Healthcare CIO Advice On Leading Through the Complexities Of Change

Sobol: Thank you for joining us. Today, we've got Al Smith, senior vice president and CIO of Lifepoint that is based here in Nashville, Tennessee. So, excited to have you joining us.

Thank you very much.

Smith: Thanks for having me.

Sobol: We always start with a little bit of an overview. So, if you wouldn't mind, Al, just tell us a little bit about your journey as an IT leader in healthcare. I mean, you have witnessed some tremendous changes in the industry over the years and experienced a lot of growth and a variety of companies that you've served. Tell us a little bit about what that journey has been like for you.

Smith: Yeah, I think it's been an interesting journey along the way. I don't know that when I started out and when I got out of college, I wanted to be a CIO. I think your career takes you in interesting ways, but overall, it's been a lot of fun and very challenging. I think one of the reasons, when I first got out of college, I worked for a consulting firm and had the opportunity to work in five or six different industries: the Department of Defense, and public utilities—all over the place.

When I got to healthcare, I just liked it. It just felt good. It felt good to be part of something that was a little more tangible than widgets. Something that was you know, it sounds bad or a cliche but sort of, you know, something a little higher calling. Helping people, helping patients, helping our frontline clinicians give the care that we all deserve. So, I kind of landed there. I kind of fell into it a little bit. Overall, it worked out really well. It's been an interesting ride. And I think part of what I've always enjoyed about healthcare is it's about as complex and as difficult and as interesting as you can possibly get.

My attention span isn’t super long. I can get bored with things, and I have found that I have never been bored in healthcare and as my career has advanced and been the CIO through now multiple companies and mergers and M&A work and all this stuff that there aren't a lot of dull days and that fits my personality pretty well.

So, I think overall I ended up in the right place. I get to do a lot of cool stuff.

If you even look at the acquisition of Kindred Health back in January now, I'm learning about post-acute care, behavioral health hospitals, different vendors, different business models, different billing. I'm like, wow, I didn't even know some of this stuff existed. So, it's been a lot of fun from that perspective just to continuously learn and continue to be challenged to have to learn something new and fun.

Sobol: That's great, I think for those of us who have been in different industries in the past, when you get to healthcare everything does change. Some of the underlying technologies might be the same but, the application, right? The end results of what we are doing is radically different and that higher calling really does come into effect.

And I think that's why so many of us, yourself included, stick around and stay and really enjoy and thrive in it. So, I appreciate you sharing that.

Smith: I think it's something you can really hone back in on when everybody has bad days. I mean there days where everything is falling apart and everybody's mad at me and why isn't this working and at some point, you can go back to why are we here and it is back to the patient and the caregiver. Which to me, is a really nice thing to go back on. It's not like I am producing a car, nothing against that, but I'm not producing widgets. It's something that's tangible because at the end of the day, we have all been patients, right? So, we there's something you can relate to that's meaningful to me.

Sobol: Absolutely. Well, let’s pivot a little bit and talk a little bit about some of the leadership strategies or your lessons that you've kind of gleaned and gathered over the span of your career. Some of those are timeless, regardless of when and what you happen to be facing. Others might be specific to instances like oh, I don't know. What is one that has happened recently, COVID. So, you know, what are some of those kinds of insights or tidbits, that you know you gleaned over the years that you feel like other healthcare leaders should really pay attention to it now.

Smith: Yeah, COVID, I mean we all experienced COVID, but I think those of us in healthcare experienced that maybe a little bit differently than many other people did. Yeah, so I would throw out a couple things that I like to always remember.

One, we talked a little bit about resiliency. I had a former boss that used to say keep moving forward. In fact, he used to say stumble forward. Don't go backwards. You're not always going to be running full breakneck speed making progress. It might take a step back but keep moving forward and I think that's really good. And I think that's really good for anybody in IT.

There are bad days, right? I mean you look at cyber issues or upgrades that go bad—no matter how hard we work. There's something that's not going to go well, and I think just having resiliency to say—you know what let's fix it. Let's move on. Let's learn from it but let's just keep moving forward. So, I put that one there.

People first. I mean, you're only good as your team. I know that sounds a little bit of a cliché as well, but you need to surround yourself with people that not only bring out the best in you but also shore up some of your weaknesses.

