The Healthcare Leadership Experience Lisa T. Miller

Strategic planning is vital to successful healthcare management. President & Co-Founder of The American Healthcare Journal, Cole Lyons, explains his goal of fostering a community of education to Jim Cagliostro. 
 
Episode Introduction
Cole explains why transfer of knowledge is a key goal of the Journal, why healthcare strategy can be described as moving from checkers to chess and emphasizes the importance of thinking before you speak. He also explains the importance of competition in healthcare and identifies humility as an essential leadership trait.
 
Show Topics
 
Redefining healthcare strategy
A strategic alternative for nonprofits 
Breaking down silos in healthcare
Join Cole’s community on LinkedIn
Applying economic theories to healthcare strategy
Leadership tip: why humility matters
 
 
05:36 Redefining healthcare strategy 
Cole explained why thinking about the impact of your actions matters. 
‘’For me, it's kind of thinking before I speak. I think that's the best way that I've come up with how to explain it. In operations, day-to-day, things are quite hectic, especially at high volume clinics. And you have to make very quickly, fairly educated decisions based on standard operating procedures. But sometimes that doesn't always lead us down the best path. So part of that is creating standard operating procedures that allow you time to think about how it impacts things long-term. So, thinking before you speak for me means instead of just saying what I need to say in the moment, I think about what I say, how it will impact the person hearing it, how it'll impact my image. And if you apply that kind of thinking before acting approach to your actions in the operations space, it means taking a step back and looking at the competitive landscape in your industry, looking at the competitive landscape in your institution, different departments competing for funding, different departments competing for exposure, and looking at how even small actions in the operations world will impact that.’’
 
08:12 A strategic alternative for nonprofits
Cole said the Journal aims to foster improvement and education in strategic thinking for nonprofit institutions. 
‘’… the problem right now is VC-backed healthcare firms, those that are backed by venture capital. They have a high concentration of MBAs who have really good strategic insights. So don't get me wrong, and we can always go into this anytime, but there's a problem with a lot of the strategy theories out there in general that are taught to MBA graduates because it's based on economic theories that don't always play out in the real world. But still when they make decisions, it is much more strategic than in nonprofit healthcare. And so, one of the issues is that I'm not a fan of government-run healthcare, which is a little contrarian. I'm just not particularly a fan of it. I think that free market healthcare is good, nonprofit institutions are my favorite. I love nonprofit institutions. I think that that's the best form of delivering healthcare. But they don't act very strategically, especially compared to VC-backed or for-profit healthcare, which employ all these MBAs, they recruit MBAs from the top schools, they can pay them. …I'm not saying that they're any less educated, they're just educated differently. They have MHAs, they have MPAs, a lot of them have MDs, and they are educated in a very different way. So the journal's purpose is how can we foster this community of improvement and education in strategic thinking for these people who are educated in a much more practical way? An MHA isn’t sitting in their office thinking and going into philosophy a lot of times. A lot of times they're figuring out, how can we solve this problem? How can we deal with this emergency situation?’’
 
13:36 Breaking down silos in healthcare 
Cole said administrative fellowships can help to develop a well-rounded approach.
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Tech startups are predicted to disrupt US healthcare in 2024. Scott Nelson, co-founder, and CEO of venture backed FastWave Medical, offers his strategies for success in innovation with Jim Cagliostro. 
 
Episode Introduction 
Scott reveals the two signs that an idea has potential, why market trumps everything in innovation, and why leaders should focus on eliminating pain points for their end users. He also advises innovators to connect with potential strategic acquirers at an early stage and explains why leaders of startups shouldn’t put all their eggs in the venture capital basket.
 
Show Topics
 
Two signs of a good idea 
Market ultimately trumps everything in innovation
Engage with potential strategic acquirers at an early stage
Finding investment in your community 
Flipping the script: eliminating pain points
Effective ways to raise capital
Leaders of startups don’t have to be the CEO 



05:49 Two signs of a good idea 
Scott said there are two things for leaders to consider in innovation. 
‘’I guess to answer your question in a little bit more long-winded way, I would say if you've got an idea that you can't seem to shake a little bit… It's sticky and you find yourself maybe waking up at night thinking about it or you thought about it and then two weeks ago you're still thinking about it, maybe a month goes on, you're still thinking about it, that's usually a good signal. Maybe there's something there, but the most important point from my perspective is before you go too far, before you get too latched onto this idea, you really need to think about two things primarily. One, does it solve a real glaring problem? Is it a painkiller? I remember interviewing Dan Hawkins way back in the day. He was actually the founder of Shockwave, the company I mentioned previously, was very early at Intuitive Surgical, was the founder of Avail Medsystems, et cetera, serial entrepreneur. And he phrased, this was back in, I think 2016 or 17, but he mentioned finding a painkiller, not aspirin, not Tylenol, but a real painkiller, something that really causes a lot of pain, whether that's from a cost perspective, whether that's from a workflow perspective, but something that's like, there's a lot of friction there. That's what your idea hopefully solves for, a real painkiller. And then secondarily, if you think you're onto something that solves that real pain point, secondarily, you need to think about this as early in the process as possible. Who's going to pay for it?’’
 
