When Healthcare's Toughest Problems Need an Outsider's Perspective

Phil Sobol: 

Welcome to the CereCore podcast, where we focus on the intersection of healthcare and IT, from practical conversations to strategic thought leadership. Let's unpack the decisions, challenges, and journey of those whose purpose it is to deliver technology that improves healthcare in their communities. Kim Waters is a Principal Consultant at CereCore and assists clients with strategic planning, governance, and program development framework. In 2019, she founded Dynamic Strategy Partners, a progressive advisory firm designed to provide fractional C-suite, go-to-market, operational readiness, optimization, change management, and product development services for startups and fast-growing companies. She has also served on advisory boards for startups in healthcare, fintech, SAS sectors, supporting strategy and product development. Kim served as a CEO, a COO, and an EVP with healthcare and healthcare technology companies. Throughout her career, she has led digital and process transformation efforts coupled with cost containment strategies focused on helping health care providers and enhancing access to care. Kim holds a Bachelor of Health Care Management from Western Governors University and a Master of Business Administration from Western Governors and is part of the ILP program from Stagen Leadership Academy. She is a member of the ACHE, HFMA, and CHIME and serves as a board member for Brave Love. So Kim, welcome to the CereCore podcast.  

Kim Waters: 

Thanks for having me, Phil. You make me sound important.  

Phil Sobol: 

Well, we think you are. So, we always like to start these off with a little bit of background. You know, certainly I read a little bit of the highlight stuff, but you would love to understand a little bit more if you would share with our audience about, you know, your background and your path to becoming a principal consultant here at CereCore. 

Kim Waters: 

That's always a fun question. How did you get here? Right. I think for me, I was always drawn to health care. Initially thought I was going to be a surgeon. That was that was the road with a husband in law enforcement that was not going to happen in our world. So I chose the business route and quickly you fell in love with that. So I think for me, I started a managed services organization in DFW back in 2007, originally, and really focused on helping serve independent providers, ambulatory providers. We started with revenue cycle, it was a way to have quick wins, everybody had issues there. If you could fix money problems, the doors open for you to fix other problems. And so that was a place we started. And that led to building technology solutions around revenue cycle, which was exciting. And then from there, took a little stint and did some work in the payer space and got to see the other side of the world and see claims from the other perspective. It's amazing how much data there is on the payer side and being able to really help impact care from you know, care navigation and pop health type solutions. And then came back to the provider side quickly after that, which gave me some really unique perspective just in how to approach, you know, revenue cycle issues and some of the workflow issues that organizations had. So with all of that, it was okay. I think, you know, let's put that to work for good use. And that's about the time I met CereCore. 

Phil Sobol: 

That's fantastic. So certainly having all of those experiences and perspectives, it really puts you in a unique position where you've seen so many more things than a normal individual who has grown up in the provider space only or, has only been in maybe one or two or three of those sorts of positions before and being able to gather all of that intelligence and real world experience and be able to bring that to the table is fantastic. Part of that is you have to have those conversations, right? With the CIOs, CEOs, CFOs that, you know, and that's normally kind of your main, I guess, initial conversation. So, you know, maybe tell our audience, how do you get that conversation started with those C-suite individuals?  

Kim Waters: 

I love just to listen and ask questions, right? Just wired with an innate curiosity. And I think each of those people, right, your CFOs, your CIOs, your COOs have a different perspective and problem they're trying to solve. And a different version of what success looks like, right? So I think depending on who you're talking to, it's really understanding what pain points are they feeling, taking a consultative approach. You don't get to solve all the problems in one phone call, unfortunately. But if there's a way to provide value in that initial conversation, just maybe calling out something that might be a really quick win for them or a different way to look at something. I'd love to be able to provide that value even in those first conversations and build trust, because it's really about building a purposeful relationship first, and then you can dive in and start solving problems. So that's how we start. And that conversation can take a lot of different avenues. 

Phil Sobol: 

Always, always. It is interesting because we have a lot of conversations and I think one of the things that comes up a lot is, you know, when, what are those areas that an organization is just going to handle themselves, right? Versus when would they or when should they turn to somebody from the outside?  

