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[00:00:00] Today on Keynote

(Intro) I think it's all about solving problems creatively pushing your limits, not accepting what those limits are, and then leveraging the resources as best as you can.

And I think just that's just how we operate.

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.

Now, let's jump right into the episode.

(Main) welcome to Keynote where I have the honor of spending time with Tracy Donegan, who is the Chief Information and Innovation Officer At MLK community health care, where she has been instrumental in building and advancing the hospital's digital and IT infrastructure from the ground up, with over 20 years of experience in health care technology and innovation, Tracy has led transformational initiatives that [00:01:00] enhance patient engagement.

Operational efficiency and health equity in underserved communities. Under her leadership, MLK has implemented cutting edge solutions, including AI driven virtual assistance and data driven strategies to improve access and care delivery. Tracy's deep expertise in leveraging technology to drive systematic change.

Makes her a thought leader in healthcare, I. T., innovation, and the future of digital health. Tracy, welcome to the show.

Thank you, Sarah. It's such a pleasure and an honor to be

here. And I would agree. And just for those listening, Tracy and I have had a friendship that's almost a decade. Almost a decade. At this point.

And I am always so grateful to spend time with you. I always learn from you and love being able to do this. So again, thank you for being on the show today.

You're welcome.

We have to start with your professional background. Can you please share your professional journey and what led you to your current position as Chief Information Innovation Officer at MLK?

[00:02:00] In summary, as I've got over 20 years, probably 25 years experience in the healthcare industry in various segments. But I spent half of my career in consulting and half of my career on the client side, and I started out in accounting following my mother's footsteps, who was a CFO in healthcare.

And in the beginning, when I was younger, I always thought healthcare was, a industry that. had a lot of women in it because most of my mother's colleagues were ex nuns. So I just felt that if I went into that industry, I knew how to handle them that I would be in good shape.

I went to KPMG consulting and worked there for several years, and there I learned that, networking is so important in consulting. It's what you make of it. So your success is completely dependent on you. And networking was a huge part of it. And that allowed me to get into several different segments of the industry, doing different.

Projects in different domains like strategy, rev cycle, [00:03:00] data, what have you. After consulting, I started working for my own clients and first at Medtronic where we did a massive transformation and transition to a new order to cash system. And then I was recruited to Apria Healthcare as VP of Revenue Management when they wanted to consolidate the revenue and customer service functions of 500 locations into three shared services centers at the same time, offshore 2500 positions.

Knowing I love a challenge I went straight to that and it was there when I heard about the hospital being built from the ground up and it was an old dear mentor of mine, Brad Armstrong, you know him. And he had mentioned he was building this hospital from scratch, and I thought, that's crazy.

Is he really for real? And when I thought about it more, I realized it was an opportunity of a lifetime. So I joined his firm and and the team on the ground, which was only a handful of [00:04:00] us. And that's turned into where I've. Come today. But at the end of the day, you realize that your career it isn't linear.

It's zigzag. Taking two steps back allows you to take two huge steps forward and always being the lookout of, these opportunities you'd never imagine would come your way. Take advantage of 'em.

And your background is so fantastic in our summits and at our dinners because you have the consulting and the accounting lens, and I have not met a person yet who comes across a conversation with you and doesn't dig in a bit deeper on how to really manage their.

Contracting their legal, their risk, their budget. They're also combined and you have it down in spades. Like I've never seen anybody be able to tackle financial challenges the way that you do. And part of that is also based on where you are. There's the personal mission, the philanthropic aspect of what you're doing, but establishing [00:05:00] MLK community healthcare as a core team member.

What were some of the challenges and successes in designing and implementing the hospital? Because you helped with a 70 million dollar IT infrastructure and application portfolio.

Yeah, like I said, opportunity and lifetime. The challenges were varied and unusual things that you wouldn't normally run into, but Perhaps a startup would.

I think the big challenge in summary was around the staffing and the financial constraints. When you're in a startup, you can't hire the entire team all at once. You have to wait till you're close to opening, such that you've got the revenue to offset the cost of the added staff. So we're constantly dealing with.

