On this episode of The Vurge, get to know Divurgent's EVP of Delivery, Joe Grinstead. Joe's vast experience and expertise bring insight to the interplay between the business side of healthcare and the IT industry. He shares his career journey, spotlighting the evolution of the CIO role and the impact of technology in bridging the gaps between infrastructure and end-users. Joe also unpacks the value of managed services offerings, elucidating the strategic benefits of vendor partnerships in handling predictable, high-volume work.
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On this episode of The Vurge, get to know Divurgent's EVP of Delivery, Joe Grinstead. Joe's vast experience and expertise bring insight to the interplay between the business side of healthcare and the IT industry. He shares his career journey, spotlighting the evolution of the CIO role and the impact of technology in bridging the gaps between infrastructure and end-users. Joe also unpacks the value of managed services offerings, elucidating the strategic benefits of vendor partnerships in handling predictable, high-volume work.
Thanks for listening! Like what you hear? Follow us on LinkedIn, Twitter, Instagram, Facebook and be sure to subscribe to The Vurge for the latest episodes and more!
Interested in being a guest on the show? Click here to learn more.
Hi everyone and welcome to another episode of the Verge. Today we have Mr Joe Grinstead here. He is the Executive Vice President of Client Services at Divergent. Welcome, joe.
Speaker 2:Hey, rebecca, thanks for having me. I'm excited to have a conversation today. Yeah, as you said, I have responsibility for the delivery portion of our client services here at Divergent. I've been with Divergent about a year and a half but I've known the firm for gosh probably seven or eight years. We've done a lot of work at mutual clients at different times in my past and was really excited when I got the opportunity to come join the firm and we've been really having a good time working with all the great people here and doing the really fun and innovative work that Divergent is known for.
Speaker 2:My background is my entire career has been in healthcare IT. I often tell people I started off in the basement of a hospital out in California as a computer operator mounting reel-to-reel tapes and loading green bar paper and claims forms and all that sort of stuff. I didn't quite know it would be my career at that time but I managed to make it a career which has been a lot of fun and very fulfilling. I've probably done just about every job that there is in a healthcare IT department. I've done work in application side, then work in technology side, racked and stacked equipment in data centers and deployed PCs and printers. Ultimately, my final role when I was working for healthcare providers was as the regional CIO for Christus Health in San Antonio. I decided in 2003 to jump over and do the professional services side and got to work with some great organizations there. Places like Perot Systems and Dell Services spent some time at Cornerstone Advisors, which became healthcare triangle and then came to Divergent. Really excited to be here and look forward to our conversation today.
Speaker 1:I'm super excited to be working with you. For those of you that don't know, joe was actually my couple people in between. We were at a boss when we worked at Dell together and it goes without saying don't burn a bridge in healthcare IT because the world is so small. And here I am, years later, working alongside of you again. It's awesome to be back together working with you.
Speaker 2:Same for me, absolutely. I was excited when we met and I realized we made the connection and I was like this is awesome, I can't wait.
Speaker 1:Yeah. So you mentioned something in your intro I'd love to start with over the course of your years and how you have transitioned roles. You come from a very infrastructure background. How have you seen the CIO role change? How have you kind of changed as well in your career and in your thinking and developing, as EHRs have evolved and CIOs are kind of taking on more of a COO hat and bridging that gap between infrastructure and technology?
Speaker 2:Yeah, it's an interesting question. You're absolutely right. The role of the CIO has changed. Used to be we'd pick our CIO, and that's sort of how I ended up in IT leadership roles by promoting a strong technical person. Many, many CIOs today still came from that background, but the successful ones have definitely had to go through an evolution, as did I, of understanding that.
Speaker 2:What I always like to say is that it's IT for the sake of healthcare. So whatever we're doing from a technology perspective, we have to be able to draw a line to the caregivers and ultimately to the patients out there. And more and more, if we're deploying digital strategies and digital front doors and things, the patient is more and more the consumer of the IT services. So we've got to understand the business better and that was one of the things I was really fortunate with one of my first IT leadership roles.
