First and Third: One World Serious Health View

“Don’t go walking around like you just hit a triple – when you were born on third base.”

- unknown

“He wants to know why your skin is white and his is black,” clarified my translator. The Tanzanian boy, about 10 years old, was pointing to the skin on his hand and then to mine. His question in this remote kijiji (Swahili for village) was as arresting and profound as the inequities in global health.

My global interdisciplinary health team was in Africa as part of a feasibility assessment in partnership with a Tanzanian team to determine how to improve health in the region near Lake Tanganyika, which borders western Tanzania. While Tanzania is considered a low-resource, less developed country, the western region is considered the least developed area within this ‘third world’ country.

The local team was dedicated and committed to make a difference in the health of the people in the region. They believed that they needed a hospital and many clinics to do this since they knew that my colleagues and I had led hospitals and clinics in the U.S. and in eastern Tanzania. But my team was convinced that exporting the U.S. acute care model was not going to help them improve health, at least not nearly as much as investing the few available resources in other more impactful social determinants of their health. In addition, the local team did not have the resources, expertise or mission to expand the existing healthcare system.

First world population health is not an effective solution for Third world health challenges. First world population health efforts are often supported on the back of an acute care funding chassis: a hospital or healthcare system with access to a reimbursement system to sustain it. By design and nature, first world population health is typically incremental: icing on the core fee-for-service reimbursement cake.

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Your People Are the Key to a Successful System Transition

With an unprecedented number of healthcare provider mergers and acquisitions in recent years and new requirements being ushered in with the Affordable Care Act, healthcare professionals are in a constant state of technology systems transition. Though replacing a legacy system can be necessary and even beneficial to patient care or a hospital’s bottom line, times of transition deeply impact the people these organizations are relying on to provide quality care and keep the healthcare organization running efficiently.

To consider the implementation of a new system a success, you need to do more than make it to launch day on time and under budget. Your employees—the intended users of the new technology—need to understand the “why” behind the switch and actually use the system as intended with their sanity intact. In my experience, this can only be accomplished by engaging your people and giving them a voice at every step in the process.

Preparation

Before selecting a new system for your hospital or healthcare organization, it is essential to get the right people at the table to create a roadmap for the transition process. Be sure to involve and gather feedback from:

  • Employees who can think critically about workflow efficiencies so you can ensure that you aren’t carrying bad practices forward with the new system.
  • People who are highly knowledgeable about the current technology in place and its limitations. They will have invaluable insights into problems that any future systems need to solve.
  • Anyone who has a vested interest in the new system. If the new technology is clinical in nature, you need to make sure physicians and nurses have a voice. If it’s a change in back-office technology, human resources professionals or accountants who will use this technology regularly will need to be invited into the conversation.
  • Any department who will deal with a heavier-than-normal workload during the parallel running process or launch.

These groups have the expertise and high levels of investment to help your executive team document your current process, find the right technology to replace your legacy system, determine real costs, and set a reasonable timeline.

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Building Trust to Succeed

When it comes to building a strong leadership team, choosing top talent isn’t the only priority; building a culture of trust is also essential to growth and success. According to a recent PwC survey of more than 1,400 CEOs worldwide, more than half of organizational leaders believe a lack of trust is a serious threat to the success of their teams and their business. However, if you are aware of the importance of trust, and actively working to make it part of your workplace culture, you can use it as an asset to your organizational function, rather than a liability.

Environments where trust is a key component encourage innovation, increase the pace of decision making, and often team members outpace their competition. The Workplace Therapist Brandon Smith insists, “Trust enables teams to not just take risks but also to move more quickly. There’s little second-guessing in high trust environments because team members assume there’s positive intent.”

It’s hard for teams to move forward effectively if they don’t trust each another. Instead of innovating, they are second-guessing each other, unnecessarily reworking tasks, or relying on one or two key team members to get the work done. I have found that when you have trust, things move much more efficiently. You have the ability to take the risk because your team feels comfortable and supported.

Trust is key, and risk, innovation, growth, and expansion can only happen when you have a solid foundation of trust to build upon.