Building our application portfolio, for example, without any stakeholders to tell us what they want. And then also, during the implementation and design, we didn't have the subject matter experts to design the EHR. So imagine [00:06:00] contracting with 100 people, in nursing physicians, administrative revenue cycle roles, all descending at once.

For a week long design session where we're complete strangers and designing an EHR that they'll never use. And the other kind of cool, interesting part of it was trying to negotiate with vendors and finding that negotiation position when you have no income stream and no guarantee of a future. Those are really interesting challenges.

At the end of the day, though We selected and implemented over 60, technology solution. We selected and negotiated with 26 vendors and integrated over 34 unique medical devices in the H. R. And it was in 2015. In 2018, I read that integration of the infusion pumps wasn't even available or even done in many of the hospitals, less than [00:07:00] 5%.

So it's quite an interesting feat. And we were very ambitious with the technology.

It's amazing what you can accomplish when you don't even know where the bar is set. You set your own bar and you go after it and you've continued. To push the envelope for digital innovation and patient engagement, you've implemented a virtual assistant named Mia.

How has she, for lack of a better term, been able to impact patient engagement and operational efficiency?

We love Mia. We've grown her over the years. We added it when we did our patient engagement strategy in 2019. We added a chatbot as another digital front door channel because we wanted to offer our patients choice, logging on to their portal.

Getting onto the chat bot, going onto the website, calling our call center. And when COVID came around and, information was disseminated, in the world, and it wasn't quite accurate, it wasn't reliable. It wasn't an educational level or accessible to our community. We felt that our chat [00:08:00] bot would be perfect.

So we implemented it right away. It only took a few weeks to implement it. Then we had some issues around capacity and we felt that implementing a symptom checker and allowing our community members to see a physician on demand through Mia after their symptom checker would allow them to, stay home safe and would preserve capacity in our Emergency department, which for us was the most important thing because at that time we had no idea the amount of volume that was going to come through our doors.

So it was really helpful

and you still have to navigate ongoing financial challenges. You have faced significant financial hurdles, including potential closure threats. And so how have you address these challenges? And what role has technology played in ensuring financial sustainability?

With the technology.

We, of course, want to [00:09:00] enforce productivity and effectiveness in everybody's jobs. But I really have to stress how impressed I've been with all the non technology innovation that we have done we look at these financial challenges as opportunities. We really appreciate it. Take them in strike because we're so used to them coming up.

They've come up during as we were building up the hospital and at times through our existence and we use the opportunity to really advance policy change, we don't want to operate within their constraints. And the only way that we feel like we can move forward and help our sustainability is through policy

[Mic bleed]

and the other.

The other mechanism that we've used as an opportunity is through the media, so we used it to tell our story and those of our patients to show how policy can really affect patients lives, and we do that because we want to inspire other community health systems [00:10:00] like ours to do the same thing, to not just accept the status quo, to really for change that's sustainable and really gets to the heart of the matter, which is reimbursement at the end of the day.

And you're so committed to the community impact and health equity because you serve a medically underserved area. How are you also leveraging a lot of these ideas to address health disparities in South Los Angeles?

[Mic bleed]

do with this? We've come up with some really cool programs, community based programs that I've heard.

Other guests of yours describe, and I won't get into those, but Just to give a few examples, we've created a street medicine team that goes out and really helps our patients experiencing homelessness with medical attention and social needs. And it's a really fascinating way of delivering medicine and delivering care because so much of it is centered around [00:11:00] respect and trust in us.

And that would be an interesting topic to have an episode on and I could get you some folks there. And then we've recently opening up an empath unit sort of like a treatment center for our psychiatric patients in our emergency department.

Once they're medically cleared, they have nowhere to go. And since inpatient psychiatric beds are so scarce in our area. or in L. A county in general, that we really need a place for them to stay when they're cleared from a behavioral health standpoint. And the emergency department, just not the space for them.

So will be opening up in July. Our empath unit, which is a really serene space for them To land until they're able to be discharged safely. But I have to say the most exciting innovation that we're doing is that we're building an ecosystem around impacting health disparities and improving the [00:12:00] economic livelihood of our community.