09:03 Market ultimately trumps everything in innovation 
Scott explained why market is the #1 factor for potential entrepreneurs. 
‘’I sort of fundamentally believe that market ultimately trumps everything else, right? Now, don't get me wrong, you could have a great product and a great team, but if it doesn't serve a huge market, you're going to have to think about other ways to fund that, right? Maybe it's a product that you can invest your own money in. Maybe it's a product that you can get to market quite quickly and use revenue and profits to support the company's growth, etc. But the reality is you need a big market to serve in order to give you optionality to capitalize and fund your idea or fund the company moving forward. So I do kind of think market trumps everything, because again, you could be working on a great product, have an awesome team, but if the market just doesn't support it, it's likely not going to have a lot of substance there. On the flip side, you could have an awesome market and maybe a decent product and a decent team, but it's probably going to do fairly well because the market supports that need. So, long story short, there's a couple of different ways to think about it. They're all important. ‘’
 
12:38 Engage with potential strategic acquirers at an early stage
‘’Obviously you need to be careful and cognizant about not disclosing too much, but the imperative is

Purchased services is often the most overlooked expense in healthcare yet offers opportunities for cost savings. Brian Bartel shares his best practices for effective contract management, with Jim Cagliostro. 
 
Episode Introduction 
Brian explains the unique challenges of purchased services, why a centralized contract repository is the first step to successful purchased services management, and why hospitals should never allow contracts to auto-renew. He also explains why ‘’red flags’’ aren’t always necessarily malicious and why it’s vital to question the line-item details of your purchased services invoices. 
 
Show Topics
 
Purchased services present a unique challenge in healthcare
#1 tip: Create a centralized contract repository
Review your contracts on a minimum annual basis
Don’t assume all red flags are malicious
The hidden cost savings in your line-item details
Be inquisitive, be patient, be strategic – and build relationships




06:35 Purchased services present a unique challenge in healthcare
Brian explained the difference between supplies and purchased services. 
‘’…When you're talking about supplies, it's pretty easy. You've got a specific item number, you've got your power set, your requisitions, everything is very orderly. So things are coming in, you can track it, you've got the data behind it, there's a contract with that line item pricing. And then when you get confirmations back, usually people are using some form of EDI, which makes it relatively easy, and you can track that. Item A is item A, item B is item B. Purchased services is different because it typically is not on a PO. Again, I've worked places where it is, but that comes with its own challenges. It's very department specific, so you've got usually a department manager or leader that's kind of running that point with it. We don't have as much interaction on the supply chain side of this either. Communication is usually kind of sparse between supply chain and a purchased service provider as compared to a typical supply vendor. And again, the data is just, it's more difficult. When you start looking at how things are being invoiced because there's no PO line, it gets very challenging to try to figure out, "Okay, what's actually happening with this spend?" Typically, an invoice will come in, the department manager signs off on it, it gets paid, and that's it. So a lot of opportunity there.’’
 
08:30 #1 tip: Create a centralized contract repository 
Brian said a centralized contract repository was the essential first step to successful purchased services management. 
‘’I think that at square one, I think the biggest thing you can do is if your organization or your hospital, your ASC, your clinic, whatever it is, if you don't have a centralized contract repository, that's step one. Again, stepping into certain roles in my past, you've got contracts that might be down in admin. You've got department managers that have signature execution authority and they've got them in their files, and then you realize three years later that there's been this contract that nobody's really paying attention to because it's just a paper copy. Really I think that that's the biggest thing for me is getting your hands around it. Number one, you've just got to have that centralized repository. Again, that doesn't mean that you need to use software. Software obviously makes things easier. I'm a big proponent of that. But again, even just saying, "All right, nobody can sign contracts except for," whether it be your CEO, your CFO. "Send all these down and we're going to put them in a file cabinet." At least then you can go and try to find where those contractual documents are.’’
 