None of us are perfect at everything. You have to find people that bolster areas that maybe you aren't quite as strong. There are things that I'm good at. There are things I'm not as good at. So, find people with that. Find people of diverse backgrounds.

I like people that will debate. I don't want a group of people that all go—yep, great idea and then later you're like—well, that was a bad idea. Let's debate. Let's do it respectfully, but I think we get the best output when we have the right team. The team needs to have diverse viewpoints. I think that's really good.

But ultimately, I look at my job as I need to be working to eliminate barriers so the rest of the team can be productive. If it takes an hour of my time, but it frees up six people to be productive for a day—that's well worth my time.

I'd also throw in leverage partnerships. I think I've particularly found that here in Nashville. You can’t own everything, and you have to find strong partners that can do things that you're either not good at, you're not resourced at, you can't find the people whatever it is—expertise. Find partners who can help you.

As an example, we have had a long one with Tony and CereCore and Parallon, and there are things that they do really well that we are not good at. I need to leverage them for that. There are things that we are good at that we need to internalize. But don't be afraid of partnerships. You can’t own it all. And you really shouldn't want to.

So, I think those are a few things I would throw out there.

The last one I would throw out would be business acumen. Where I sit, I need to be a businessperson that understands how to apply technology, not a technologist. I find that I do a lot of translating, a lot of interpreting, a lot of listening to try to understand what is it that the business is trying to do. How can I help. Then how do I place technology behind that. Technology is a tool. And there are lots of tools, but it is a tool— a very effective tool for many things. But it has got to start with understanding the business.

Sobol: That’s right. All great points and I think we could do a podcast on each and every one of those topics. They are really in depth. But I think the last one that you talked about—the concept of business acumen really flows into my next question.

Technology is an enabler, and it is part of it. But you still have to be interfacing with the other folks inside of the organization and relationships are vital and key to that. Some of the things that we ask our clients and our prospects, and we've done surveys through HFMA and CHIME and various others, but you know, it speaks to that collaboration from a CIO to a CFO to a CEO a CMO and so on down the line.

Can you speak a little bit to just kind of how you all get on the same page? You know what that collaboration looks like so not only does the business acumen raises in the IT organization, but the business acumen also raises across the organization.

Smith: Yeah, I think that is a daily work in progress, and in every company, it could be a little different because the culture is a little different. But a few things I try really hard to do is: walk around, go find people, drop in and talk to people. It's amazing how many issues and potential areas you can help with if you just ask. I think that's really important.

I think another thing that is really good is to be known for resolving issues and bringing value. Strategy is great, but you have to be able to operationalize it. At some point, if people say, you know what Al’s got a reputation of delivering the goods and can get stuff done that helps me, then I'm much more likely to get invited to the table. You must be willing to really roll up your sleeves and be known for getting things done. I find a lot of those doors start to open up because over time, people say—well wait, he helped me last time. Maybe I should go talk to him.

I think it is always a little dangerous to stay here at the corporate office or what we call the HSC. We know what we know. But at some point, you got to get out in the field. You can't manage everything from here. It is amazing how you get a very different lens if you are talking to a CEO or a clinician in the field than maybe how we think it all operates. So, relationships with a CEO and the CMO in corporate — absolutely got to have those but relationships down in the facility. You know a CEO that will call you to say—this is not working and here is why and I need help with this. You can get a lot done that way as well. But some of that is you have to go meet them out where they are and see it. Then you bring it back and then from a corporate perspective, say what can we do about this?

The last thing I will throw in there is, I like to say IT is a team sport. So, I have my piece, but operations has got to be at the table, too. So, if you don't have those relationships and I can't get the COO or the division president or a facility CEO lined up. It's not going to work.

So, you've got to have them through all those levels. Otherwise, IT is just not going to work. I mean people will eat technology for lunch unless you deal with the change management. You see it all the time.

Sobol: Yeah, you are spot on and I think some of it comes down to just figuring out a common language or learning some of the vernacular of how a CFO or how clinicians think. So, it's not only the day in the life, but it's also coming with that common language. So, that you truly can communicate, and it speaks to what you talked about earlier right—elevating that business acumen. So, whether it be dusting off the accounting 101 book or maybe even taking an online course on clinical workflow or you name it to try to elevate and understand. I think it's certainly critical, particularly in our line of work.

Smith: So yeah, absolutely agree. Now, but I would also say part of that is having the right team around you, right?