To maximize your organizational potential and lead in your sector and community, you have to create a climate of trust and transparency.

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Community Vitality: The importance of access to high-quality healthcare and K-12 education

The question of why some communities and companies grow and prosper, while others shrink or even cease to exist, has intrigued me for decades. Theories exist with no single one applicable to every situation. Two variables stand out to me as “must-haves” to ensure community vitality.

  1. Access to high-quality healthcare, and
  2. Access to high-quality K-12 education

As a registered nurse I have focused on the delivery of and access to high quality healthcare for the last 28 years. Having cared for patients at critical times in their lives, I have consistently seen how reliable access to affordable, preventive and restorative healthcare services is critical to community health, especially for vulnerable or indigent populations.

My focus on quality and access in healthcare for all populations broadened during my tenure working with large geographies and populations as an experienced healthcare CEO and as a member of numerous boards of directors.

The ability to recruit, develop and retain human talent is essential to the success of any company, and healthcare is no exception. My experience suggests that since 2011, it has become harder to recruit and retain human talent based on each region’s overall access and quality of K-12 education.

In my rural area of Virginia, from a healthcare perspective, recruiting nationally and internationally was challenging for all types of careers, from entry-level professionals, through senior leadership positions. I attributed the recruiting issues to fierce competition over a finite talent pool, but exit interviews and feedback from existing employees and prospective employees indicated that a significant concern was the quality of K-12 education in my area.

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Want to get the most bang for your tech bucks? Stop automating bad practices.

The business world seems to be moving in the direction of business process automation, yet in the healthcare industry only about 20% of provider organizations are widely engaging in hospital financial automation, according to a new Black Book CFO survey.

Automation can result in immediate cost savings, the elimination of duplicated tasks, and improved visibility. For the healthcare industry in particular, the automation of business processes can result in improved compliance, elimination of errors in workflow processes, enhanced vendor management, and better billing practices, to name a few.

So why are so few hospitals adopting automation for their back-office processes? I believe it’s because they have seen that automation technology doesn’t always save money as it claims. I have learned that when automation is employed without critical thinking around cost and workflow efficiency, the result is automation that will only produce unwanted outcomes—faster.

Consider the actual cost.

I don’t want to come across as overly negative toward technology—I love technology! My doctoral studies examined impact of computerization on business administration in healthcare industry. However, through the course of my research, I learned that despite promises to the contrary, technology doesn’t always save you money. In many cases, the difference in cost savings between companies that had completely automated their business functions and those that didn’t use automation at all was negligible.

As I have said before, all technology has a cost beyond the sticker price. Account for all the costs of automation to measure the impact to the bottom line. Things like training, data storage, equipment, and fees to make ongoing changes to the technology as your company’s needs evolve should be considered in addition to the named price of the technology.

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Looking to the future of healthcare

Leaders in the insurance arena gather to discuss innovation while remaining practical and compliant

I recently had the privilege of hosting the Think Tank at the Rise Association West Summit 2019 conference in San Diego, containing many of the top senior-level insurance executives from around the country. These impressive and inspiring individuals provided unique insights into practical and compliant innovation ideas impacting the future of healthcare.

Think Tank participants shared “What’s Working in Their Organization and the Overall World of Healthcare Innovation,” focusing on how to get the most comprehensive, accurate, and robust insights in taking accountability for the health of their members. In addition, we considered the latest innovation in telehealth, predictive analytics, AI, and machine learning. Furthermore, participants discussed the broader view in overcoming barriers to members’ health including social determinants and the keys to provider and payer collaboration in solving many of these issues together.

The final two hours allowed for a vigorous discussion centered on, “What does the Future of Healthcare Innovation Hold,” as we explored drivers of innovation and examined the role of health plans and providers in innovating the healthcare delivery system.

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Recognizing Emergency Nurses

Over 145 million patients come to US Emergency Departments every year; it takes over 167,000 emergency nurses to provide compassionate care to these patients: whether a child with a fever or a senior struggling to breathe, they are America’s frontline for care.