Kim Waters: 

Sure. Well, I think a lot of us like to think we can do everything, right? And it's not usually a lack of not knowing there's a problem, or even feeling like you have a solution for that problem. I think a lot of the groups I talked to understand where most of their issues are. I do think it's interesting, though, because oftentimes the named problem isn't the actual problem. So really diving into, okay, we think that's the problem, but let's go, you know, ask the five whys if you want to use a framework, right? To really get to that root cause of what's going on and where that really might be stemming from. So think, and everybody's moving fast, right, and short staffed. So think, when you can identify there's a problem, that's great. Then understanding your team and if you have the talent, in place that can actually execute that change is maybe the question to ask. And if you don't have that talent there, it's a great opportunity to reach out and to see what kind of augmentation that could look like. I don't think it has to be a full outsourcing, it could just be support and augmenting that team through change. 

Phil Sobol: 

That makes sense and I think the five whys it's a great path to head down. And I think a lot of times those issues what you see initially kind of snake throughout the organization and you begin to realize the complexity that leads up to the issue that at least people are observing and sometimes there's a lot of politics at play too right inside of an organization so perhaps an outside voice might be an easier course for a leadership team when it comes to strong personality versus strong personality and having someone to come in from the outside and kind of balance that all out with, hey, I don't have a dog in this hunt, so let's get to the root cause. 

Kim Waters: 

Being able to align people is so key, and sometimes when you're embedded, that's a hard thing. 

Phil Sobol: 

Indeed. And in many instances, I mean, we look for other opinions all the time, right? And it's not just in the consulting side of things, it's whether it is, oh boy, I got this diagnosis, I want a second opinion, or whether it's I got a kid going to one parent and, oh, I got this answer, I'm gonna go to the other one, see what I get over here too. You're triangulating, and so sometimes, time and time again, a board will ask have you got an outside opinion on this? It's just kind of that additional checkbox to make sure that things are progressing the way they need to. So that makes a lot of sense. As you're having these conversations, what are some of those common areas that organizations, health systems are looking for from an improvement standpoint when they engage with you? 

Kim Waters: 

There are a few buckets. How do we improve patient outcomes, how do we improve financial outcomes, and how do we improve experience, both for patients and for our internal staff, right? And, you know, whether that's to tackle resource issues from a financial standpoint or resource issues from a staffing and burnout standpoint. So I think they fall into a few buckets, but, you know, with so many healthcare organizations sitting in single digit or even negative EBITDA numbers. I think that those financial outcomes, end up supporting patient outcomes because patients can achieve, you know, can achieve care and have a better experience. So if we can help, and I think there's one thing about the revenue cycle piece, it's end to end, right? If you think about the way revenue cycle works, it's a great place to start, not because it's everybody's favorite place to start, but because it touches that patient from pre-registration all the way through the end and transition of their care to the next provider. I think it not only gives you a chance to evaluate your technical issues, whether in your EMR, but workflow issues, as well as journey map type of issues. So, you end up uncovering things that impact the revenue cycle that aren't directly revenue cycle. But it's a great through line in your organization to start. 

Phil Sobol: 

It touches on what we were talking a little bit about earlier, which is the value of bringing someone in from the outside that understands the IT component, that understands the revenue cycle component, that understands the executive component, that understands the payer side of things. It crosses a lot of boundaries. And sometimes if you try to do it internally, your lens, your viewpoint is going to be in a department. It's not necessarily going to be holistic. And so, making that approach makes a lot of sense. And, any time that you come in as a principal consultant and you're really you're coming alongside of an organization in a partnership manner. The word partnerships is thrown around a whole bunch and it's abused and used by people in so many different shapes and fashions. If you would describe what does the ideal situation look like to in order to have a productive partnership between a principal consultant like yourself and a hospital or health system? 

Kim Waters: 

For me, it's going back to that being intentional about purposeful relationships, because you're spot on about the partnership term being abused. I think when you remember that people are at the heart of what we do, whether it's patient care or the technology or the person submitting, you know, hitting the submit claims button, like people are at the heart of what we do. And so if you can really focus on solving the problems for the people, the problems in the organization ends up getting solved. A great partnership starts again with those relationships, but it is also the mindset of an organization, right? Are you ready to embrace a change? Are you ready to work across the aisle to what you said earlier, bringing CIOs and CEOs and CFOs and COOs together to be business partners is a way that I like to approach it because it is so siloed today. So if you're seeking alignment amongst your team, and you're ready to kind of make those changes, that will really impact your culture. Ultimately, I think that's when you know, it's going to be good. 