Sobol: Absolutely.

Smith: So, for instance, I have a CMIO he knows things about clinical workflow that I will never understand like he does. So, knowing and having a good team and knowing when to pull them in and say look, I'm not the expert on this one. I can help facilitate but I need so and so at the table because they know a lot more about rev-cycle than I do.

Sobol: That's right. All right, you know you hit the nail on the head there. It is about building those cross-functional teams, in such a way that you have all those elements at the table together working effectively. So, that's great.

Smith: Absolutely.

Sobol: You have led IT organizations and teams now for a while through acquisitions, mergers. You mentioned Kindred. You've managed a very complex environment with multiple EHR environments. Obviously, lots of moving parts and pieces. I think you mentioned earlier—there's never a dull day, right?

So, what does that decision making process look like for you as a leader when you come to some of those pivotal crossroads and what does that thought process involve?

Smith: So, I’ll throw a few things out there. I mean all of us try to leverage our prior experience. I mean we do that by nature, but I found listening and understanding before we just apply it. I found a lot of times if you just say I've done this before, here's what I'm going to do. You make mistakes. So, understand every organization is where they are at for a reason, even if you think it's crazy how they're organized or something.

There is a rational reason why they are there. So, first try to understand. Listen. I think that is always important.

Usually, our due diligence process is a lot of questions. A lot of data gathering, not a lot back to people. Just I'm trying to understand, I'm trying to understand. And then you can make some rational decisions based on data. Do you convert their EMRs? What do you do? I find that it is especially important when you start talking about the human side, the teams, the organization. How do you redo that? I would say overall. I'm kind of an incrementalist and I'm not somebody who's usually going to go in, unless I have to for some reason, just blow it up and start over.

I think that's usually not a good way to do it. Yeah, you can cause a lot of wreckage that way too. But you know, go understand and then start to figure out what's the best thing. Learn from what you have from the past. Learn from what this company that you're merging with or acquiring—they've got best practices. They probably do some things better than you do and you do some things better than they do. And the end product is to figure out how to blend that together.

Now I will say I've made some mistakes along the way. I think you do have to have some what I'll call “non-negotiables.” I'll throw cybersecurity in there. You need to get pretty quick to—this is the common set of security tools that we think best protects the new company. And you need to get there relatively quickly, and you may have to be a little dictatorial about that.

That's an example with cyber in today's environment. You don't get a lot of options. This is where we are going to go with it. So, you need to have some non-negotiables, but I find the non-negotiables are a lot smaller than the negotiables. Let's think about this and what's the right way to do it.

So those are a few things that are there. I think the other thing you brought up too is because we run so many different EMRs and different systems. You know, look for tools that are EMR agnostic.

Why do you have to rip out the EMR? Yeah, there is a time and a place to do that. But if you can wrap things around and make it better for your clinicians and more effective and maybe more efficient. Do you really need to do that? Challenge those assumptions that well, we have always done this. Well, that's not necessarily the right answer. I tell my team quite often if you tell me, “That's the way we've always done it.” That's absolutely the wrong answer to give me, because that's not a rationale. Tell me why it applies this time, because it may not.

Sobol: You are spot on. I think that applies to what you talked about earlier when it comes to those non-negotiables and those sorts of changes. It comes back to that level of communication, right? People, for the most part, are logical. Yes, we have sacred cows here and there, and sometimes we have to be dragged by our ear lobes to make a change. But for the most part, if things are communicated properly, if they are communicated respectfully, and logically, folks go, okay I get it. Yes, I might not like it, but I understand. Getting those folks on board to move is certainly critical and it's easier said than done.

But you know, it is certainly one of those areas that must be addressed when you go through those situations. So that's great.

Smith: Absolutely.

Sobol: You had mentioned it earlier. A little bit when you started talking about bandwidth, right? And there are organizations that cannot just do everything. Especially in today's given age, you know, maybe 10 -15 years ago. Sure. But with everything going on from cybersecurity to business intelligence, to you name it. There is a lot on the plate. You had mentioned that we have had a long-standing partnership, and I appreciate you mentioning that earlier. Certainly, we have valued that for years and look forward to more years to come on that delivering that value.

