually, one of the things that I found is when you have the people who are most opposed to it, you need to have them at the table.

Dr. Mary Jo Cagle (12:48):
Advocates and adversaries during the development, during the development, but when you get ready to execute. I had a mentor who used to say, "If everybody's feeding the horse, then the horse will go hungry." So when it's time to execute each of your operational areas, you need one strong leader who is accountable for delivery of that operational area.

Dr. Cynthia Horner (13:18):
In a particular time. It has to be bound, it has to be clear, it has to be measurable, all those sparkles.

Dr. Mary Jo Cagle (13:25):
Yeah.

Sarah Roller (13:26):
And one thing we didn't bring up in the, who should be in the room? That I feel really important right now given the state of our workforce is the people that are going to be doing the change, the physicians, the nurses, the frontline staff who are going to be having to drive the change at the end of the day. And I know that's something you're both passionate about, is how do you approach getting those folks invested from the get-go in the change that you're doing, especially when it can take a long time to see the results?

Dr. Cynthia Horner (13:58):
Sarah, I think you have to help them understand why is this change going to help me, not just why is it going to help the system? And for many direct clinicians, it's also why is it going to help your patients? Because many of the clinicians that are providing the care actually still retain the nurses that are frontline, the physicians that are doing the care, they still care about these outcomes, they care about the experience that their patients are having. So whether it's how is it going to help them personally and ease the amount of administrivia that they're going to have to deal with on a day-to-day basis, reduce their burnout, improve their experience, or whether it's improving the patient experience, I think you've got to have a really crisp story on that.

Sarah Roller (14:46):
It strikes me that you pointed out earlier to me that it can take a year, a year and a half, you mentioned it today, to really see the ROI of an investment you're making, but we often hear from strategy leaders that they look at a 12-month timeline. We got to see the ROI more quickly. And I would say that the frontline staff is looking at a much shorter timeline. We've all been through an EHR implementation. Three months. Three months. There is going to be so much pain before you see the other side. Mary Jo, what have you seen successful in getting through those pain points, the stuff that's going to be really hard and probably worse before it gets better?

Dr. Mary Jo Cagle (15:31):
So this is where the change management comes in. So I think that gets overlooked way too often, how important change management skills are for leaders up front? You need to say what are the quick wins and what are reasonable short-term goals? So there have to be some quick wins.

(15:51):
You're absolutely right, Cynthia, the big ROIs that we get sold by the big companies are longer term to get, but there are some quick wins and they need to be determined up front and we need to clearly articulate what they are, and we got to celebrate them when they happen. And I don't know if any of you are like this, but to me, finishing the project's the win, and I'm delighted when we finish the project and I'm happy with that and I'm ready to go to the next thing. That's just my wiring, but that's not most people's wiring. And I have to learn to acknowledge that and learn that when you got that quick win and people accomplish that, you got to celebrate that. And it's got to be a big obvious celebration. And it can't just be a memo and it can't just be-

Sarah Roller (16:47):
Not a pizza party?

Dr. Mary Jo Cagle (16:48):
No, not just a pizza party. It's got to be something big and obvious. And some of that depends on the culture of your organization, what the celebration looks like in your place. But we bring in food trucks and ice cream and we do drawings, and each draw will have a winner. I mean things that relatively don't cost a lot, but people recognize that we're saying, "Hey, you've worked hard and we want to acknowledge that you've worked hard and thank you." And you can't say thank you enough to people who are working really hard and you have to. My vice president of communications and marketing keeps saying, "Mary Jo, you got to say it seven times, seven different ways before it breaks through all the clutter." And I think that's good advice, and that's what we have to do when we're celebrating those little wins. And so then when you get the big win, it's got to be an even bigger celebration.

Sarah Roller (17:52):
Well, and one shiny new toy that I think most organizations are trying to grapple with right now is AI. So I want to talk about it directly because I think it's one of the biggest, it's not COVID-level disruption maybe, but it's a pretty big potential disruption to how we practice. So starting with you, Cynthia, how do you think about the change management around AI? And what do we need to do now to make sure that we can keep up with what's inevitably going to change in that space in the upcoming years?

Dr. Cynthia Horner (18:25):
It will and it already is. I mean, anybody who is using a smartphone, if you look something up on your smartphone on any one of the search engines, you have just leveraged AI. So the idea that healthcare would be immune to AI is naive, but I think part of the problem that we have, we need to call out and acknowledge there's a trust gap. There is real and legitimate concern that AI left to its own devices, particularly in the generative AI space, could result in really problematic outcomes, dangerous outcomes, death. And I'm not being too dramatic when I say that, we've all seen sort of the mild examples of when you do a query or leverage one of the AI generated chats and you get back a really bizarre answer that you know is wrong. So humans, to address that trust gap, humans are never going to be out of the process.