Phil Sobol: 

We touched on it a little bit at the top of the conversation, but I think you talked about just coming in and asking questions. Some would call that an assessment, but you take a much more, I would say, conversational approach But I've got a sneaky suspicion that there's a lot of framework behind that conversational approach. You're working through the checklist and you're working through all of the areas that you need to touch on. What are some of those hallmarks, must do's from your questioning or assessment process that just need to be done every time? 

Kim Waters: 

You're right. I try to make it conversational, so it doesn't feel transactional, but yeah, it's definitely there. It's a combination of data and storytelling, right? Being able to take a look at the data, be very objective, but also bring in people's experiences to that. Initially it's just being incredibly clear on expectations because when you are conversational and consultative, it can take rabbit trails and so being very intentional on the expectations and very disciplined on what you're trying to solve for is something that I have to be intentional about and also make sure that the partners are intentional about. Regular communication, obviously, is key in any of these conversations. But also the ability to be agile and adaptable, right? In a lot of these engagements, it's evaluating what your current state is, and understanding what you want to be when you grow up, right? Or what you want the future to look like, what does success look like, and then helping develop and build a roadmap to get there. And then not just giving you, I think I love to do zero, like zero based planning, zero based road mapping. Because I think a lot of times people get stuck in, well, this is how we do it. So if we just go build something or automate something the way we do it, we haven't really fixed anything. So really enjoy the creative process, sitting with a team and talking about, okay, what would best case scenario look like for you? What would an optimized workflow for this situation look like? Forget about how you do it today, like no limitations. Let's think outside the box. And that's always a fun process. And then, you know, how we get there is a little tactical. 

Phil Sobol: 

That's right. I love your comment about you need both data and you also need the story. Because when you fill in an assessment, you get the data, but what you don't get is the why. You don't get the, how did we get there? Why did we get there? Why were those decisions made? What were we trying to accomplish? You have to seek to understand. And I think that's a lot of what you do really is in that conversational approach. 

Kim Waters: 

Sometimes they don't remember why, and that's okay. Why do we do this? I don't know. We just do it.  

Phil Sobol: 

I was at a client meeting this week. And one of the things that we talked about is they were getting ready to embark on a large project, which was you have for all of those critical decisions, they have to be documented. Because inevitably somebody will leave, people will forget, and you'll get a year down the path, you'll get two years down the path, and you'll be like scratching your head, why in the world did we make this decision? You need that documentation to go back to go, Ah, that's right. That's why we made that decision. And then you can say, okay, yeah, but the situation's changed and we need to change that process. Or, oh, nope, I forgot about that. Yep, that's exactly why we made that decision and let's move forward. 

Kim Waters: 

But you have a launch pad, at least. 

Phil Sobol: 

Indeed. So, you know, I'm sure that you've gone into situations with clients that were great, right? They were primed, they were set up ready to go and your efforts were perfectly collaborative and the outcomes were amazing. And then I'm sure there's been times where you got in and hit a brick wall. Right? Somebody wanted you there, but the organization was not ready and willing. So, what are some of those prerequisites that an organization really needs to have in place in order to make an engagement with you or any other principal consultant a success for their organization?  

Kim Waters: 

It's a great question. I think acknowledging there's an issue to be solved, right, is a place to start. I think that's the beginning of frameworks even outside of healthcare, right? Just acknowledging there's problems. And then, I don't think you have to have everybody on board that it needs to be somebody from the outside. I think that's something that can come through conversation. But early discovery, getting leadership buy-in is critical to success and finding that champion inside the organization. If you show up and you're a consultant, and it's just, hey, go talk to my people, and there isn't a true champion at the organization, then it's very difficult to impact change because you're not there day-to-day to execute, right? Which for somebody who has executed day-to-day is hard, because you know what can be. But I think really having a true champion on the inside is absolutely vital to success. And acknowledging who that's going to be and aligning on that success criteria is critical to do up front. 

Phil Sobol: 

I think you're spot on. And those leaders from an organizational standpoint, they need to develop that culture of learning or that culture of continued I guess I can call it optimization, right? Where you're always looking for, how do we improve? How do we make this better? And so, you know, I think that's, and you see organizations like that all the time. It's in their vision statements, it's in their DNA and their culture. What are some of those characteristics that you find that would be evident in an organization that truly has that built into their culture? 