Speaker 2:I worked in an organization where I got to sit on the administrative team and actually at various points ran some operational departments on an interim basis, so really got to know the business really well, and I think that's probably one of the biggest things that a successful CIO has to do is you can be the geek in the room and who understands the bits, the bytes and the technology. But you got to understand the business and you got to understand the challenges. You got to understand the drivers and be ready to move for the business where they need you to go to help them be successful. So there is a lot of good analogy between CIO and COO because really what I've spent a lot of my career doing is out in operational areas understanding the business, understanding the challenges and helping to figure out how technology can improve or enable so that they can get to the business of what is ultimately for help here taking care of patients.
Speaker 1:Yeah, yeah, absolutely. I find frequently I'm bridging that gap between the infrastructure side and the end user and even more now the patient, and I always try to say that you put it in context that your mom can understand, so that everybody is at the same playing field. Do you want to speak about maybe some of the work that you're doing at Divergent and talk about some of the managed service offerings that we provide and what those sort of offerings look like at what different level? Right, there's various options there. Go ahead.
Speaker 2:Sure, I'll dive into our managed services, because it is an area that I think has some real interest in the market right now. You know managed services. When you contract with a managed service and do it successfully, first and foremost you've got to partner. You know you need to find a vendor that you can partner with, because it's got to be a two-way street. But really what your goals are is you're trying to take that commodity, work, those things that are predictable, repeatable, ideally high volume, and packaging it up for someone else to really be able to take care of that for you. Do it based on some service level agreements, so that you understand, not only are they going to take care of this for me, but they're going to take care of it in this way and the results are going to have this, these characteristics. The simplest one to talk about is a service desk, which we you know we're privileged to work with several customers on providing service desk services out there. The SLAs for the service desk are things like how quickly do we answer the phone or respond to an email, or respond to a ticket that's put in via a portal or something? How many times do we resolve the issue before we are done talking to that end user. So we used to be called first call resolution and we've evolved to calling it first contact resolution, because help desk today are more of a multi-channel experience where you have stuff coming in through chat, through portals, through emails and things like that. But how many times does that managed services provider bring that issue to a successful resolution and not require additional engagement by your level two and three folks in your organization? You know we're, we are hearing from a lot of clients that there's some real interest in that and there's a couple of things you get by looking at a managed service One. You do get cost savings and I know there's some skepticism out there about that. But here's what I can tell you If I take a look at a service desk, if you're a healthcare system trying to provide service desk services, if you've deployed in the HR, you need some sort of a 24 by 7 service desk. If you're going, I guarantee you most health systems, I guarantee you almost every health system, is going to find that their after hours, evenings, weekends, things like that their volumes are fairly low. But those calls are equally important as the calls that come in during the day. The challenge is how do you staff for that after hours and weekends, you know? Are you going to pay somebody whether it's on fall or somebody to be sitting in a call center to take the call or whatever, knowing that the vast majority of the time they're not going to be occupied by taking calls? Or could I give it to a managed services provider who provides the same service to multiple healthcare systems so that they can have that same person or persons, depending on volumes, more occupied all the time because they're covering for multiple entities at the same time? There's a cost savings there and we can prove out the numbers to show that.
Speaker 2:Another thing you get out of managed services is you reduce your distraction as a healthcare IT leader to not agreeing about. Oh, bonnie and Sam called in sick today for the help desk. What am I going to do to cover that? You know I've been in cases where I ran that and I've been in cases where I literally went to the help desk, put on a headset and took calls, and I'm not unhappy about that. I actually love to take help desk calls. I think they're a great opportunity to turn people's impressions of IT around, but that's not the best use of my time as a senior IT leader, I'm supposed to be focused on what's next for the organization I'm supposed to be focused on. Hey, we're under pressure to reduce costs over here. How can technology help us Not taking help desk calls? That's not me practicing at the top of my license.
Speaker 2:When you engage a managed services provider to do that work for you, they're handling all of that overhead for you.
Speaker 2:They're making sure the staff is there and, by the way, because they've got scale, it's easier for them to make sure the staff is there.
Speaker 2:It's easier for them to find coverage.