Many people outside of emergency medicine may not realize that our nation’s EDs provide an accurate and unfiltered view of society. This slice of reality shows humanity at its best and worst. In addition to the joy of saving a life, the occasional thank you and smile that an ED nurse will receive, they may be yelled at, unappreciated, subjected to unpleasant comments, and even assaulted…. by people they are just trying to help.

Yet, 24/7, 365 days per year - days, nights, weekends, holidays, sunny days, stormy days, natural disasters— these dedicated professionals put their personal needs and those of their families aside and dedicate themselves to caring for all types of strangers.

As an emergency physician, I can personally affirm that I could not do my job without them: they are my right hand (and my left), my eyes, my ears, my conscience, and sometimes even my kinder, gentler voice!

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Everything I learned in Girl Scouts

I was honored as a Girl Scouts of Western Ohio Woman of Distinction a few years ago, and I was asked to share some of the lessons or “words of wisdom” that I’ve learned through my own experiences and through others. As I reflect, the Five Key Ways that Girl Scouts help young adults thrive, are applicable and transferrable to every rising leader in general.

Girl Scouts is proven to help girls thrive in five key ways as they:

  1. Develop a strong sense of self.
  2. Seek challenges and learn from setbacks.
  3. Display positive values.
  4. Form and maintain healthy relationships.
  5. Identify and solve problems in the community.

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The Benefits of Building a Diverse Team

“Strength lies in differences, not in similarities.” - Steven Covey

Diversity and inclusion are top priorities in many organizations today, and there are plenty of benefits that come with implementation. First of all, there’s an increase in profitability. A McKinsey & Company report found that companies with leadership in the top quartile for gender diversity were 15% more likely to have financial returns above their industry median, and those with leadership in the top quartile for racial and ethnic diversity were 35% more likely to do the same. On the other hand, McKinsey also found in a follow up that companies with executive teams in the bottom quartile for both gender diversity and racial and ethnic diversity were 29% less likely to achieve above-average profitability.

There’s more at stake than immediate profitability. Through my own experience, I’ve also seen improvements in:

Retention - Diverse leadership communicates that leaders cannot all look and sound the same, and a diverse leadership team helps create an environment where people of all races, genders, sexuality, religions, socio-economic backgrounds can thrive. It creates an environment where employees can see their path to advancement and leadership positions within the industry.

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Want to make the right permanent hire? Hire an interim first

When an executive leaves unexpectedly or a major personnel changes occur in your organization, the void is felt at all levels of the organization. Rather than rushing to return to a feeling of equilibrium, I believe one of the best ways to make the right permanent hire and position your organization for long-term success and stability is to first hire an interim manager.

Interim managers do more than just “hold down the fort” until a permanent hire can be made. Interims bring their expertise, perspectives, adaptability, leadership and motivation skills, and entrepreneurial mindset to the challenges your organization is facing. An interim executive comes in with an analytical mind and unbiased view to help your organization achieve sustainable results in a short amount of time, allowing you the time to iron out persistent organizational issues and assess your organization’s needs so you are better positioned to make hiring decisions with purpose and wisdom.

Gain fresh perspectives and re-focus on your mission.

Getting the objective outsider view that an interim can provide is important for the long-term health of your organization, especially if your organization tends to promote from within. Often, when a management position becomes vacant unexpectedly, organizations will rush to promote a promising lower-level manager, even if he or she still hasn’t fully developed the skills to be successful in the vacant position. Hiring an interim manager into this position for a short time before you hire internally allows your organization to work out process issues, for example, while bringing the potential internal hire up to speed. The interim can bridge that gap, setting up the internal hire and your organization for success.

Times of transition provide the opportunity to consider who you are as an organization and whether processes currently in place promote the organization’s mission and values. A lack of crisis doesn’t mean everything is running smoothly. When growth slows, mission creep sinks in, goals go unreached, or when urgent issues distract your organization’s leadership from mission-centered issues, an experienced interim’s perspective could be just the breath of fresh air your organization needs to refocus on its unique identity.