Kim Waters: 

You said it earlier, but like change is inevitable, progress is not, right? So I think there's a lot around, you know, movement is life and all these phrases you can throw out there, but change is going to happen. We've experienced a ton of change over the last few years. And some organizations really rose to that. And it was a beautiful example of how you can be innovative, you can reduce red tape, you can reduce bureaucracy, and you can get things done. Right. And then I think, you know, for some, they've kept that maybe not quite at the speed we had to do it a couple years ago. Nobody can sustain that pace. But for others, it was really easy to kind of fall back into status quo. patterns of behavior. But I think it comes down to behavior changes. And really, what are you as an organization doing? Have you made the intentional effort to align your people and your process and your technology and your strategy? And so those that have a clear strategy at the top of what they want to accomplish, and a way to hold their teams accountable to that strategy, always thrive in optimization efforts. 

Phil Sobol: 

You're spot on. I think they called it like this COVID pace. I heard that bantered around a whole bunch and it was interesting how quickly we were able to move, but at the same point, sometimes there were things like governance and testing and some of those things that do need to be put into that process. 

Kim Waters: 

You still have to check the boxes. 

Phil Sobol: 

Yes. So, but now there is that ask from the board and senior leadership from an IT perspective, you've got to do it faster, because I've seen you do it. But there has to be that level of communication between the two that says we did. However, here's what was left out and here's why that's important and then a plan in place for improvement.  

Kim Waters: 

I think we've seen some CEOs really step in and be visionary with their teams and eliminate those silos, because it does start at that leadership level, eliminating those silos. They're bringing in CIOs earlier into business conversations, treating them as business partners too. So you're not halfway down an optimization effort, and then IT gets brought in and, hold on, we can't do this for X, Y, or Z reasons, not to be throwing up roadblocks, but legitimate to your point, governance reasons or things like that. When we can bring our leadership teams together and eliminate those silos, truly work as business partners, it moves so much faster. 

Phil Sobol: 

I think you made a really good point there. And that's that continued leadership engagement whether it be CEO, CFO, CIO, COO, you name it, they all need to be communicating as one, not just a group communicating and then at some point in time pulling in IT or whatever. It's just because they all have different perspectives, they all have different sides. But collectively, if they're all on the same page as a rallying cry around the mission of the organization, the outcome's gonna be so much better. So that makes sense. I think one of the things, we've talked a little bit about this already, but you know, organizations will, you know, they'll get down a certain path and they'll have an event and that event will then trigger, boy, we probably need an outside assessment, you know, to come in here. And, you know, we've seen it time and time again, whether it's, you know, we're thinking about doing something different, get into a new market, do some M&A or, hey, I just, I'm looking at a large implementation, what's that going to look like? Or we went through one, now what do we do? So maybe what are some of those areas where that organizations should truly consider, you know, an engagement model like that? And then what would the value and benefit to the organization be of that? 

Kim Waters: 

Anytime you're going to make a big change, understanding how it impacts your entire organization is important, right? Not just, we keep going back to this, but not just like that silo or that group of people, but understanding that any big change for it to be effective is going to require behavior change. There's a McKinsey study out there that says something about 72% of organizational change efforts fail. And so much of it is due to a lack of alignment and a lack of communication. And so really having a true understanding, if you can get in front of it, which is ideal, right? Get in front of it and understand like, how is it going to impact, you know, my tech stack and what do we have the ability to do? What processes are impacted? How are our people going to be impacted? Are our people ready, right? Change readiness assessments are kind of key to some of these initiatives. and then enabling those teams. Having the right voices at the table is at the very top of that list as well. It's very easy to feel like you don't have, and a lot of these groups don't have project management offices. And if they do, they're stuck doing the day-to-day stuff, right? Not the innovative stuff. So ensuring that you have the right voices at the table so that you aren't kind of going, oops, later, you know, three months after you've rolled something out, you forgot something really big and it's impacted cashflow or clinical workflows, especially impacted patient care, right? If you can kind of get in there, establish all those things and put metrics in place to measure throughout the implementation and you know where you're at. And you end up not getting to the end and wondering what we did wrong and why is it not working, right? You're measuring along the way. It's, you know, incremental steps that I think are important. 