But, for those folks that are listening and maybe at that crossroads. Where it is more than they can handle. What guidance can you give to them or points or check marks where they are doing their analysis to say, hey, maybe here is an area that we need to look at a partner. Or no, this is something that you know, we should keep in-house. Are there are some of those checklist items that you could walk folks through?

Smith: Every organization is a little different, depending on your strengths and some of your strategies—like what makes sense to outsource. Obviously, there's things like help desk that people are probably more comfortable and then things that might be a little more strategic etc.

So, you kind of got to look at that. So, is that the question or is it more about how do you find the right partner?

Sobol: Well, finding the right partner would have been the follow-up question.

But I think it's more along the lines of, what are those things that folks when they are in that position need to look at, right?

Smith: Yeah.

Sobol: I think you mentioned a few of them being internal talent. I think you mentioned the strategy. So, maybe if you could just touch on those briefly, to kind of give that logical flow of the thought process.

Smith: So, I mean where my head goes these days is where do you look for partners? There are areas that jump out at me like cybersecurity, some of the more technical skills where it's just getting harder and harder to get people and retain people. I'm always really leery of if I'm going to have an N of one on a critical team—that's risky, right? And if I can't get two, I can't afford two people or more— then that's a good one to look at a partner who has scale, right?

So, if I come to somebody and they have 10 of x, if somebody leaves, we still have nine. Now, sometimes you pay a little more but risk mitigation, I think is always a good place to look at that. Where you just need either skills, scale or something that says—somebody else can do this better than I can. I think cyber is a great example of that. Where all of us are kind of at an arms race for cyber people.

You know, how do you combat that? It is just getting harder in those areas and it's so critical that you got to have that nailed. And it’s getting harder. It is getting more and more complex where it is just difficult to find people that have all the skills. Now, we have a great cyber team.

But I always worry about that debate that with my CSO—is this sustainable? Can we keep this going for a long period of time because those folks are really in demand and our folks do a great job.

So, those are probably the biggest ones that I look at scale, risk mitigation. There's also places you can look that are more what I would call for lack a better term of a commodity—help desk is a little bit easier to kind of outsource to somebody than maybe some other functions. So, those are the ones that jump out to me as far as areas that we look it.

Sobol: That's great. Any words of advice (you've mentioned it earlier) on how to go about looking for that right partner?

Smith: Yeah, I mean, I think there's a few things that we kind of look at and some of are probably mom and apple pie, but you know, I think the term partner gets overused many times. A lot of people want to be your partner. But, at the end of the day, they are really not your partner. It cannot be transactional. It cannot be one sided, right? A real partner shares the upside and downside, there are times where, you know what, the partner can say. I am a little upside down on this. But in spirit of the partnership over long term, that is great, I will make it up later. I think of someone who gets down in the trenches with you. It is somebody that when it gets bad, they say, I am digging in and if I must throw an extra person in there we will and we will make this happen.

I think it is always good to have someone who is a real partner, debate should be fine. Right? I mean, we do not always have to agree at the end of the day. We need to lock hands or stack hands and say this is the approach but, again back to the comment I made about having a team around me that says, “Al, you’re making a mistake here.” That's fine.

As a partner, I think that's good. And then the last thing I'll say is sometimes a good partner says, you know what this isn't for me. It may be something that the partners have never done, and they say, you know what, you need to go find somebody else. I think that is good and honest communication. I find a lot of times, people think they can just book some more revenue, but if you are not good at it and it damages the partnership in the long term. Is that the right answer? I think it is really good advice sometimes to say, “You know, what Al, this isn't our wheelhouse. We can't handle it.” Maybe you can bring another person along or another company along that fills that gap but, none of us are great at everything and I think a good partner just admits that acknowledges that it's just honest about it.

Sobol: Very true. Great advice so, you know as we wrap up, I always like to look towards the future. So, there are so many things that are hitting us we do and the buzz words, right? You look at consumerism, automation, and so on and so forth. From your perspective, what are some of the next big things that healthcare IT leaders will need to be prepared to lead their organizations through?

Smith: Yeah, there is a lot. There is stuff coming at us almost every day. There is another great idea, another vendor, and to be honest, some of it are the terms AI, ML, cloud. Some of the stuff is just overused or incorrectly used. It is almost like if I say it is AI they will listen. So, I think some of the challenges from my seat is figuring out how do you weed through all the stuff to say this one is worth spending time on and the rest is just noise.