Speaker 2:The other thing you find when you engage a managed services provider is that many times they enable you to improve your capability in that space because they're bringing best practices.
Speaker 2:They're bringing tools that you may not have access to or not been able to implement, or you don't have the skill set in house for you know so, for example, one of the things we're working on with our managed service desk is beginning to deploy a conversational chatbot on the front end of it, so that instead of having a human being answer the call, we'll have a conversational chatbot answer, and we're seeing data out there that 30, 40% of those calls can be resolved by that chatbot.
Speaker 2:Well, I don't need to charge the customer as much for that call if I can get an automated chatbot to do it. And, by the way, as long as we're making sure the customer is still getting the outcome that they're looking for a quality of service, speed of service and that sort of stuff it absolutely makes sense. Well, it's hard for many health care systems to. They just don't have the bandwidth or the expertise to start digging into chatbots. But you know, we, as Divergent, we're spending some time on it because we do this for multiple health systems and we do this at scale.
Speaker 1:Yeah, we can become the experts while they're focused on their digital front door and other innovative things that are going to help the organization right.
Speaker 2:Absolutely. Yeah, I mean, it's all of it again, right, as I said, it's about practicing at the top of your license, which is a clinical term, but it applies here as well. I want to make sure everybody's doing the most high level and complicated work that they can do and we can force the other working in another direction so that we can make the best use of that expert in your organization. And that's usually one of the biggest areas of expertise is just that organizational knowledge that your team has. That can move the ball forward.
Speaker 2:One of the things we're also working with some clients on is things like Large upgrades to the EHR. So we've got a couple of clients who are a couple of versions behind and want to, you know, leap frog forward. Well, that's a lot of work, we all know that, but they're struggling because they're Experts. Their analysts, their level two and three analysts are also bogged down in day-to-day maintenance of the system break, fix and that sort of stuff. So, again, applying the top of license analogy to that, we're working with them to bring our resources to bear to deal with that Next level after the help desk, so that their experts can focus on Project-based work and more complex stuff like those upgrades right, right, right right.
Speaker 1:I find it interesting as the managed service has evolved right where. You know, years ago, when I was newer in my career, a lot of stuff was, you know, at a off-site location and and potentially with another Bender, and then everybody kind of pulled it back in and, you know, had the help desk and everything, and then COVID came along and blew that all up again and Now you have it really hard to find workforce. Really. You know people want to work remote. It's hard to find people that know about the particular EHR that that people have and they want to work from there. You know, mobile RV, while they tour the country, but have that full-time job right, and how Interesting it is that this is, you know, turning back around and we're able to provide those services to our clients.
Speaker 2:Absolutely. I continue to say that I think we're seeing a resurgence of managed services and sourcing, of Selective sourcing. I would say we're not seeing as much wholehearted Outsourcing of everything. That's not what we're seeing. As much in the market we're seeing very selective sourcing of things that are again commodities, and If you look at other industries, they know how to do this very well.
Speaker 2:Yeah, I was in the airport with my wife a few months ago and we were checking bags and stuff and I we got to talking and I said you know, you understand that, you know these baggages Really are airline employees. They source that out to a third-party company because it's a commodity activity. So somebody else worries about making sure that you know enough people show up at the right gate at the right time to do all Of this stuff. There's other industries have been doing this for a long, long time. Healthcare has been a little bit behind, but I think that's also because healthcare tends to be careful, which is a good thing. Yeah, but we do need to look outward and look for those opportunities to find out ways to, because you said it yourself, it's it's the cost pressure, it's the hard to find talent.
Speaker 1:We got to optimize the talent we have and and sometimes that means we give the the commodity work to someone else so I also think some of the cost efficiencies that you can find in in managed services is you have an inner city where cost of living is so high. You can find that cost savings with people that are remote living in locations that are, you know, not as high like a New York City or California, and Do you agree with that?
