Why Health Systems Won't Buy Your AI

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0:00 So health systems aren't buying AI. They're buying better outcomes. And the vendor partners have to be able To explain the operational path between Their technology and that outcome. We were with the health system last Week that said they have 1,400 Applications in their health system. 1,400. They want to reduce it by 25% Over the next three years. And we're also finding is if you're A partner trying to get in the door, If you're a vendor, the CIOs talk To each other. they're not going to Respond to the email, they're not Going to respond to the cold call, I would say build the relationships You need before you need them, Before a moment of crisis or opportunity Arrives and really get close to The people that you serve in your Organizations and your communities, And listen thoughtfully so that you can Be a resource they can count on when They need you the most. Revenue doesn't Stall because your team stopped trying.

It stalls because of friction. I sit down with other commercial leaders Who find that friction and fix it. I'm Terry Coutsolioutsos. Let's get into it. Welcome to the Zero Friction Podcast. This is Terry Coutsolioutsos, And I've got a unique guest With us today, Sarah Richardson. She's a principal at The 229 Project. She's a former CIO that has Touched many different large Healthcare systems across America. And she really arrives on the Zero Friction premise, and she's a leader That is removing friction from the Process and the people that they serve.

She now helps run a highly curated Community that brings together healthcare IT professionals along with vetted Partners in a small invite only program That helps take friction out of the system And move healthcare forward. Sarah, Great to have you on the program today. Looking forward to our discussion. Give us a little background on You and professionally, and then What you're doing today from a 229 Project perspective. Sure, Terry. Thank you for having me today. I've spent probably the majority Of my career at the intersection of Technology operations and leadership.

What I've learned over that time is That transformation rarely fails Because people lack great ideas. It fails because the right people aren't Necessarily aligned around the work. And after a decade at HCA, Which I absolutely loved, and then Running operations and organizations To connect leaders across the industry. All of that led me via Optum and DaVita Medical Group and others to the 229 Project, where we have the ability To really foster the environment To transform healthcare together. I also spend time coaching executives. I serve on boards. I moderate industry Conversations pretty regularly.

2:56 And recently did an AI strategy Certification through MIT. I love to help leaders make better Decisions by connecting them, Having the candor that makes real Conversations possible, and then being Pragmatic about the execution that it Takes to make great things happen inside Of our organizations. That's great. And I know you've described your Work as kind of being like you're The human connector in the loop. And so tell me about like in today's World, where technology is really Coming at us in multiple directions From automation, from data to AI.

How does the human connection sit in The center of all that and how do we as Transformation leaders sort of help The rest of the organization get there? I like the question because one of the Things that we do so well at the 229 Project is we bring large groups and small Groups, but together for conversations That allow people to understand how Are they solving similar problems. And we do this both regionally, But also across the US, but in the last Week and a half, we've done what we call Regional staff roundtables, bringing 70 Plus healthcare leaders together from 10 Different organizations at a time, Along with 10 different partners, And it gives people a sense that Here's what is working next door to you, Or here's what's working in a region That you may not have been aware of.

And when it comes to you specifically, And the topics we've focused on, Terry, have been AI and resilience. We're doing that because those are the Things that are happening to them the Most right now. And it's really about, And you've heard this through the AI Parameters of take shape and make it. It's like, what work can AI remove? What work can it improve or redesign? And what are some of the new capabilities That become possible through that. And the technology might be ready Before the organization is. I often tell People that technology is the easy part, But what happens if nobody decides who Owns a workflow, what work might go away, Where the exceptions might land, And how reclaimed capacity can be used, Then AI specifically is becoming Another layer of coordination Rather than a reduction in friction In people's lives today. So you're Seeing ambient clinical documentation, Which is one of the biggest wins.

5:34 But then you've got the governance Between IT, clinical, rev cycle, And operations. You've got the need To measure ROI beyond the adoption. And then a platform consolidation Versus some of the vendor optionality. And lastly, I would throw in really that Importance of learning across deployments Because so many of them are treated As individual per-deployment events. And there's really this whole ecosystem Of connectivity that's required for These things to be successful as well. So those are a lot of the things That we're seeing and hearing Specifically in that space.

