Rae Woods (00:02):
From Advisory Board, we are bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods. You can call me Rae. Every year, Advisory Board gets hundreds, maybe even thousands, of questions from healthcare leaders about what's happening in the industry and what they and their organizations should do next. So in this very special episode of Radio Advisory, we're going to take you behind the scenes. In the first half of this episode, I want to introduce you to the team at Advisory Board, that's actually responsible for answering questions from health leaders.

(00:38):
The team is called AskAdvisory, and they're here to share some of the biggest questions that they've received this year and, of course, to give you some action items that you can take into 2024. We're going to continue with this behind the scenes theme in the second half of the episode, but instead of talking about questions about the industry, we've gotten questions about this very podcast, about Radio Advisory, about the team, about how we actually produce a podcast every single week. So I've brought a very special colleague of mine, podcast producer and founder, Chris Phelps. Make sure you stay tuned, but for now, I'll let AskAdvisory take it away.

Bri Whitfield (01:25):
My name is Bri Whitfield. Leaders continue to explore how artificial intelligence can be used within their organizations. I'm often asked about how to build an effective digital strategy team, that can help deploy AI technology and mitigate its potential risks, especially when it comes to data bias. For instance, I was just speaking with a health plan member, who was trying to figure out where ethical AI should live within their organization. "Should it be the IT team? Should it be the legal team? Should it be the quality team?" That was a great question, and if I could give you one takeaway, it's that AI cannot be siloed or stationary as a solution within your organization. It requires a collaborative approach from multiple stakeholders to ensure it's optimally utilized towards your organization's specific goals.

(02:16):
An example I like to point to comes from UNC Health and their efforts to mitigate the challenge of data biases. They formed an AI and automation advisory group, that includes data scientists, clinical leaders, ethicists, privacy and security experts, and operational experts, who evaluate and test AI algorithms to help mitigate the risk of data bias. We've included a link in our show notes that outlines five AI challenges, including data bias and ways to address them. And remember, having a diverse team of stakeholders can help ensure that your AI strategy continuously evolves to meet industry standards and is not reinforcing long-held biases within healthcare.

Ali Knight (03:07):
Hi, I'm Ali Knight. One question that we're receiving regularly is around staff retention. Nursing and human resource leaders from rural hospitals to major academic centers are asking, "Where should I be focusing my efforts to keep the nursing staff I already have?" We are facing a supply and demand imbalance with more openings than we have nurses to fill them, making this a challenge you can't hire your way out of. We are seeing a slight decline in turnover overall, but early career nurses are departing at a disproportionately high rate, especially during that first year. So let me address the early career problem. Here, we're recommending extended onboarding and mentorship programs. We also recommend professional development opportunities, advancement potential, and flexible work arrangements. But addressing burnout for all nurses requires us to look at the root causes of the problem. One is incivility and violence against caregivers, and the other is improving workflow inefficiencies.

(04:07):
There is a lot of focus on workflow these days. So let me address violence in the workplace, which saw a drastic increase in 2023. It's important to foster an environment where staff can make meaningful connections with colleagues and patients. We need to ensure the presence of tools and support levers for coping with a stressful emotional work environment, which includes equipping our nurses with the skills to have difficult conversations. Introduce these tactics during onboarding and visit them frequently as a team. You should also keep relentless focus on zero tolerance for point of care violence and audit the processes and protocols in place to keep your team safe. When it comes to workflows, make sure you're revisiting the processes that seem clunky or time consuming. Are they improving patient care or outcomes? Fulfilling a regulatory requirement? If they are, work with your frontline to optimize them. If not, let them go.

Annie Lindner (05:09):
My name is Annie Lindner. One of the biggest questions we're getting from our members is how to engage physicians in cost containment. This is no surprise, given the relentless margin pressures facing provider organizations and an increasing involvement in risk-based contracting. This requires an intentional communication strategy, that engages physicians in care standardization efforts. To ensure that physicians are a driving force behind cost containment efforts, we encourage leaders to focus on four key motivators, that drive physician behavior, their hearts, their minds, their wallets, and their watches. In other words, we need to be acutely aware of what motivates our physicians and then, appeal to these four drivers.

(05:53):
Most leaders understand that financial incentives are important, but relying solely on compensation fails to leverage the intrinsic motivation of physicians. Appealing to their hearts means coming back to the mission and is key for gaining physician buy-in. Physicians are also scientists and want to practice evidence-based medicine. It is up to you to make that low cost high quality standard as easy as possible. However, it's easy to overlook the last one, which is their watches. If leaders don't make changes user-friendly, they won't be done, even if you've appealed to the physicians' hearts, minds, and wallet. We need to ensure that physicians are not viewing these cost containment initiatives or even value-based care more broadly as a trend. This requires a cultural shift in our provider settings, that we will only see if we tap into the core values of our physicians and incorporate accountability measures into clinical practice.