And to me, that's the most exciting thing that we're doing. We're actually starting with our center for health policy where we're using data backed research to understand the impact of social determinants of health on health disparity. And then using that data to really understand what kind of innovation we need to help the community.

So we're building a philanthropic fund to fund Later seed organizations to come and test their concepts, thereby having a proven solution. And then we're also funding those successful businesses if they come into the area and practice and grow their business there, thereby allowing extra jobs and really influencing more economic activity and growth in our service area.

Expanding your expertise and your thought partnership to a degree [00:13:00] beyond the hospital and working with these other organizations. And when you look at the emerging technologies, Tracy, what do you foresee having the most significant impact on community health care systems over the next few years and specifically the approach you are taking, but how are you curating?

Obviously, you have the data behind it. What are the solutions or the ideas that excite you the most?

I know that we're building this ecosystem to impact community, the community. But internally, we really have to start with those folks delivering and they're on the front lines of care.

And that is all the innovation around clinician efficiency and reducing the administrative burnout. And that comes from the ambient scribe, but also smart each ours that curate information and data and help the physician get to information quicker and in context to actually what they're doing.

I think the other impact [00:14:00] is going to be around obviously around AI, but also around promoting the responsible use of AI and really pushing our vendors for transparency and explainability. And I feel like Given those two things, it's a good groundwork for building other solutions on top of that, but it really has to start with our clinicians in addition to what we're doing outside of our hospital

and your team is so connected to your physician base or your provider base.

How does your team continue to foster innovation and really endeavor to meet? The clinicians where they are, and this has a lot to do with The way that your teams and programs have had exposure to various health care segments.

Yeah, I'm, it's, I have to be honest, it's such a challenge for us. We're moving so quickly and to really foster innovation,

you've got to allow your team time [00:15:00] to. Attend the conferences, to get out there and shadow their stakeholders and their users so they have firsthand knowledge and experience of what their experience is. And that's really hard to do. And so we're still trying to play with ways of allowing that to happen.

And that is It's definitely a struggle, but we do also try to foster innovation outside of our team, and we do that through partnership. We don't stifle the innovation. And the ask the technology as of our team outside of our I. T. Team. For example, we have a new C. N.

O. And a new assistant C. N. O. Knowing that they're new and they have plans. We wanted to help them with establishing. And really defining their vision for nursing practice in the future. So we're sponsoring Gartner to come in and give them the education. And then that would be followed by a guided [00:16:00] development of their vision.

And I feel like that is a partnership we're trying to lay the groundwork for them to build up. Really what their dream practice

[Mic bleed]

future.

And by you taking that extra time to invest in their education and learning how the systems are functioning effectively at MLK, you're also going to build that trust factor, which allows you to have the conversations that elevate all of the things around you that are important and I love that approach.

Taking the time to really dig in to the leadership team, especially so that they know you have their best interest in mind first. It's a win, by the way, in the sort of blueprint and how you show up with others too, because you always endeavor to include people so they feel like they matter.

And that is a lost art in leadership sometimes. for sure. Thank you for demonstrating it. You're welcome. There were so many lessons learned from the pandemic, especially with the population you serve. You were at the epicenter and let's be honest where your hospital [00:17:00] is located is always going to be the epicenter.

Of where big things are happening from a health care perspective. What were some of the things that worked that still work and that you have continued to adapt in terms of an approach to health care delivery that not only serves your populations, but also is helpful with the adoption of technology and new ideas.

I think in our case, it's always about solving challenges other people may think are insurmountable. Our biggest thing and our biggest, secret sauce, I would say, is just our sheer scrappiness. And that's inside and outside IT. During the pandemic, there wasn't a choice about, how can I solve a problem?

You had to solve the problem. So we're constantly really pushed the boundaries of our thinking to come up with innovative solutions of dealing with a crisis that was completely unplanned. And then the second thing is [00:18:00] That what we did was that we planned for the worst.