It also changes the dynamic for how a Vendor needs to engage thoughtfully With the health system as well. The one thing I think about as well is How does AI, especially in a healthcare Environment, it's a new security risk. And that's another element that you hear a Lot about where wonderful transformation, And wonderful operational efficiencies, And especially with that ambient Technology about being able to sort of Take all that healthcare information In very easily, which I'm sure causes Other problems when it comes to the Data governance side of those things, But how does AI and security And breach and all that sort of Play a role today in healthcare?

One of the key things is why we spend The afternoon talking about resilience Is that any solution has to start with The health system's operating problem, Not the product, we work with our Partners and we say, what is the Problem that you solve in healthcare? When you understand who owns the problem, What the problem is to be solved, Who experiences and what has to Be changed from a really behavior Perspective, then you can start Tying in this evidence to outcomes, Workload, cost, security, risk, The patient and clinician experience.

What's so fascinating is that You can't confuse, I think, Access to an executive with their Organizational readiness to buy something. And you have to stay involved through The implementation and stabilization. So health systems aren't buying AI, They're buying better outcomes. And the vendor partners have to be able To explain the operational path between Their technology and that outcome. A lot of that also rests on the Ability for the resilience of The organization to understand Where does the human loop remain? How do you understand how decisions Are being made? Because when you Think about true business continuity, Disaster recovery, and planning, Did you plan for an agent swarm, Like non-human employees being a part Of that, and you're seeing it pop Up in some of these conversations.

8:09 Also the ability to realize that the More that we rely on the automation Of certain systems, the more somebody Starts to understand how it works, How it was built, how to contain It appropriately, and how to audit And measure some of those outcomes. And then also understanding what is The true value that it is bringing, And because if you don't identify Those things upfront, inclusive of the Security and risk protocols, then it Ends up being just one more quagmire of Things to fix inside of an organization.

And so upfront, truly understanding What the implications are going to be. Even in, we were just in New Orleans about A week and a half ago, and we're like, If we're so good at desktop planning And we're so good at these exercises From a tabletop perspective in Terms of like a security outage, Then what do we keep missing? Like what is happening here? And it tends to be the interface That was attached to a third party That we didn't know how to shut Down to a server under Bob's desk, Which is still a thing to this day.

And more importantly, the ability To really understand I now have Non-human agents working on behalf Of my organization or my product set. And do I know what they're doing? Do they have their own identities? Am I managing them like they are a Separate employee, or is it five agents Attached to Terry's profile? Those things Are all as huge considerations when you Think about the security, the data, And even just the enterprise architecture, They need to go into a lot of these Decisions that are being made today.

And especially when you start bolting On all these new technologies, Many times things aren't being Torn down to build back up again. You're kind of building a Frankenstein, Right? where you're bolting things on, And that obviously has a lot of Challenges. It might seem like that's An easier short-term solution, But then when things break and you've Got to fix things and then you've Got to tear them all back down again, It can be really challenging. I would think that also when you bring New technology in and have aligned goals, It's really important for that vendor Providing the solution and the provider, The healthcare provider, to be aligned on Outcomes, to be aligned on transformation, Engagement, to be aligned on who's Going to serve and do what so that Alignment actually works cohesively as One plan versus a vendor just kind of Coming into an already moving system Inside of healthcare because again, That's a business that's already running.

10:43 You can't just close it down and stop it. Like you have to continue running. So how does that work? We're hearing From a lot of healthcare leaders now and We do something called a signal index. Before we have a big event, we query The attendees to talk about what's Happening, things that they're facing, Things that they're thinking about. And then we produce that feedback To anyone who's in our community That registers for our information. And we do that. We don't anonymize the Information. We don't sell the data, But we keep pulling in these different Perspectives. We really get a Signal on things that are happening.