Jacky Veiga (06:58):
Hi, my name is Jacky Veiga. I often receive questions from members about the financial impacts of high length of stay for hospitals. This year, many of our members saw their average length of stay decrease, which is a good thing. However, this has led to a false sense of achieving the full potential of cost savings. Advisory Board's Hospital Benchmark Generator can help you assess length of stay metrics for your organization and compare them to your competitors. This can give you a full sense of unrealized opportunities you have for length of stay. In our research, we have found that focusing on quicker turnaround times for low acuity patients can create additional room for high length of stay patients.

(07:41):
One of my favorite examples of this is all about fast tracking low acuity patients. Mary Washington implemented what they call their Super Track system. Through this system, low acuity patients are able to be released from the emergency department within remarkably short turnaround times, typically ranging from 30 to 90 minutes after arrival, depending on the necessity for different tests. Mary Washington achieved a significant increase in productivity and avoided unnecessary admission. I'll put that case study in the show notes, plus some other materials to help you reduce length of stay.

Claire Shields (08:24):
My name's Claire Shields. And this year, AskAdvisory received a lot of questions about site-of-care shifts. Hospitals and health systems want to understand how the shift to the outpatient setting is going to affect them, which services it's going to affect, and how quickly they need to prepare. All of those are great questions, because we know that the shift to the outpatient setting is not happening at a uniform pace across the country. While volumes for most procedures shift to the outpatient setting slowly, we found that procedures do have the potential to shift quickly, if certain regulatory and market forces align, like removal from CMS' inpatient only list and addition to the ASC payable list. Those favorable market forces can look like a low risk patient population, a high degree of specialist independence from health systems, or just preexisting ambulatory infrastructure. The bottom line is that procedures are moving out of the hospital altogether, and these are the ones that traditionally brought in revenue for hospitals, things like orthopedics and cardiology services.

(09:35):
Instead, these procedures are moving into non-hospital settings, like ASC'. Now, this is good news for stakeholders, like independent physicians, ASC operators, and even payers. But if you're a health system or a hospital, you may want to find other ways to invest in outpatient services and not rely on inpatient volumes to make up the difference. So the biggest question we get is, "What does the data look like in my market?" And there are two tools that I'll put in the show notes that can help you. The first helps you understand which shift is happening the fastest in your market, and that's the Market Scenario Planner forecasting tool. The second tool will help you visualize, through graphs and maps, how site-of-care shifts have happened across the past five years. And these are our site-of-care shift maps. Both of these tools are the actionable guidance that will help leaders like you be forward thinking with your long-term site-of-care shift strategy.

Rae Woods (10:46):
Chris, are you there?

Chris Phelps (10:47):
I'm here, Rae.

Rae Woods (10:52):
Tell me the truth, is this the first... No, this isn't the first time you've used your microphone, but you haven't used it in a long time?

Chris Phelps (10:57):
Haven't used it in a long time. Early days of the pod, we're talking like year one, I used to be the voice of our breaks at the time, right? So I was plugging other Advisory Board services. That was me. That was sort of me in the background contributing to the pod.

Rae Woods (11:11):
That's a deep cut. Only loyal listeners will recognize your voice from four years ago, from year one of Radio Advisory.

Chris Phelps (11:18):
That's my ask of everybody. I think you got to go back to year one and listen to every episode, redownload those and hear me.

Rae Woods (11:22):
Oh, God, please don't. Please don't.

Chris Phelps (11:27):
So I'm here. You're usually asking the questions, but this time, it's my turn to put you on the hot seat.

Rae Woods (11:34):
Oh God, okay. I'm ready.

Chris Phelps (11:36):
Great. Just a quick thanks to everybody who sent in questions. We've been collecting these over the last couple of weeks. Quick reminder, you can always email us at podcasts, that's plural, podcasts@advisory.com, or go to our website and leave us a voicemail or find other ways to reach out. But we would obviously love to hear from you, so please keep sending your questions. Question number one.

Rae Woods (11:59):
Yes, tell me.

Chris Phelps (12:01):
Is Rae your only nickname? Or did you have others growing up?