(19:23):
Some of the work that we do, and Amwell at this point is not engaged today in generative AI, there's a whole host of regulatory precautions around that. So I think that is coming down the road, but there's a lot of nuance in there. But even for the non-generative AI, I think humans are still going to be making decisions based on the recommended next best action. And one example. We have, one of our clients in the Midwest had a virtual companion program that they built and leveraged to take artificial intelligence to go out and actually stay with patients post-emergency department discharge. And the virtual companion reached out to them periodically, I believe it was daily, for several weeks after discharge. And the goal of this was to reduce emergency department readmissions and bounce backs, if you will.

(20:21):
So the clinicians that were a part of helping to advise this from our company, as well as our partner, built this program based on the goals and the specific issues that they had to deal with. The nursing staff was monitoring a dashboard, so there were alerts that were put up, and this is standard for the program itself. So alerts are brought up saying, "This patient actually is having risky symptoms. Somebody should probably do something about this," or we can actually recommend some interim solutions. So there are levels of gradation, but it's not human-free. The great news on that particular program is that that hospital system saved a million dollars within 12 months and reduce their emergency department revisits and returns within 48 hours by a relatively small amount, 5%, but that's a million dollars worth of savings. And that was AI-based, not generative, but still AI-based.

Sarah Roller (21:18):
Well, I think I'm going to butcher something that my colleague, John Leake, likes to say about AI, but essentially the idea that you don't need an AI strategy, you need to input AI into your strategy. And I think we could probably say the same thing about AI in your operations. We don't need a separate operational group on AI, we need to figure out what AI or any technology, how that fits into the operational initiatives that come from our strategy, because it's inevitable. We talked about workforce shortages, we've talked a bit in other sessions today about the influx of drugs and information and prescribing. We have too much information and we can't sort through it. So I think this idea of technology enabling operations and enabling our workforce is where we need to be going.

Dr. Cynthia Horner (22:11):
And keeping a larger group of clinicians adhering to your standards, whether it be your clinician group that is working in your primary care offices in your community, and making sure that they are, if you're in a risk-based arrangement, that they are aware of some of the implications of their decisions. To your point, there's so much new information out there. Is it acceptable within your risk-based arrangements for somebody to say, "I read an article to prescribe this medication that looks like it might work"? Or, "Do you want that to be a part of your consistency, or do you feel comfortable?"

Dr. Mary Jo Cagle (22:46):
So Cynthia referenced earlier the shortages of nurses, and she referenced the shortage of primary care, but we also have a shortage of radiologists. They didn't fill all of their residency programs this year. We have a shortage of psychiatrists for the last several years, all of the residency programs have not been filled in psychiatry. This past year, all the residency slots for emergency medicine were not filled the last two years. It's not hard to look down the road. When I talked to my physicians, ENT, urology, dermatology, I could go down, I could go down the list. There's an article in Becker's today talking about the shortage of nursing assistants. That's the next big one coming up.

(23:43):
So it doesn't really take a rocket scientist, or even an MD, to figure out that we're going to have to think differently and use some different tools, because I could talk to every nurse in this room and you would tell me about the bureaucratic nonsense that's taken you away from the bedside and taken your colleagues away from the bedside. So how do we redesign care so that we put nurses and doctors doing the things that only human beings can do, the reason that people were drawn to healthcare in the first place? And then let human beings work with AI to do the things that it doesn't take a human being to do.

Dr. Cynthia Horner (24:40):
Like remote patient monitoring and understanding. You can have a team of virtual nurses that are overseeing your remote patient monitoring devices and the dashboard that says, "This particular patient hasn't been turned in X period of time." The virtual nursing team can look at that and say, "We actually need a nursing assistant to go in and help with that." And it doesn't have to take a round every single visit.

Dr. Mary Jo Cagle (25:04):
Doing chart audits and pulling out only the abnormals.

Dr. Cynthia Horner (25:08):
You bet.

Dr. Mary Jo Cagle (25:09):
I mean, there's so many things that we have people doing that AI is perfectly designed to do that would get the bureaucracy off the back of our clinicians and let them be at the bedside doing the things that drew them to healthcare in the first place.