We are hearing more and more that The enthusiasm for things like AI is Truly shifting towards ROI governance And what is leaving the workflow. So you've got this three-dimensional Aspect of some of the resilience Components. You've got human, Operational, technological, but they Want practical peer intelligence Versus a narrative from the vendor. And understanding that the workforce Capacity and change fatigue are as Important as some of the technical Capabilities that they're being asked To produce. So organizations are Asking how they can scale what works, How they stop pilots that don't work, And then really understanding that That expertise is everywhere, But how do you bring it together in A cohesive way that people feel like They're going for the same outcomes?

Too often, again, you've got individual Groups that are thinking about How they can solve for one thing, But that collective strategy about What it looks like six months from now, Because Terry, let's be honest, You can't really set a strategy more Than about six months out at a time With how fast the technology is moving. And yet healthcare has never been known For expediency and adopting the newer Technologies except that it's just Coming at them. Platform providers Are doing an amazing job of that. And yet these releases are coming Out all of the time embedded inside Of their platform capabilities.

And so you may have governance in terms of Like what AI things you want to pursue, But what's happening when they're getting Released inside of your existing products And you're having to constantly be Educating your organization on how to Best utilize the tools that are available. And when it started out as all you can eat And now it's consumption-based modeling, Now you have a whole FinOps aspect Of what's happening out there too. So it's moving faster than Healthcare's comfortable moving. And so how do you put any kind of a Gateway around it so that people feel Like they're a part of it versus having it Just happen to them? Yeah, it's really, And again, I love what you just said.

13:15 I've used sort of a framework on that Through some of the transformation Work I've done at larger companies. And I use two different words. I use the word change, And I use the word transformation, And I think change is a scary word For people because it's something That actually is happening to you. It's an external factor. And then Transformation to me is something that Is an internal exercise that you're Actually adapting to that change. And so how do you get that mindset Rolling in an organization moving from This is changing on me versus how do I Actually adapt and fit into something That's transforming? How does that work?

I would say that the best leaders Don't eliminate the friction. They're distinguishing, gosh what, Productive tension, like what sharpens a Decision that gets made from unnecessary Friction that exhausts people and Can slow execution. You've got to Have curiosity without indecision. You've got to be able to have the courage To stop work that doesn't deliver value. When's the last time? There's two Questions I always love to ask in our Events. When did governance say no?

And then when did governance pull Something out of production that wasn't Delivering the value that was identified Inside of the business case? You'll Literally almost hear never and never. I worked at a previous organization and I had an amazing leadership team with me And we set up governance appropriately. Of course, we had infrastructure, we had Data management, all the things that you Needed and the organization never said no. And so I literally was like, why do we Spend three hours every Thursday by Bringing things forward to governance Because we say yes to everything.

So might as well give everybody their time Back and just let it be a free For all on the prioritization Because everything was important. People looked at me like I was crazy. And I'm like, but if we don't do anything Differently, why are we doing it? And you just go back to throw it in the Pipeline, we'll get to it when we can. So You have to have clarity about ownership. You've got to create the psychological Safety for bad news to travel quickly. You Have to remain close to that front line.

And then you got to build that resilience Before there's a crisis at hand, But honestly, if the organization does Not have the discipline to focus on, You have a limited set of time, Money, people, materials, et cetera, Align that to your outcomes. It sounds simple, but after 32 years, Governance, prioritization, Capacity is still a conversation we Are having almost every single day.

15:46 You know, and I find that so interesting Because you talked about psychological Safety and you talk about prioritization, And you talk about all these things That happen with change. I want to Pivot to a different direction so that We're looking at the provider side. I think part of my audience, What they would really like to understand Is the complexity of bringing new Things into the healthcare system, Whether it's AI or software or platforms Or hardware, or even new technology Devices and new ways of new formularies, Do therapies, help us appreciate What's on the other side of that seat.

Help us bring more empathy to the Table when we're bringing new things, New transformational things to the Healthcare system. What's it like On the other side with all this new Investment and innovation coming at you In an environment that is already Arguably could be one of the most Complex things that happens in America?