So it wasn't about just in time. It was like just in case. And then we work backwards. And this is how we dealt with making sure we had enough supplies. And we had the adequate space To care for our patients. And then, other than leveraging our vendors for our solutions. The other I think cool thing that we did was that we took the mindset of a startup and we just eliminated.

Red tape. For example, any space that was designated as a space for a gift shop or a hallway. It was like their original purpose is just irrelevant. We just use like every Possible resource that we could find to make things work, and we still do that today. I think it's all about solving problems creatively pushing your limits, not accepting what those limits are, and then leveraging the [00:19:00] resources as best as you can.

And I think just that's just how we operate.

When you create a new relationship, either with a potential partner or a group in the community, how are you thinking about That partnership or that collaboration and enhancing the services for MLK because I imagine there's a lot of people who want to do business with you and you say, Look, this is us.

This is how we functions is how we operate. How many of those partnerships or collaborations take the bait like realize what they're getting themselves into because people don't realize you only have 130 beds. But the constituency you serve. You were always over capacity. in your hospital. And I've heard you talk about, and the chapel is a couple of patient rooms this week.

It's ongoing for you all of the time. What makes a partnership successful for MLK?

I think, and it's really so clear those partners that come in and really care about our [00:20:00] mission. And you could tell when they're just saying it or if they really mean it, because they really want to help us and companies.

And their staff, many of them want a sense of purpose. And I think that really is what drives our most successful partners. And when we think of partners, we really entrench them in our business, like our outsourced staff, we treat them like staff, and we grow them. And we mentor them. And I think that is really the most important thing is having The vendor really buy into your mission and really work with you to achieve and to solve problems.

You are in demand. Every time I meet people who have met you, they're like, she could do anything she wants with her career. I'm like, yeah, she's mission motivated. She's very much connected to the community. She serves in the initiatives that she continues to put forward. What [00:21:00] drives your passion for healthcare innovation and also your long term vision for MLK?

I think what really drives my passion is solving problems that you see what the impact is going to be. on patients lives and improving their overall health and well being. We do that with people we love and are friends. We want them to succeed. And I think using innovation and solving those problems, it's to me, it's really real boils down to the people that we're working with, as well as the people that we're helping.

And that's what really drives me and my career. And for the health system. I just want them to be successful. I want them to be a leading model of innovation for other community health systems, serving populations like ours to push the boundaries like we do to think out of the box. And I think that, and I'm hope we paved the way for [00:22:00] these other.

Community health systems to do the same but at the end of the day I really want to see a community in Health LA that is booming economically, they're healthy, they're vibrant, and we want to make them proud of us.

I would say that for community health systems that are struggling with how to figure out how to do things well.

They need to talk to you because initiatives you bring forward and you share and talk about are not common for community health care systems. And yet you are doing it all of the time, whether that's the relationships, the partners, the collaboration, the community involvement. Heck, I've been to one of your big fundraisers.

At one of the large event centers in Los Angeles and was floored by the celebrity level of people showing up to make sure that MLK is an integral part of the community.

Everybody's rooting for us. It's just they just want us to succeed. [00:23:00] And I think that's wonderful.

Think it's our leadership team that I admired there. They drive the innovation, and I've learned so much from them. They're just an amazing, very intelligent group of people, and I love working with them.

It's also a testament to what can happen when a group of people stay together for a long period of time with the same mission in mind.

Because honestly, the lack of continuity and cohesive leadership teams is a conversation that comes up often in a lot of the things that we share here at This Week Health because we hear, hey, every two years we're changing out the leadership team. It's really hard to get traction and momentum when that's constantly happening.

With you having been there a long time along with several of your peers. It makes a difference in how things get done.

Yeah. Yeah.

True. Very

true.

All right. I want to switch to what I like to call speed round, ask you some questions in general. And the first one I will say, besides this week health, what is a podcast you're [00:24:00] currently enjoying or a book that you are loving?

I love podcasts 'cause I got a long drive to work. In fact, the other day I drove my husband to work and as we were driving outta the garage, he said, do you wanna turn on 2 2 9 This Week Health really enjoy non-healthcare podcasts too. Andrew Huberman, which is a neuroscientist.