Rae Woods (12:06):
So I'm a big nickname fan. I've had lots of nicknames. Folks who listen probably don't know that I actually am a veteran. I used to be in the Army, so lots of folks called me by my last name, Woods. My beloved college swim coach, Jim Yemens, Coach Yemens, shout out to you, he used to call me Woodsy, which was very fun. Rae became something that I offered once my little cousin started calling me it, and then, I learned that, if I offered in nickname, folks wouldn't call me Rach, which I truly detest. I truly detest Rach. So I found, if I offered something, then they would use that, as opposed to me saying, "Please don't call me Rach, stranger."

Chris Phelps (12:52):
Yeah, I was going to ask if Rach was up there.

Rae Woods (12:54):
No Rach.

Chris Phelps (12:55):
Tapping into the '90s Friends phenomenon.

Rae Woods (13:00):
No Rachi. Rachi, awful. Awful. But I truly do go by both Rachel and Rae in my life, not at work. Work, I'm pretty exclusively Rae at this point.

Chris Phelps (13:10):
I think so. All right. A little more serious. We had a question about, what is it like to run a healthcare podcast? What kind of goes into it? What's sort of the process? How do you do this every week?

Rae Woods (13:24):
Honestly, it takes a team and a mindset of being willing to be on a treadmill that does not end, because every single week, we do episodes. Every single week, something happens in healthcare. There have been times in which, speaking back to the early days in COVID, where we were just constantly trying to keep up with what was happening in the news and make an episode every week. So what it takes is the willingness to get on the treadmill and go, "We're not getting off," because we know that our listeners want to hear something from us once a week. And that's really the best way to run this pod and make sure we're getting our messages out there.

Chris Phelps (14:09):
And what's your favorite part of making an episode?

Rae Woods (14:13):
Okay, so my favorite part happens before the recording actually. So we spend time obviously thinking about what episodes we want to produce, but in this early stage, we focus on, what's the message, what's the tension that we want to address in an episode, and what's the end point? What does it mean to overcome that tension in healthcare business? And there's this point that's not at the very beginning of coming up with this episode and not at the very end either, when we're actually feel comfortable to press record. There's this sweet spot that happens somewhere in the middle, where the light bulb goes off and we realize, "Oh my gosh, this is the thing. This is the thing that we're going to tell healthcare executives to do." And when that light bulb happens, that's the best moment of my week. I hope that's the best moment of our team's week too, because it's the most fun for me, for sure.

Chris Phelps (15:06):
And last one about the pod here. We're coming up on about four years of the podcast. What do you think the biggest thing that's changed since we've launched back in 2020, aside from COVID?

Rae Woods (15:18):
Oh God, Chris, the biggest thing that's changed is that it's not just you and me and two other people doing this anymore. Here's the thing. People don't know that, when this started, it really was run off the backs of four people, you, me, our colleague, Joe Shrum, our colleague, Alice Lee, and it took the four of us, who just really believed that the right answer, in April of 2020, was an audio only format, that would get messages into leaders' phones to help them. And we kind of put it on our backs and said, "We're just going to make this happen." And even though we're on a treadmill every week, it is no longer four humans shepherding this along, forcing this along, forcing this to happen. And now, it is an established part of the way that Advisory Board does business, and now, there's a lot more people involved. We have more producers, we have more editors, we have more folks thinking about episode content, episode strategy. We've had tons of... How many people have we had on the podcast at this point?

Chris Phelps (16:29):
Oh my gosh, probably almost 200, if we're coming up on 200 episodes.

Rae Woods (16:34):
Almost 200 people on the almost 200 episodes, right? It's just become something so much bigger. That's the biggest difference between 2020 and headed into 2024.

Chris Phelps (16:43):
The family's grown.

Rae Woods (16:43):
The family's grown, yes. It's nice to share the responsibility a little bit. I think there were times in the beginning where we were doing something about the podcast every day, literally every day, because that's what it took to stand up a channel during a global health crisis.

Chris Phelps (17:05):
So Rae, this next question came into us via email, and somebody wanted to know, what's the best scripted TV medical show, in your opinion?

Rae Woods (17:17):
Ooh, okay. Best and favorite are probably two different answers. Favorite of mine will always be ER, like early season ER, young George Clooney. I actually recently rewatched that series, because once the pandemic started, I'm just a sucker for nostalgia, so I just want to go back in time. Anything with a beeper is the show that I want to watch, and it's so fun to go back and watch old medical dramas. Because so many of the problems are still the same.

(17:49):
I'm not kidding. When there was a whole set of episodes where the bad guy was private equity, it was private equity coming in, and at this time, trying to buy up the ed docs, which was a big thing that actually happened in the nineties. And I'm sitting there going, "Oh my gosh, nothing's changed." That's my favorite. None of them, I think, are actually accurate though, in terms of...