It has to simplify a pain point That exists today, And it needs To be something that is not just Enticing to the technology teams, Because when you think about people, Process, technology, again, one of the Oldest equations we have out there. But the people part is 80% of what You're going to be up against, Maybe 15% process and 5% humans, Or 5% technology, primarily because the Technology exists. And so how are we best Integrating it into our organizations? So CIOs are constantly being asked To reduce whether that's better, Faster, cheaper, which is again Something we've heard for years.

But we are literally at an inflection Point where app rationalization, The ability to reduce the number of Applications inside of an organization is More necessary than ever because every Application requires someone to manage it. It's gonna have a cost associated With it and it's going to have the Need for some form of integration. There's hardly anything that's Standalone anymore today. We were with the health system last week That said they have 1,400 applications In their health system, 1,400. They want to reduce it by 25% over the Next three years. Each of those reductions Are retirement of an application.

It's gonna have an OpEx tail and Then all the other parameters of Like, do we need to archive it? How long do we have to keep it? What are Some of those different perspectives? And so everything that's coming into A health system today must replace One to three to five other things in A way that is incredibly thoughtful. And also how does it integrate With existing platform investments And organization has made today. So if a company has Epic, ServiceNow, Workday, Salesforce, you name it from A platform perspective, what is this Other point solution or other opportunity Going to allow it to do that's not on A roadmap of one of those other players That you already have in hand? And so Also being able to bring your partners Together for a thoughtful conversation.

18:55 So historically, if I'm doing my annual Planning from a security perspective, I'm gonna have all my security Partners in a room together so they Understand how their roadmaps are just As important to one another as they Are to me because piecing together On the back end of just the health System being expected to do that, Those days are quickly waning. And now it's like, hey, I need these three Partners to be in the room together so They understand what we need to achieve But how I need to have them understand And work together so they can also get Us to the place that we need to be.

So everything is a pretty multi-tiered, Psych-faceted conversation. And they Alone are not happening in those silos. So if you want to come into an Organization and it's solving a problem, It can't just solve one problem anymore. It's got to be able to really go across The continuum of the workflow and Operations of whoever it's meant to Impact and improve their outcomes, Their day-to-day measurements, You name it. Nursing tends to be A place where everything lands. You're seeing the rise of roles like The Chief Nursing Information Officer, Because if all of your solutions are Gonna land with the workflow of employers, It needs to be really thoughtful Application of how it's going to Work better and most effectively.

And that's also gonna rely on your Infrastructure, your data and Other aspects of your organization. So something might sound amazing, Like can't live without it. Can't Imagine how you can do it without that. Where does it fit into all those other Components inside of an organization?

That kind of brings into that human Element, where what is the right balance With technology, human connection, There's multiple things happening. So you have AIs everywhere. You have your existing platforms that Bring automation to the table. Then you have healthcare, Which is designed to be humanly highly Interactive, I think, in a lot of ways.

How do you technology leaders get all This right balance and blend together so That you can actually be more efficient And take 1,400 platforms or applications And knock it down to about 1,000? How do you work with the human Connection, the digital connection, And then you're supposed to be Reducing this by 25 percent, But you're also being thrust upon it, All this other new technology and Innovation on top of it. So that can't Be an easy set of math deliver on.

21:34 It's not. It always goes back to what Problem do you solve in health care And how do you help an organization Leverage either what it already has Or significantly make it better or Different than what they're seeing today. And how do like suppliers understand Like because that's the the challenging Side on the other side is is we don't We ask but we don't necessarily always Understand what the biggest challenges Are or the challenge of the CFO might Not be the challenge of the head of Cardiovascular services and so how do You as a vendor when you're dealing With 8.4 different stakeholders in a Decision, how do you balance all that?

Like, how do you really understand how To deliver and thread not just a needle, But 8.4 needles? How do you do that? It is 8.4 needles too. So a couple Things that we see happening often, And this is one of the conversations That comes up time and again, Is that the longevity of a C-suite Group tends to only be about three years. So that means at any given time, At least one of the leaders inside Of a C-suite is turning over. That comes with the onboarding aspect, You know, it takes six months till Someone gets settled in an org a Year before they say it's theirs.