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It’s a Matter of Scale for Healthcare System CEOs

For healthcare CEOs, as the size of the healthcare system grows, so grows their need to balance priorities. By organizational structure, larger system CEOs, including those individuals who are Physician CEOs, often coordinate with multiple individuals reporting to a board of directors. The CEO perhaps has a specific specialty from past experience––finance, legal, medical––with next-level leaders who broaden the operational bandwidth through their specialties.

In contrast to the stand-alone hospital CEO who are more intimately involved in the daily operations of the rural or individual hospital, large system CEOs find themselves in larger cities with more public points of interactions and more team members among the healthcare staff to whom they must stay connected.

Time is always a factor

Hospitals are 24/7 operations, and large systems have hundreds or thousands of people relying on services at any given time. The large system CEO cannot reasonably be involved in these daily functions and resource needs. This CEO is consistently informed by the people they’ve entrusted with overseeing specific functional areas. The CEO must hire the correct people to provide operational knowledge and support who report back on the needs of the system.

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A CARE PLAN for Burnout Prevention

Too much of a good thing can sometimes be a problem; there is a risk that caring too much can result in burnout. Even a profession that is literally and figuratively built on it, as is healthcare, there is not immunity to an overdose of caring.

You might be thinking: “What healthcare leader would ever tell a member of their team to care less?” Self-reflect and visualize your peers and the people you are leading. Do any of these characteristics seem familiar?

  • Constantly worries about what people think
  • Always feels obligated to fix things
  • Has a hard time letting things go
  • Starts the day with a list of worries
  • Ends the day with a list of worries
  • Stresses about staff turnover
  • Stresses about staff happiness

I’m sure you can identify with some of these tendencies personally or amongst your team. The answer is not to stop caring about patients, staffing, getting through your “to do” list, or about being liked; the answer is to care just the right amount! Think of care as sugar; in the words of Mary Poppins it takes “Just a spoonful of sugar…!”

Care enough to progress toward your goals, being visible and open, maintaining control while knowing when to let go, and earning respect. Care about being liked, but do not rest your self-worth on it. Sound advice you might say, but easier said than done. Try this CARE PLAN:

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Leading from the front: The importance of community building for non-profit hospitals

Non-profit hospitals are beholden to stakeholders (i.e. the communities they serve), not shareholders, and are thus pivotal community assets. While for-profit hospitals report to shareholders and investors, non-profit hospitals have an obligation to use assets for the betterment of the communities they serve. Community benefits can include charity care, expansion of existing services such as trauma care and maternity services, clinical education, increasing access to care for Medicare and Medicaid patients, and promoting community health.

One of the best ways to promote community health and serve the community at large is to create community partnerships and develop relationships with those involved in existing healthcare services in the area. This way, non-profits are not duplicating existing resources and are working toward a common mission of improving the health of the people and communities they serve.

The move to value-based care is slowly migrating to capitated payments. This is an important progression, as the capitated payments model is more person- and outcomes-centered; the focus shifts to prevention and wellness; and hospitals are incentivized to improve health status. The notion suggests that the health of the population will continue to gain importance.

True population health requires addressing underlying social determinants of health, including socioeconomic status, level of education, neighborhood environment, nutrition, activity levels and access to healthcare. It is well documented in the literature that social determinants drive healthcare outcomes. As an example, those with wealth generally enjoy better health status than the poor.

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Podcast: Getting Your Hospital to Act Like a Startup

Recently I had the privilege to be a guest on the podcast, “Getting Your Hospital to Act Like a Startup.” My part begins in minute 28, but please enjoy the entire episode.

Summary:

The innovative path is the key to the future of successful healthcare. Innovation and technology are the indispensable components for tomorrow's care; unfortunately, health systems and hospitals often allow the here and now focus to take precedence over the future. The internal daily demands can force a loss of perspective and a diminished capacity for a cultural attitude of innovation. The future positioning of the healthcare organization is always where the CEO and leadership team must be viewing today's decisions for organizational viability and long-term success.