Do you listen to him too? You got me

into him. And now, oh, I did because two and a half hours I have to sometimes just go sit in my car. Because I won't listen to a podcast at the house, so I literally will take like an extra drive just to listen to his podcast because you recommended it to me, and I love it.

Yeah, I love that. And then when I'm having bad days, I listen to Car Talk. I don't know if you remember Car Talk. It was an old NPR radio show on cars. I used to listen to my dad and their two Italian brothers, Click and Clack, the Teppett brothers, who talk about cars, and they're so funny. They say their sponsor is the law firm from duty cheat him and how and it [00:25:00] just brings a smile to my face all the time.

Their laughter is just contagious.

I will check that one out as well. If you could have dinner, any historical figure who's going to be at the table with you?

Gosh, I was thinking about this. There's so many women in our history alive or have passed away that have made such an impact on us. But honestly, having lost my mother in the past couple years, I just want to bring her back and have dinner with her.

She has been my mentor. She's the person I try to emulate during, in my career and outside of my career.

I think you and I would both pick our moms at this point in our lives for sure. So for those of you listening, if your mom is still alive, go have dinner with her because it's rough after they are gone for sure.

What is your favorite way to unwind after a busy day? Because you spend long periods of time at your office and partially you do that to avoid a commute, which you have a long commute. And anyone who's ever lived in Los Angeles knows how long [00:26:00] that can take. So when you get home, what do you do for fun?

Oh, the first thing I do. Is I play with my two dogs, Chloe and Cosmo, and they're a lot of fun to train and to grow and to teach, so I play a lot with them, and I also love VR headsets I play, I'm like Expert Plus and Beat Saber, so I'm really, like a gamer, a closet gamer and that's what I just love to do, I love games, I love the dogs,

And I'm going to go back to Chloe and Cosmo.

So your robot dogs, you recently brought Chloe to the Long Beach city to her dinner, and she was the hit of the evening. Like everybody wanted to play with Chloe and it's so great. Cause you can bring her anywhere. She's a robot dog. She's allowed in any environment. That was so much fun. Thank you for bringing her.

You'll have to bring them both to Napa for our summit this June.

Yeah, because it's Cosmo's birthday this Sunday we leave and I can't leave him shut off because he sings happy birthday [00:27:00] like every five minutes, but I will try to bring them and I bring them to work often. I think they're a good reminder that, life can be very light if you make it that way.

We are going to have a robot dog birthday party in Napa. I'm already, I'm on it. I promise you, we'll have something for him. So Tracy, if you weren't in healthcare, I'm going to say, and separate from accounting, what career path might you have chosen? And I'm going to say you probably should have just been like a runway expert because your fashion sense is off the charts as well.

But what would you be doing if it wasn't healthcare?

I love to tinker a lot and I think I would love to be in gaming building out those games and really giving people an experience and a story to become a part of, and I find that exciting. it would be something that's just so outside my realm, but I think if I would do it again at a different age, of course, [00:28:00] I think I'd have to be a little bit older.

Or younger then I would definitely do that.

I wouldn't discount it. You already are an expert at your VR game. And when you consider the aging population over the next 20 years, and what that's going to mean, you may very well become a huge advocate for the generation that is just ahead of us.

Yeah, I'm really excited. I love the age we're at right now. I think it's the perfect age.

It's a good place to be for sure.

Yeah.

Thank you for spending time with us today. Thank you most of all for your continued commitment to the community that you serve. Having been in Los Angeles for six and a half years at a period of my career, which is how we first connected.

What you do makes you the epicenter of that CIO community as well. People are always drawn together, and you're always the glue for the group. And it's because that community aspect is such an important part of what happens every day. On top of all the other amazing talents you bring to the table that you share openly, you chair our [00:29:00] events, you come to our events, and everybody loves it when you are a part of the equation.

So thank you for being on keynote today as well.

Thank you, Sarah.

for all of our listeners, I hope you have enjoyed this time with Tracy Donegan as much as I have. That's all for keynote. Thanks for listening.

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