Chris Phelps (18:15):
It's TV, yeah.

Rae Woods (18:16):
At least in terms of medicine. Physicians on the line would say not true in terms of medicine, although truthfully, a lot of the business problems come up again and again. There's always some bad guy that's trying to buy hospitals, in every single one.

Chris Phelps (18:29):
You did favorite. Did you answer the best one? Is that your answer to the best one?

Rae Woods (18:35):
I'm going to stick with ER as my personal favorite, and it's the best one. Everyone should go back and rewatch that one. Also a big fan of House, mostly because Hugh Laurie is exceptional.

Chris Phelps (18:45):
He's great. Did that get you working in healthcare? Or what kind of...

Rae Woods (18:51):
No, no. That did not get me working in healthcare. Honestly, the healthcare story is a similar story that I think a lot of folks have, which is, when you're young, literally, or in your career, you want to do something that's going to have an impact and that's going to change the world. And my first foray into healthcare was enlisting in the Army and saying, "I'm going to be a combat medic, and that's what I want to do." That resulted in an injury, that said, "You've got to figure something else out." And I was so in love with and passionate about the military, that I said, "How can I work as a civilian?" And I landed on a job in research and suddenly went, "Hey, this research thing is really, really, really cool." And there were many, many steps that brought me between thinking I was going to stay in academic research to truly stumbling upon Advisory Board and business research.

(19:40):
And I really have drank the Kool-Aid over the last decade that I've worked here, but I truly did fall in love with the way that we do research. I talked about that light bulb moment that happens in podcast episodes, but that light bulb moment is actually a part of the way that Advisory Board does all of its research, right? You're trying to help health leaders work through a problem. You don't know the answer to that problem, because no one knows the answer to that problem. And then, somewhere along the line, you figure out, "Aha, this is the thing that's going to actually help," and that's just the best drug. And so, kind of stumbled upon healthcare, but the business research is absolutely, and feeling like you're actually helping real health leaders navigate tough moments, is absolutely what's kept me here.

Chris Phelps (20:32):
The next question I have here came from our Instagram account. So reminder for everybody, we do have an Instagram account. You should totally follow us there. We're doing some pretty cool things there, but we got a question about, how do we choose topics to cover on episodes? What helps us kind of bubble up?

Rae Woods (20:49):
This is the thing that stresses me out probably the most is choosing topics and also leaving room for that moment when something, all of a sudden, happens in healthcare, because you can't plan for that, and it always, always happens. Radio Advisory really tries to do episodes every single Tuesday. We take a short break around the holidays. You know that we're going to take a break after this episode, before a couple weeks into January, and that means we have about 45 opportunities to say something to the public. Do you think 45 sounds like a big number, Chris?

Chris Phelps (21:19):
To me, it does, yeah.

Rae Woods (21:22):
I think it sounds like a tiny number. I think it sounds like a tiny number, because in part, truthfully, Advisory Board does so much research for every single corner of the business. And it's a really hard job to make sure that, every year, we can say something about all of the different work streams that Advisory Board is doing, plus make sure that you're saving room for what other thought leaders in the market, what other executives in the market are actually doing and overcoming themselves, and again, saving room for the kind of "Oh (censored)" moment that happens in the news. So 45 opportunities, how do we decide? We really work through, what are the central messages that, this year, are going to impact healthcare? And that's a lot of what we're spending time doing as a business right now. That may change over the course of the year, because we have to leave room for it to change. But we really spend several weeks and months talking to the front lines in healthcare and trying to understand, what are the biggest pressure points?

(22:20):
What are the things that they're not thinking about, that we are hearing from another stakeholder? And those become the foundation of what next year's episodes are going to be. I will also say, this is a difference from other podcasts. Some podcasts plan their whole season, and they say they're done. I don't like to do that. We plan several weeks ahead, because we have to for our own sanity. But we don't plan an entire year or entire six months or sometimes even an entire three months of episodes, and we're constantly moving things around, because new data from Novo Nordisk shows what's happening with GLP-1s. And we go, "Oh, let's move an episode up. We've got to do this now." Or speaking of GLP-1s, we decided to do our first episode on weight loss drugs after the infamous Oscar speech about Ozempic, and I said, "Hey, this is something that's showing up in the Oscars. We should probably talk to health leaders about it. Let's do an episode."

Chris Phelps (23:20):
And we're going to put that in the show notes, right?

Rae Woods (23:22):
That's your job to make sure it ends up in the show notes.

Chris Phelps (23:24):
All right. Rae, just a couple more questions. I'll call this like the podcast recommendation section, right? Classic [inaudible 00:23:33] podcast deal.