10:07 Review your contracts on a minimum annual basis
Brian said it’s important not to let contracts auto-renew. 
‘’It’s always good to have that check-in annually, even if it’s just pulling the contract

Flourishing supplier relationships can transform healthcare organizations. Samer Haddad, shares his experience of building and navigating successful partnerships with Jim Cagliostro. 
 
Episode Introduction 
Samer explains why trust is the foundation of all successful supplier relationships, the importance of human-to-human connection and why a partnership sometimes means giving your partner the benefit of the doubt. He also outlines the key to a successful exit strategy (plan, plan, and plan) and why solid leadership means treating others as you want to be treated, and leaving your ego at the door.
 
Show Topics
 
Supplier relationship management isn’t just a keyword 
Trust is the foundation of successful relationships 
Managing multiple suppliers is about more than spend
‘’Partnership is a partnership’’
Managing a successful exit strategy 
Leadership tip: keeping your ego out of the way





04:33 Supplier relationship management isn’t just a keyword 
Samer explained how the impact of Covid revealed the importance of strong supplier relationships. 
‘’When the world went into COVID and all the crises that came after that, in terms of shortages and everything, I can make a pretty easy judgment that there was a big differentiator between companies who made it and who maybe struggled mainly was supplier relationship management. Because when the real challenge came to the world, companies that invested in relations, companies that had deepened their relationships, especially with the significant suppliers to their production or to their delivery, whatever that is, made a difference. Those were the ones who were able to actually leverage that challenge to their benefit in the market. So they gained market share. The ones who had superficial relations, maybe more towards purely commercial kind of dealings, I think they struggled because, at such a moment, that kind of... I can't call it a human-to-human relation, or personal relation is where things are tested, and when companies need to make decisions, that's always an element. The trust between those organizations is essentially trust between humans that are doing business for years together. So if you just... we learn from the past two to three years it is I think many of my peers in procurement supply chain will vouch to the importance of supplier relationship management in general and not just like a keyword that you use and throw around…’’
 
07:09 Trust is the foundation of successful relationships
Samer said KPIs can help to measure progress and build trust. 
‘’It takes time to build up that trust. So it is very important when we start a relationship that we create the proper agreement because this is why contracts are there. Contracts manage the relationship between parties. And you're establishing basically a baby kind of relation that has no trust yet, and you need to monitor it and start putting in the building blocks of that relation. Usually, in my opinion, that is established by having mutual mechanisms to judging how companies are engaging with each other. That could be the KPIs that you set. And it's not fair only to set a KPI for the supplier that you're establishing a relationship with, especially if you're looking long-term. Some KPIs should be set, maybe not in the contract, not necessarily, but self-imposed as you manage that important relationship that you know about. So you can even monitor internally how you're engaging with that supplier. Now, if you do that kind of fundamental layer of developing that relationship and you start building upon it, with time, trust starts getting improved and starts growing. It's like a baby, and it grows. It becomes an entity.’’
 
10:24 Managing multiple suppliers is about more than spend
Samer said organizations need to understand how suppliers can impact their business. 
‘’…... But let's say what are the top 10 suppliers that basi

An estimated 40% of expenditure in the supply chain goes to waste. CEO Luká Yancopoulos explains to Jim Cagliostro how Grapevine Technology aims to put the power back into the hands of hospitals.
 
Episode Introduction 
Luká explains how Grapevine can help hospitals save up to 80% on a single line item, how even small healthcare businesses spend six figure sums on the supply chain each year, and how to frame the reality of years of overspending to his clients. He also reveals three key ways that hospitals can lower the expense of their vendor management. 
 
 
Show Topics
 
The power of building networks
Supplies are a huge expense in healthcare
Up to 80% of spend may be waste
Connecting the source of supply to the end user
Framing harsh truths on expenditure
Seeing value every step of the way
Leadership tip: deliver solutions to real problems



03:12 The power of building networks
Luká said Grapevine can help its clients to save 70-80% on a single line item. 
‘’So Grapevine is working to make it very easy to basically manage your existing network. We've got healthcare businesses. They usually come to us, and they've worked with a handful of suppliers over the years. They think of each of these suppliers as their supplier for blank, fill in the blank, and Grapevine rewrites that. We think they're all your suppliers, they're all your network. Every time you add an item to cart from one of them, let's make sure it's the best price and that your other suppliers that you already trust and know don't have the same exact product at a cheaper price. Oftentimes, they do. We've basically redirected spend from one major distributor to another major distributor, saving the customer or the healthcare business 70%-80% on a single line item. The thing like a Becton Dickinson or a BD catheter or infusion pump or something they buy, and they have a bad habit of buying it from the wrong guy. So we basically let them link all their suppliers with the click of a button to a single screen, read in their current offerings, and tell them where to redirect their spend, acting as a traffic cop if needed.’’
 