Dr. Cynthia Horner (25:27):
And working at the top of their license.

Dr. Mary Jo Cagle (25:29):
Oh my goodness, yes. And so I think that we're just beginning to see the things that could help us solve some problems that we've got to solve. And so I think that yes, and we need to have our clinicians at the table helping us to determine what are the problems we want to have this new tool help us solve?

Sarah Roller (25:56):
What's the biggest lesson learned that you have on operational excellence from your career so far?

Dr. Cynthia Horner (26:03):
I only get one, start with the end goal in mind and be laser-focused on your strategic goal. I think we've spent an hour talking about a lot of implications of all of that, but I think I would condense it to, you've got to marry your operational strategy to your strategic goals.

Dr. Mary Jo Cagle (26:30):
I could say what she said, but-

Sarah Roller (26:32):
Ditto, but now we get a second one as opposed to-

Dr. Mary Jo Cagle (26:34):
Okay, good. Yeah. So at its core, good operations is good discipline. And so one of my favorite sayings, you get to choose the pain of discipline or the pain of regret. And so choose the pain of discipline because it doesn't last as long.

Sarah Roller (27:56):
We have a question from the audience. I find that most health systems don't have a culture of accountability. How long does it take to create that, and how you? We can't drive to metrics without it.

Dr. Mary Jo Cagle (28:09):
So sometimes people get accountability confused with punishment, or trouble, or, "I'm in trouble." And so you need to take an honest look at your culture and make certain that you haven't done that. So I think that's the first thing I would say. Let's go back to the accounting term. Accountability is account for what I have done and what I haven't done to get the results I've achieved. Here are the results I have. If they're great results, here's what I did to get them, I'll share it to get these results. Let's share it with everybody so they can be successful and we'll celebrate it. So accountability can be a celebration. If I'm not getting the results I want, here's what I have done and here's what I haven't done. Let's look at that together to see what we need to do. And I think help people move away from this idea that accountability is about, "You're in trouble."

Dr. Cynthia Horner (29:15):
Yeah. And I think one of the ways that you can do that is you start with your Objectives and Key Results, your OKRs, and they have to align all the way from your CEO to every single person in your organization. And so not every person in the organization is going to have the same OKRs as Mary Jo, but they should be related, and they should be able to see what the C-suite team's OKRs are, and they should be able to hear, "How are we as an organization doing against our OKRs?" And not just at the end of the year, hopefully we worked. But I think defining the objectives, the key results, and they have to be measurable, and they have to actually... Everybody has to see how they're related.

Sarah Roller (30:04):
And how they impact those, how what they're doing impacts those.

Dr. Mary Jo Cagle (30:08):
And are they incentivized and how are they incentivized?

Dr. Cynthia Horner (30:10):
That's exactly right. Yeah.

Sarah Roller (30:13):
We have a handful of questions here around leadership. How do we create leaders that can carry on this bridge of operational excellence in the future? I know both of you are passionate about that, so I'd love to hear both of your perspectives around, how are you training these leaders? What's the most important in your operational leaders?

Dr. Mary Jo Cagle (30:31):
Can we just come back and do a whole session on training?

Sarah Roller (30:35):
Yeah. Someone write that down. Next summit, yeah.

Dr. Mary Jo Cagle (30:38):
That's my favorite. I do think, and I've said this already today, but what you need in today's milieu is someone who understands change management.

Dr. Cynthia Horner (30:50):
Most young leaders start because they're identified as leaders because they're really good at getting stuff done. And so they become subject matter experts and they move into an area where then they have to actually become better at understanding the team dynamics and helping empower others to get that stuff done. And so really, it's a significant transition going from not just individual contributor to manager, but actually from a VP level to even... It happens all the way up the chain.

Dr. Mary Jo Cagle (31:28):
Young leaders are really great at tactics. They're the doers, they're the tacticians. So taking them step by step and saying, "Those are great tactics. Now let's talk about the operations, what the overall goal is," and you having team members that know the steps to do to get there. And then as you move them up, teaching them about strategy. And it takes a while for somebody to understand the difference between that. And it's okay that it takes a while. It is harder. But if you're really committed to developing young leaders, helping them understand the difference between tactics, operational goals, and strategic goals, that's golden when you do that. And I'm going to say it again, enroll them in a good change management course because that's what is so important. Change is hard.

Dr. Cynthia Horner (32:29):
Yeah. One of the things that is never going to go away in healthcare is it's changing and it's changing rapidly. So you have to, I completely agree with you, Mary Jo, you have to a really good change manager, especially now.