Speaker 2:Absolutely. And you know, while a lot of healthcare organizations during the pandemic evolved, they're thinking about hiring and got more willing to hire multiple geographies, there's still a lot of health systems out there that are only willing to hire, or local, so to speak. Sometimes that's a cultural thing, sometimes that's a HR doesn't want to deal with multiple state payroll situations and that sort of stuff. But you're absolutely right, we can arbitrage cost and, by the way, that doesn't mean we're off-shoring work. You know divergent doesn't do off-shore we we do everything in the US, but we can Source resources in lower cost of living areas to provide services into the higher cost of living areas. So we can definitely find some cost arbitrage there.
Speaker 1:Yeah, yeah. So why don't we move over to project management as a service and offering that divergent has as well, and how we can help.
Speaker 2:Yeah, that's a, that's a new one that we're rolling out right now. It's really. I think it's really exciting. I'm gonna say something and you know I make it some feedback. I'm at Greenstead Joe on Twitter. If you want to send me some some hate tweets or something, I'm okay.
Speaker 2:Healthcare in general while there are pockets of excellence, healthcare in general is not good at portfolio and project management when compared to other industries, and what I mean by that is we're not really good at things like resource management. So I don't see I owe. I've got a staff of X and Most days you know, I always say I've been to a lot of healthcare IT departments. I've never seen anybody sitting around looking for work Everybody's. Usually it seems like they're fully utilized, but a lot of healthcare organizations don't understand what fully utilized means and and they can't break it down to understand that this group my, my network team, for example is fully utilized. But what are they fully utilized on? Is it because that's just what it takes to run the stuff day to day? Is that just what it takes to do all the projects that are getting thrown at them? And, by the way, how do I Prioritize and manage the influx of projects based on that resource pool.
Speaker 2:Now the goal of the CIO, I think, has to be not to say no, which you know some of them are out there going. I have to say no, I just don't have enough resources. But you can modify the answer and with good portfolio and project management and resource management capabilities, you can not say no, but you can say not now, but it looks like I have capacity in three months. Or you can say Not with my resources, but we can bring in some outside resources and increase our capacity to get this done. A lot of healthcare CIOs aren't equipped to have that conversation and you know I've been there and I know others who've been there in the executive meetings where your peer executives are putting pressure on you to say, hey, we spend a good $1 trillion it always feels like a good $1 trillion on IT. How can we not have enough resources to implement this new solution that's so important to me as the chief nursing officer or something, and many times the CIOs just find themselves back on their heels.
Speaker 2:So what we've put together is a suite of services that range from a fully outsourced project and portfolio management service, if that's what you want as an organization, all the way down to just being able to access very senior, very healthcare and, in many cases, very EHR experienced project managers, sometimes on a fractional basis, because one of the other challenges is more and more we see the project portfolios increasing in the number of projects, but the average size of the project is smaller and many times we don't need a full project manager. We need someone who can do 20 hours a week to update the plan, update the issues list, run the status calls and do all of that sort of stuff. So we provide to our customers the ability to engage fractional project managers and project management resources. So if you just need that 20%, 30%, 50% project manager, we're going to give you that heavily experienced project manager, which is often hard to find on a part time basis because those resources want to be fully engaged. Well, we'll give that to you because we'll keep them fully engaged on multiple projects for you or other clients. So we're really excited about that and we really hope it's an opportunity to move the ball forward in terms of portfolio and project management discipline in our industry.
Speaker 2:The. We also are using some outside standards to help organizations measure their portfolio and project management maturity. So much, like you see with HIMS, with things like MRAAM and the DHI and things. We're using these outside measures to really help an organization understand their current state and also understand where they'd like to be in terms of their maturity. Not every organization needs to have a fully functioning, highly mature PMO. It depends on the complexity of your organization, the size of your organization and your project volume. You know, if you're very much in a studied state mode and maybe for financial reasons or other reasons you're not doing a lot, it's not as important to you to have a fully robust portfolio and project management. But if you've got a lot going on, if you've got a lot of incoming in terms of project requests and things like that, you really need a good structure to manage and govern that process. And that's what we believe our PPM as a service is going to offer.