Rae Woods (23:33):
This is a question we get a lot.

Chris Phelps (23:35):
First, before we get to the question they're expecting, some of the podcasts I've been listening to have been doing this Best, first, favorite for recommending episodes of their most favorite podcasts that they listen to. So I want to ask you, can you recommend, in your opinion, the best episode of Radio Advisory, the first one you think people should listen to, and then, what your favorite episode of Radio Advisory is?

Rae Woods (24:01):
Oh my gosh. Let me, okay, hold on, let me pull up our website. Best episode, first episode, and what was the last one?

Chris Phelps (24:10):
Favorite.

Rae Woods (24:11):
Oof. Okay. I am definitely going to have to answer this out of order. So my favorite one, back to my love of these light bulb moments, was definitely the live podcast that we did this year at the Value-Based Care Summit. It was something that came together on stage. None of my security blankets for podcasting could be with us, because we were literally doing it in front of 300 people and we wanted the integrity of the live event to be part of the episode that went out to all of our listeners.

(24:41):
So it was really walk out on stage, press go, make it happen, and make it happen with three different guests, which is really hard, three different guests that represented three very different parts of healthcare, that frankly had very differing opinions on what it would take to build a value-based enterprise. So it could have gone really badly. It was a risk, but it ended up being amazing. It was just such a good feeling. And then, I think my note to the whole podcast team when I listened to the first edit involved another curse word. And yeah, I just thought it was perfect. That was probably my favorite.

(25:23):
The first one that I think folks should listen to, I actually want them to go back in the archive a little bit to the first episode we released this year in 2023. We did what we thought CEOs needed to pay attention to this year. It was a two-part series, because we had too much to say. And we want to keep our episodes short, but that would be the first one I would recommend folks listen to. And honestly, tell us if we were right. We said this as our prediction at the start of 2023, we're now at the end. That would be a fun one to go back and listen to and figure out if we were right. Oh, actually, here's a favorite one. It's hard for me to pick a favorite. Can I give two?

(26:05):
I'm going to cheat and give two. My favorite non Advisory Board guest has to be our friend Tom Lawry. He came on last year to talk about bias and AI. It was another one... I think we spent four minutes editing the episode, because it was just like we were firing on all cylinders, I had taken the time to make sure I read both of Tom's books, even though we weren't having a conversation about all of AI or all of tech and healthcare, we were just talking about bias. But that was one where I think we really got out ahead, frankly, of generative AI, in talking about one of the risks that we're now all grappling with.

(26:40):
Another favorite one of mine, where I think we really corrected the audience, is we did this episode with Sebastian Beckmann and Daniel Kuzmanovich on why there's no such thing as a physician shortage. Talk about an assumption that everyone has and is in every media headline around primary care. And we said, "Actually, I don't know that this assumption is correct, and let's show you the data on why and what you should be focusing your efforts on instead." So that was a really good one. Chris, I know you started off this by saying I get to answer questions and not ask them, but I can't leave this without asking you a question.

Chris Phelps (27:16):
Naturally.

Rae Woods (27:17):
You actually run this team. You actually run the podcast team and are the most important person. What is it that you are looking to do when it comes to podcasting in 2024?

Chris Phelps (27:31):
Overall for us, for me, it's grow the podcast more, right? And I'm not just talking downloads, right? It's always great to have more people downloading and listening to the show, but I think, overall, just growing our reach. I mentioned our Instagram account earlier. We would love any kind of interaction engagement there, like people telling us what sort of thoughts they have coming out after listening to our episodes, how they want to get involved, ways to reach out to us. I'm hoping this AskAdvisory episode, the first half of this episode, sort of spurs more questions to that team. So any way we can kind of connect our listeners, the podcast, into the rest of the Advisory Board, I would be so, so happy.

Rae Woods (28:13):
Ooh, Chris, you just teed yourself up perfectly, and you don't even know it. You should be the one to deliver the final line of this episode.

Chris Phelps (28:21):
Because as always, we're here to help.

Rae Woods (28:25):
Nailed it.

Chris Phelps (28:27):
Thanks, Rae.

Rae Woods (28:28):
Thanks, Chris. If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts, and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Abby Burns, Kristin Myers, and Atticus Raasch. The episode was edited by Katy Anderson, with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Carson Sisk, Leanne Elston, and Erin Collins. We would also like to thank Sarah Adam, Ali Knight, Mira Lyon, and the whole AskAdvisory team for making this episode possible. The Radio Advisory team will be taking some time off over the holidays, and we'll be back on January 16th with a new episode on what executives need to know in 2024. Thanks for listening, and happy holidays.