Phil Sobol: 

You're spot on. And it's that collective view, right? Because so many times you get it, a portion of the organization, we have to do this, right? Okay, great. But it's, it's the overall organizational impact, like you talked about, and there's very few people that can pull all that together in a manner that can then be, say, understood by a board of directors. 

Kim Waters: 

Sure. Sure. That's always a different level and fun presentation, right? I think, I think I enjoy, I loved getting in the weeds with the team because they feel seen, they feel heard and valued. That's how you gain buy-in, right? That's, that's a fun thing. And it helps you weed out the, what's the real problem. But on the same side, I love having the board conversation and the executive level conversations because they have great questions, great feedback, great perspective. They all have their own experience to bring to the table. And I think genuinely want good for their organizations and their people. And so, again, it goes back to combining data with the story and making sure that the story is being told in a way that it can be received and it resonates 

Phil Sobol: 

Indeed, indeed. Well, I know that you don't do this professionally for your health, right? And for kicks and giggles, it really is a passion, right? And you do it because you love helping organizations become more solid from a financial perspective, deliver better care. And so, without breaking client confidentiality, maybe give us just one story about the work that you were able to do to help an organization that truly delivered just amazing results for them. And it doesn't have to be amazing, but something they went back to you at the end and said, Kim, thank you for X.  

Kim Waters: 

I had a chance to go in and do some work with a group that was really trying to make sure patients were getting where they needed to go when they needed to get there. There was that whole care navigation effort. There was a lack of technology in place to do it. The data was disparate, missing. A lot of it had to do with claims data. And they're trying to get into a place where Man, how do we save some dollars, but how do we really impact care and provide valuable insights to patients so that they can make the best decisions for themselves earlier and not when they're in crisis? and had a chance to go in and identify those issues and those opportunities, work with claims teams, customer service teams, data teams to bring in the right technology solution, as well as help them build out the team to actually execute those care navigation strategies. And it was millions of dollars in savings from a claim standpoint. Also for patients. Patients saved a ton of money because they were able to be proactive, but also it allowed us to intervene with patients early in care situations and there's nothing like a patient, you know, getting a phone call from a patient because I want to make sure whatever I put in worked, right? So I would get on the phones every once in a while just to kind of QA it myself. Even though we had a QA team, it was amazing. I wanted to hear, and there's nothing like talking to a patient and knowing that you were part of building something that allowed them to take care of their son. And, you know, we, we had so many situations where it ended up being a life-saving situation, um, or, it financially saved them as a family because if they had gone down a different path, it would have bankrupt them. So at the end of the day, like being able to do all those things and then see how it truly impacts the life of the patient is a beautiful thing. 

Phil Sobol: 

It truly is what it's all about. Excellent. Well, Kim, I really appreciate it. And thank you so much for your not only your efforts with our clients, but also your time today. And we always like to wrap these up with just kind of an open-ended question, right? So if there's anything that we haven't touched on today that you just think our listening audience needs to hear, right? A little tidbit of information or something for them to ponder as they're walking through their normal day activities and, hey, maybe we should think of X. 

Kim Waters: 

I'll keep it simple because that's the best way to do it. Go back to change is inevitable, progress is not. And so when you're looking around your organization, not making a decision is making a decision. So I think it's really important. You play vital roles in your communities and the people that you serve. So making decisions to seek out ways to improve that impact and continue to serve those communities is really, you know, the core focus for you as a leader in a healthcare organization. Progress at this point is up to you and is contagious. Your people will get excited if they see you excited. 

Phil Sobol: 

That's a great point. That's a great point. So Kim, we've touched on a lot of great topics, and no doubt there's some of our listening audience that are very intrigued and want to reach out to you. So how would they go about doing that? 

Kim Waters: 

You can reach me on LinkedIn. If you just search Kim Waters CereCore. I'll be there and happy to connect.  

Phil Sobol: 

Excellent. Well, Kim, thank you so much. It's been a pleasure having you on the podcast. Thanks, Phil. Thanks for listening to the CereCore Podcast. We hope you enjoyed this conversation. Follow us on your favorite podcast platform for more episodes. Connect with us on LinkedIn. Visit our U.S. website at cerecore.net. And for those abroad, visit cerecoreinternational.net. Learn more about our services and find resources. At CereCore we are healthcare operators at heart and know the difference that the right IT partner can make in delivering quality patient care 24-7. Let's help make IT better. Here's to the journey.