Speaker 1:Yeah, and I'll challenge you a little bit. I think even the smaller organizations that are small and mighty still need somewhat of a service to be able to put all those projects and roadmap them and put the data and numbers and hours it might take together to then be able to present it to the executive team and tell them why their project, that they think should be at the top of the list, is not, and then adjust as necessary right.
Speaker 2:And I would tend to agree with you. But part of the reason I said what I said is that it's sort of acknowledging that perception is reality sometimes and that there are people out there who perceive they may not need that level. What we love the opportunity to do is talk more about it and write something for them so that they do see the value we can show. The industry has direct correlation statistics between organizations and projects that use robust methodologies and the success of the projects in terms of on time and on budget. It consistently is improved when you use these sorts of methodologies and approaches.
Speaker 1:Yeah, let's pivot over to some of the automation work that we're doing here at Divergent to stay innovative and help our clients. I know you're on various projects. Do you want to talk about one or two that might be interesting to folks out there?
Speaker 2:Yeah, absolutely so. We've done some really interesting automation work with clients and internally, by the way. So we use internally what we work with our clients for to look at those processes where we can apply capabilities such as robotic process automation and the robotic process automation that's now being powered by a lot of artificial intelligence capability to automate those processes. That again are those commodity, predictable processes that will free up human resources. That's always one of the goals and I'm always careful there to say I want to free up human resources to work on more important stuff. Again, I keep coming back to that. It's about practicing at the top of your license. I want people doing that which only human beings can do, and then I want the robotic process automation to do the stuff that the automation can do.
Speaker 2:So we've worked a lot with customers and internally on things like onboarding and offboarding of IT users. That's a high volume, important process. The onboarding process is part of how a new person coming into your organization perceives the organization as they come in. So it's about employee satisfaction or contractor satisfaction or whatever the relationship is. We know it's important that they have a great onboarding experience in general, rpa can help us make the technical part of that much better.
Speaker 2:It also shrinks the time to process, which is another frustration that often happens with onboarding, where resources show up that are ready to work but their IT stuff isn't all provisioned yet, so automation takes care of that. So as soon as HR marks a resource at a certain stage, automation starts provisioning all of that, whether it's their Active Directory accounts, their EHR accounts or whatever. We also see better quality there, which is incredibly important. When you think about the security factor of user setup, you know humans, humans are humans and perfection was not in the recipe. So we all understand that we have to engineer and manage around the imperfection of humans and we do it every day and things like the timeouts that we do in an OR fleet to make sure everybody's there for the right procedure for the right patient, and all that sort of stuff.
Speaker 1:Right circle the right leg. Yeah, yeah, definitely put a big highlight on that.
Speaker 2:I haven't had anything but I always thought of like a big fluorescent sticker or something you know cut here we can take and improve the accuracy of it so that we make sure that folks are getting provision, the right access, understanding that in our world the right access more and more is becoming the least amount of access that they need, or the minimum access they need. We often see in the human factor is things get over provisioned so people end up with access to things that perhaps they shouldn't. And you know that can be a problem if the human being misbehaves. But it's a bigger problem if that human beings account becomes compromised. And that's really why we go for minimum access. Because if somebody does what human beings do and they click on that link in that email that looks like they're going to get a thousand dollar crossbow gift card or something and their account becomes compromised, we want to limit the attack surface for that account. So automation again helps us make sure that stuff is correct and we can use the automation to apply hard and fast rules.
Speaker 1:there there's nobody to negotiate with.
Speaker 2:There's no calling to help us and saying, hey, could you also give me access to all of that patient information over there? I'm sorry, we don't provision that access. It's provisioned to you based on automation. That's just what it is and you know here's the process to get it if you need it differently or something. So we're seeing a lot of great data on automation and onboarding and offboarding.
Speaker 2:The next place we're really starting to talk to a lot of clients about is places like the revenue cycle, so things like claims denial, adjudication and auto responses. When you're getting back those claims denials for certain reasons, where what it really means is somebody needs to trigger a send of medical records to the payer, well, we can automate that process so that a human being doesn't have to sit there and spend their whole day keying in medical record requests to send to a payer or something like that. So those are some of the other places we're looking. We anticipate getting into patient care, but that's a place I think we all feel like we want to mature a little more, just as an industry, before we get too close to that.