05:14 Supplies are a huge expense in healthcare
Luká explained that even small healthcare businesses are spending six figure sums on supplies every year. 
‘’Certain medical specialties get hit harder than others. If you're performing surgery, obviously, you're burning through a lot of supplies, you're using anesthesia, you're using all sorts of things that maybe your average urgent care clinic won't need. So we focus on specific specialties that have a high consumption rate of important and expensive technologies, things like oncology, dermatology, surgery, these sorts of things. Even a small healthcare business is spending six, seven figures on medical supplies and pharmaceuticals, like, a customer that comes to mind, a family-owned dermatology practice in upstate New York, and Rochester, New York is spending $200,000 a year pre-Grapevine on medical supplies. So like the instruments and whatnot, they're using sutures and implants and this and that, and then they're spending another million a year on injectables. Things like lidocaine, fillers, and different sorts of things of that realm.’’
 
08:38 Up to 80% of spend may be waste 
Luká explained why a single supplier can’t offer hospitals the lowest price for every item. 
‘’I think that, in some cases, it's as much as 80% of the spend on supply is fruitless and extraneous. As far as what makes up those inefficiencies, there's a number of things. There's a classic idea that I am a strong believer of, that no one person or entity can be the best at everything. So even if you're comparing suppliers of the same business model, these large distributors, we could talk like McKesson, Henry Schein, Medline, the list goes on and on. Every one of those has built supply chains like warehouse fulfillment, shipping teams, cus

The US healthcare sector has struggled to put innovations like AI into practice. Mara Cairo explains the advantages of applying machine learning and AI for hospitals to Jim Cagliostro.
 
Episode Introduction 
Mara explains why the first step towards successfully embracing AI is literacy, the challenges hospitals face in system integration and why AI isn’t intended to replace humanity in patient care. She also illustrates the benefits of AI for healthcare, including predicting patient no-shows, effectively managing inventory, and reducing costs, and explains why successful leadership means getting out of the way. 
 
Show Topics
 
Taking the first step towards AI literacy
The challenges of AI in healthcare
Applying AI across industry sectors
Anticipating patient no-shows
The impact of AI on cost reduction initiatives
Leadership tip: Hire the right people and get out of their way 



03:48 Taking the first step towards AI literacy 
Mara said AI literacy helps to overcome resistance to AI.
‘’Really the most important thing is AI literacy. It's just like learning what AI is, what it isn't, the types of problems it's really great at, the types of problems you shouldn't use it for. On the earlier side of the spectrum, we have lots of training and education really meant to get industry partners, but also the general public. We're working even with K-12 teachers and students now ... to make sure that everyone has that literacy because it's just becoming more and more important to kind of arm yourself with the information because we're being inundated with information and news articles and scary stories. So it starts with literacy, that's the first part, and then kind of evolves from there hopefully.’’
 
05:46 The challenges of AI in healthcare
Mara said the complex needs of healthcare mean hospitals struggle with system integration. 
‘’There are different disciplines. Each maybe has their own labor agreements, regulation and whatnot. So when we think of human resources as a piece of inventory, that gets quite complicated quickly. Another thing, supply level. Inventory levels are complex. We kind of all saw it in COVID. The demand can spike really, really quickly. And you don't necessarily know when that's going to happen, right? So these surges can catch everyone off guard. And maybe traditionally it's been harder to anticipate when these surges might appear. Luckily, maybe machine learning is a tool that can help us with that. Also, just I think the shelf life of different supplies is unique to healthcare. You have to be really, really careful about storage and transportation requirements. And all of that is compounded by distance and transportation costs. Especially in Canada, in the far north, those care locations, they're really dependent on certain supplies, but if there's a road closure or a snowstorm or something, it's further complicated. The inventory supplies and healthcare are potentially life changing, right? So it's just so much more important that that is managed properly. And that complicates things. I think overall, in general, we've just seen that healthcare systems can struggle with system integration.’’
 
08:30 Applying AI across industry sectors
Mara gave examples of how AI helps with demand forecasting and warehouse management. 
‘’Some of the really cool projects we've worked on with our industry partners in the supply chain space, but more in the kind of consumer goods area are things like demand forecasting. So helping them better predict what items they're going to need and when. What's really great again about working with our supply chain partners is they have a ton of data, historical data. And that's really, really important. When we start looking to build machine learning solutions, we often rely heavily on that historical data to be able to make those predictions about the future. So the demand forecasting problem is really ripe for