I don't know if I have a good answer for that, depends on the day. But when I look at things that are coming when I look at innovation and we at Lifepoint are doing a lot more innovative stuff than we did historically in the last couple years. I really think COVID was the catalyst behind that. If there was anything good that came out of COVID, I'd probably say work from home. For many people that’s one. The second one was acknowledging we have got to digitize some of this stuff.

Sobol: Right.

Smith: Whether it's telehealth visits or other things and we got some momentum. I think part of what happened during COVID is we got a little bit more liberty to fast fail and to try some stuff.

Sobol: Yes.

Smith: We moved quicker, and we made some mistakes and we retraced but we made a lot of good decisions and did a lot of things, and we got more ability to try to innovate and try stuff. So, I think that was good. Now you are not going to bet the farm and bet a billion dollars on that kind of stuff, but you know little incremental pilots and then can you scale those? I think, was really good.

But to answer your big question directly, I will put it under innovation. Now, that is a big buzzword. But the big things, I think here, are new care models. How are we going to extend outside of the clinic, outside of the behavioral health hospital, outside of the acute care hospital? That's not where care is going to be in all cases like it was in the past.

We are going to have to meet patients where they are: in their house, remote patient monitoring, what I would call telehealth, care anywhere, care everywhere a lot of different buzz words, but that’s going to be a big focus.

And those of us that figure that out are going to do well, and those of us who don’t are going get our lunch eaten by new entrants and other people.

In the past we have been able to say, hey, I kind of dominate a geography. Well, the internet doesn't know what geography. So, suddenly that geography just started to break down and now you have new entrants into your market that you didn't have to worry about in the past.

I think that's going to be huge to figure some of those things out. I think the other thing I would throw out there would be artificial intelligence and big data analytics. But we're now capturing more and more data and as we extend into the home, we will have even more data.

What do you do with it? How do we make data actionable at the caregiver side, in the care processes and or automate things and predict things that we could not do in the past?

So, in my mind, those are the two biggest areas. There are lots of others: digital patient experience, analytics in general, etc. But I think those are the ones that are going to differentiate most of us one way or the other in the next few years.

Sobol: I completely agree. I wish we all had a crystal ball that was 100 percent accurate. I think there are so many things we can draw from. You mentioned so many things at the end. Are there a couple of go to publications or places where you turn to for what's going on from the latest and greatest, that you would recommend to our audience.

Smith: Yeah, less publications. There are some trade shows that jump out. Gartner is one we leverage, and they do some great research. It is not perfect. But it's really good research on a lot of different topics and I think they have gotten stronger and stronger in the healthcare market. We also now have a chief innovation officer and some people that are focused on looking at innovation. It is not a side job to say, “Hey, Al from six to eight at night, can you research this?” I think that has been helpful.

We also belong to the Heritage Group and some other people that do early-stage digital investments. We are doing some of that through Lifepoint Forward as well. So, I think all of those are really good things. If I look at them like a Heritage group, they are out there looking at this stuff all the time. So, I can call them any time and just say, “Hey Brian, have you ever heard of this company? Yeah, and I've looked at three other ones. Oh great. What can you tell me?”

So, I think those are really great. Then last but not least, it's your peer group. There are probably 10 CIOs that I stay in touch with. We are always asking each other, “Hey, have you ever heard of so and so? We just did pilot and it has worked really well.”

Well, that is way more important to me and a much better reference than any of these other ones, because it is somebody that I trust. Somebody I can call and go — okay, how much work was this? What did it really cost? You know those types of things and I think those fantastic. So networking. I probably don't make enough time to network, and it can't be your full-time job, but man, there's a lot of power out there and just learning from other people.

Sobol: Great advice. Well, Al, I have really appreciated your insights today. As we wrap up, is there anything that we have not gotten to that you just absolutely think that our audience needs to hear?

Smith: I mean the only thing I would probably throw in there is — enjoy what you do. And we can't ever forget those pieces either, right? All these other things — you have to enjoy some of these things or it's not worth it.

Sobol: Right.

Smith: So, hopefully along the way you can enjoy at least, you know a good chunk of what you do and find some passion behind it. Those are those are important things.

Sobol: Great advice. Well, Al, thank you so much for your time and appreciate it and look forward to the next iteration of our journey together. Again, thank you so much for your time.

Smith: Awesome. Thanks everybody.

Sobol: Thank you.