Speaker 2:The other place where we're seeing some automation is with patients, so helping patients do things like schedule and reschedule appointments without having to have a human being working with them, those sorts of things. I will tell you I choose my providers based on the ones that I can access and schedule my appointments online. I don't like having to call in and go back and forth with somebody on what days are available. I'd rather have just log on to the portal and be able to say, hey, I need to do my annual physical, I'd like to do it sometime in these three days, and it says, hey, okay, here's some spots the way I go. That's all automation at work. So we can really help. I think patient experience there and again take human beings out of doing that commodity wrote work that really could be done by that automation.
Speaker 1:Yeah, same with the reminder calls and the reminder text messages, and I too pick my doctor based on their technology and what they're using and that I have the least amount of forms when I walk into the office. Let me just fill them all out at home electronically, because if I have to fill it out in the office and write with a pen, you're not going to be able to read it anyway, so you might as well let me type it and send it in on my own time.
Speaker 2:Absolutely, and trust me the employees that are having to deal with all that. They appreciate that too. It makes their lives easier and it lets them focus on the more interesting and meaningful work.
Speaker 1:Right, and the patients that are coming in there standing in front of them, that have real questions. Let's them focus on them. Yeah, joe, this is.
Speaker 2:Just to play on that a little bit there. That's a really good point because I think about my grandmother. My grandmother got lover. She was never probably going to log on to a patient portal and make appointments and do all that stuff. She wanted to call and talk to somebody. She wanted to interact with the human beings Great, and I'm not going to be free at human beings to interact with her because that's what's meaningful to her. But we know that there's generations coming up where we're all the ones who picked the self-checkout lanes in the grocery store now because we just want to get through on our terms, at our pace and deal with as few humans as possible.
Speaker 1:Yes, it's so funny. So when we go to the grocery store, sometimes I'm I don't know, maybe too lazy and we go and I just want them to check out and then bag it. I don't want to have to think about it. I'm going to hit my girls in tow. They want we want a self-checkout. And they choose and one of them's scanning and one of them's bagging, and then one of them's grabbing my credit card, like it's, like it doesn't matter what lane I go through, like they love the self-checkout. They don't even see the other lanes.
Speaker 1:It's interesting what the generations are doing.
Speaker 2:And maybe that's some sort of vocational training, you know, just in case they have a fallback with working in a grocery store, if they can.
Speaker 1:Yeah, yeah. They just don't even see those other lanes. It's the same as them using the technology and picking up my phone or whatever. It's the same. I sit here with screens at my desk and they're like mommy, why do these big screens not touch screen and why can't I touch it and drag it? You know they want all of this or craving it. It's awesome to watch.
Speaker 2:Absolutely.
Speaker 1:Yeah, joe, it's been so fun chatting with you and so awesome to be working alongside of you again. I have one question that I ask all of my contestants in the hot seat I want to know what is your superpower?
Speaker 2:Oh golly. I often think my superpower is something you mentioned earlier, which is translating between operational folks and technology. I've really found that I think I'm pretty good at being able to sit down with an operational person, understand what their challenges are, what they do, and look for and find ways to apply technology in a meaningful way. So I think I'm a translator. That's my superpower.
Speaker 1:I would agree with you. I think that's a good choice. Yeah, and you have a way of explaining it kindly to whatever, whoever you might be talking to, and explaining it a couple of different ways and not getting frustrated. So it's nice to watch, you explain everything.
Speaker 2:We're all in this together. Our goal is to make sure patients are getting taken care of. If we're not in here for that goal, we may want to reevaluate the industry we're working in.
Speaker 1:Absolutely, Joe. Thank you so much for your time.
Speaker 2:My pleasure, Rebecca. Thank you.
Speaker 3:Thanks for tuning in to the Verge podcast brought to you by Divergent, a leading healthcare IT consulting firm. We hope you enjoyed this episode. Be sure to hit the follow button to stay up to date with the latest IT developments and the exciting ways tech is transforming healthcare today.