Designing and living a successful innovative culture is possible. The adoption of the "start-up" culture should be the drive of every CEO and leadership team. In this podcast I share my experience in working within health systems and discuss adopting the necessary characteristics to successfully acquire the adventure, joy, focus and discipline of a startup culture. In addition, the obstacles start-ups face when working with health systems is also explored.

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Inspired Leaders Create Strong Organizations

Gallup’s State of the American Workplace reports that while the U.S. has more than 100 million full-time employees, only about one-third of them could be considered engaged at work. These are the staffers leaders dream about - they love their jobs and just make their organizations better. At the other end of the spectrum, 16% of employees are actively disengaged and generally miserable at work, and the remaining 51% of employees are not engaged at all – they’re just there.

For a leader, those are some sobering statistics, and should serve as a wakeup call. While engagement is important, chances are, you don’t just want your employees to engage, you want them to be inspired. Suze Orman once said you cannot inspire unless you’re inspired yourself. That means as a leader you should have passion – for the work, for the mission, and for what that means to people and the communities you serve.

Inspired employees impact an organization’s bottom line too, and studies have shown that inspired employees are more than twice as productive as satisfied employees. Inspiring behavior unleashes the energy within people to do their best work. It also helps them connect with an organization’s purpose and meaning.

Change starts at the top and looking at the power of a company with leaders who inspire at every level, Bain & Company launched a research program to understand what inspires people. Their research helped them identify a number of distinct and tangible attributes that leaders can use to create inspiration in others.

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Does your hospital know what happens when your bill goes to collections?

This article published recently in the The Atlantic points out that unexpected, large hospital bills can happen to anyone. This caregiver was hounded by collectors, one even inviting them to connect on LinkedIn! As healthcare administrators, we have a good understanding of our average reimbursement and collection rates, as a percentage of the gross, billed charges. But do we really know what happens when the uncollected charges are turned over to collection agencies? Are we aware when and if they are then turned over or “sold” to other debt buyers? To me, poor treatment by collection agencies and debt buyers is still a reflection on the health system where the patient received their care. Can health systems and doctors afford this type of reputational risk?

I turned to a colleague, a revenue cycle professional and expert - the best I’ve ever worked with in the business. They provided a more balanced perspective:

There are two sides to this dilemma depending whether you are a patient or provider. From the patient perspective, medical debt is increasing and in too many cases crippling, often leading to financial ruin, depression and shattered lives. Statistics show the percent of total bankruptcy, because of medical debt, at over 50% and employers shifting costs through deductibles, now on average over $1,300 and growing, according to the Kaiser Foundation. On top of that, healthcare spending as a percent of GDP is approaching 20%; an unsustainable trajectory. Bottom line, patients and families are harmed by unaffordable medical debt and there is no solution in sight.

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Hurricane Florence is no match for Florence Nightingale: Nursing process and human resiliency wins out every time

Since the 1990s, I used the nursing process (assessing, diagnosing, planning, implementing, and evaluating) plus a healthy dose of human resiliency in healthcare leadership and my personal life. Little did I know that this training would benefit me when I least expected it. In September 2018, Hurricane Florence made landfall on the coast of North Carolina and with it permanently changed the residents’ lives. Homes were swept away and people feared how they would provide something as simple as the next meal for their families. My family was fortunate because our home only sustained minor structural damage; the only major damage was losing our dock. With hard work, determination and a disciplined process, the dock was transformed into something even better than it was in its previous state.

The nursing process started in the form of preparation. Before the storm hit, we boarded all windows and doors, turned off all utilities and prayed that no one would be injured as we drove away to ride out the storm in Virginia. The process continued as my wife, Angie, and I left to return to North Carolina and assess the damage. We loaded our utility trailer with fuel, building materials, food, water and shelter. By determining safe, accessible travel routes within 24 hours of the storm and leaving the area kept us safe. Constant reassessment of changing travel conditions kept us alert and ready. No planning in the world could have prepared us for the devastation that we would see. When we arrived at our home, we found the lower level destroyed, the main level exposed to the elements, debris as far as you could see, and only broken poles where our boat dock and pier had stood.