Sarah Roller (32:41):
Yeah. We talk about it a lot at Advisory Board about adaptive leadership. It is about how do you respond to the ever-changing world? Because it changes the constant, which is important in our strategy and our operations. I think we have time for one more here. And because I'm in control, I get to ask us the last question. So the other kind of theme of what folks are asking is about M&A and when systems get bigger.

Dr. Mary Jo Cagle (33:12):
You might imagine that I have had a year of talking about that with my upcoming partners. And so there has to be a plan for that. And change management is absolutely an intricate part of that plan. So it is very much like all the other operational management in that there have to be very clear KPIs and everyone has to be very clear on where we are going, the problem we're trying to solve, the goals that we're going to reach, and the timeframe in which we're trying to do that. And you have to make certain that everyone really knows, "Here's what you're accountable for." And I think in times of very big change, communication over and over and over again with the CEO in writing, in person, multiple, multiple town halls, I do video blogs. Every format we can think to put it in, so people see over and over and over again, "Here's what's changing for you, here's what's not changing."

Sarah Roller (34:29):
That not, it feels really important.

Dr. Mary Jo Cagle (34:30):
The not is as important.

Sarah Roller (34:32):
Here's what's not going to change.

Dr. Mary Jo Cagle (34:34):
What's not changing, here's what is changing.

Dr. Cynthia Horner (34:37):
And there's the positive of that, but there's also the part of the change management is addressing the unspoken fears that people have. And I think whether it be anybody who's ever gone through an EMR transition, I've been through four personally, you've seen that, but an M&A, same thing.

Dr. Mary Jo Cagle (34:56):
So that's why the town halls, whether they're in person or virtually, and we do a mixture of both to allow people to ask questions and unscripted, just be ready to answer whatever questions people have. And that's part of how you achieve operational excellence is transparency to address those fears.

Sarah Roller (35:17):
Yeah. Well, you have a daunting task in front of you, but it seems like you're up for it. My last question before we wrap up today is if you were to be able to ask one thing, again one, of another sector of the industry that would help you achieve or take next step in operational excellence, what would your ask be?

Dr. Cynthia Horner (35:41):
I would say regulatory advocacy. It was the one thing that we haven't really spent a lot of time talking about because it's sort of a sidebar to this, but again, if we are starting with what are we trying to do here? Why do we care about strategy and operations? Well, we care because we're trying to drive better health. And if we want to drive better health, we need to improve access, we need to improve, break down some of the barriers to enabling, whether it's technology or whether it's ensuring that the payment models actually reward the health systems in ways that drive those excellent outcomes.

(36:30):
There are legions of regulatory issues that come up on a weekly basis, at least on a monthly basis. And I think right now we're in a lot of transition with the states and the Federal Government looking at removing some of the PHE, Public Health Extensions. Some of those make sense to remove them, some of them it may not. So just take a look at those and advocate where you think it's going to be really helpful to improving the outcomes in your community. Yeah.

Sarah Roller (37:02):
How about you, Mary Jo?

Dr. Mary Jo Cagle (37:03):
So I would say one of the areas that I would ask everybody to join arms around is around medical education. And I don't mean just for physicians, I mean for nursing and for everyone that's touching the opportunity for people to go into a healthcare education because it's going to affect everyone in this room. I listed some of the shortages, but we are going to fill those, and certainly in the next decade, it will be significant for every one of you and those that you love, unless all of us and all of those we know start advocating at our state levels, certainly, but also federally, for more dollars for education, for physicians, nurses, and others. And that's hard to imagine in the United States that we know, so I would ask you to make your voices heard.

Sarah Roller (38:07):
Appreciate it. I think it's a team sport, right? We represent different sectors of the industry and I don't think anyone can go it alone when it comes to operational excellence. So thank you both and thank everyone here for joining us today.

(38:21):
What stood to me from my conversation with Dr. Cagle and Dr. Horner is that operational excellence requires more than just a good strategy. It takes adaptive leadership. Healthcare leaders have to roll with the punches and inspire their teams through difficult times to achieve true sustainable growth. And while this may admittedly sound daunting, our panelists showed us that it is achievable. Remember, as always, we're here to help.

(39:27):
If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts, and leave a rating and review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Sarah Roller, as well as Rae Woods, Abby Burns, Chloe Bakst, and Atticus Raasch. The episode was edited by Katy Anderson with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Leanne Elston and Erin Collins. We'll see you next week.