Hurricane Florence met the nursing process in North Carolina. Constant implementation of the process (assessing, diagnosing, planning, implementing and evaluating) ensured that the right steps were taken in a structured and manageable fashion. Florence Nightingale is widely known as the founder of modern nursing. Nightingale said “Rather, ten times die in the surf, heralding the way to a new world, than stand idly on the shore.” Over 110 years after her death, and throughout the Hurricane Florence recovery process, Florence Nightingale was a beacon of hope in my life.

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Navigating the Outsourcing vs. Hiring Dilemma

Among the dilemmas facing healthcare executives, the decision to hire more in-house staff or outsource non-core functions of an organization is becoming increasingly common and complex. In the healthcare industry, business process outsourcing (BPO) can allow hospitals to increase their focus on what they do best: caring for patients and serving them well.

BPO includes benefits like lowering costs, increasing efficiencies, increasing focus on core business functions, and partnership with trusted experts in a wide variety of front- and back-office functions. But outsourcing has a cost that is more than just financial. Working with a BPO company requires releasing control, and if the relationship doesn’t work out, it can be hard to recover, both for your organization and your people.

Is business process outsourcing (BPO) right for my organization?

How do you know if it makes sense to outsource a function of your hospital or healthcare company? Start by weighing the costs and benefits to determine if outsourcing makes more sense financially than hiring or training an in-house employee. Ask yourself questions like:

  • What specific process or function does my organization need performed? Where is this function lacking in efficiency or cost effectiveness?
  • Does my organization currently have the skill set needed to perform this function internally? Locally?
  • What is our budget for this function, process, or service? What can we afford?
  • How often and for how long do we need this function performed?

If it has been determined that it is financially viable and necessary to your company running efficiently to outsource a service or process, here are some things to consider as your company explores outsourcing options.

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The Wedding Toast: Lessons in Leadership from Love

Recently, I had the opportunity to share the joy and intense emotions of giving away my daughter in marriage. At this extraordinary event, I had the fatherly privilege of making the welcome toast. Reflecting on these thoughts in the days that have passed, I realize that these principles and practices that guide us toward happy and healthier relationships are key traits that great leaders exhibit. Please indulge me in the following excerpt from that toast I gave at the wedding of my daughter Francesca to her husband Matthew.

One of the privileges of being the Dad of a little girl is that she sits on your lap and you have little talks from time to time. One I remember in particular is when her mother was out shopping, because that’s what she did when Daddy and daughter spent time together, Francesca looks me in the eyes and says: “Daddy when I grow up I want to marry you” ….. I had to politely explain to her that Mommy wouldn’t like that too much! She then went on to say: “How will I ever find the right person to marry?” I said: “Honey, when you fall in love and if that person treats you as well as I do, then he’s the one.” Matthew you’ve passed that test.

So I can’t leave without a little advice for Francesca and Matthew…..You are starting your life together, what’s the most important thing? The most important thing is LOVE….that’s a great word but there are a lot of things that go into it. For my colleagues in medicine, you know we have to make acronyms out of everything to help us remember….

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Are tech solutions the only solution?

How to think critically when solving healthcare operations issues

Within the next five years, technology could be performing as much as 30% of tasks commonly performed by people in today’s workplace, according to Supply Chain 24/7.

People tend to react to statistics like this in one of two ways. Some throw their full confidence behind the inevitability of technology, believing it to be the solution to nearly every financial or operational issue. Others view these numbers through the lens of a “doomsday-er,” prophesying that technology will upend business-as-usual—for the worse.

Whether 30% of people-powered tasks will be fueled by technology a few years from now, I can’t say. But here’s what I do know: The future of the workplace and of the healthcare industry will look different than it does today. We just have to make sure it’s going to be better. With the costs of technological solutions playing a role in the skyrocketing cost of healthcare, hospital executives must think critically when considering tech solutions to operational issues.

How can you tell if a tech solution is 1. necessary, and 2. worth the time and money to implement?

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