Well, you get fatigue from the chronic Leadership changes because you're having To reestablish strategic priorities, Reestablish who's responsible for what, Everybody comes in with their own Ideas of how to do different things. And it's unfortunate because the Strategic plan shouldn't be changing Every time someone in the C-suite Swaps out, but it does. Then, again, Technology is the enabler and the partner In making all these things happen. How thoughtfully does the organization Want to prioritize its greatest needs And where can technology be a win for Them in the utilization and application And even in some of the expense?

That's where a truly well-defined Governance model is so absolutely Important because you're going to have Your champion. You might have a couple Champions in the organization, but those Champions have to be aligned with the People who can also make it happen. So if you go to the CEO, or the CFO, Or even the cardiovascular surgeon, And technology's not at the table From the beginning, or the security And architecture teams aren't there From the very beginning, you could End up with what you said earlier, A Frankenstein approach to certain things, Or it's just one more layer of complexity That could have been reduced from The get-go. So who do you need at The table from the very beginning?

You may end up with 8.4 decision makers, But who is the champion and who needs To be there from the onset of the Conversation? So, the right questions Are being asked to reduce those Areas of friction that allow you to Make the traction that's necessary, But you're still looking at a 12 to 18-Month pipeline. Average organization Is over 300 projects in queue. That's basically saying if you did one a Day, you could get caught up, and there's Absolutely no way one project every day, Because go live is just the beginning.

24:33 And yet think of what it takes to Sometimes even get to go live and I say that's the starting point. Wow The entire you know next phases of Tracking monitoring and scaling that Solution that are in play well that's Because that's where you know getting Something to to market or getting Something to go live is very much A production activity and Getting it To work is there's more humans and like You're actually the transformation is When it begins and that's really frankly That's all the subjectivity, that's where All the variability comes into play, Is that that whole human reaction, Whether they take it or don't take it, Or adopt it or don't adopt it, Or how fast or how much they adopt it.

That's all really a really challenging Thing from a change agent, Transformation agent perspective. I used to say 10% are going to sign up At the front of the line for change, Period, no matter what it is. 10% Are going to be at the back of the Line and they're never going to change. So there's 20% that sort of, You know you're not going to have Any influence over. And then there's 80% That sit in the middle that are Waiting for leaders and other agents Of change or transformation to sort Of guide them on how much, how fast, And when and where they go do that change.

And so that's probably a really tough Role in a healthcare environment with The diversity of all the different people That are engaging in that platform. And any organization that doesn't, This is going to be on the partner side Or even on the practitioner side, You have to have people who are Literally well-steeped in the change Management aspect of human behavior. Whether that's from the view of a Toyota production system process Improvement lens, or that's the side Of a pro-sci change management, Change leadership perspective, Those things all have to be true.

And so I've historically either Embedded that inside of my PMO, Or into my general IT leadership teams, Because eventually it hits us as well. So, but I tell mentors all the time, Have people on your team who truly Understand change management, Because when you can get past the Adoption component of why people wanna Be using this in the first place, you're Gonna have greater buy-in and uptake. But also understand that a pilot is A pilot with a set period of time, And then if it can't scale beyond that Or doesn't have a use case beyond that, It's probably not going to get as Much energy around it, as it will Something that has a larger implication For a healthcare system today.

27:10 There's really a push to go, What are the platform capabilities That I have first? And then what Do I need to add in secondarily? And how is that going to be handled Inside the organization in a way that Feels like it is truly accretive to What our mission is, versus being One more thing for people to handle? And that topic right there leads Me as we come to the circle part Of the back end of the circle, Is a topic I could have brought up at the Beginning of our discussion, but I think This is a great time to play into it.

Let's talk about The 229 Project and How it came to be, and because I Think this is a great place to do it, Where you tie it all together, But give us the evolution and what Was the pain that actually caused This community to come together And bring value like this? Yeah. It started with Bill Russell creating A podcast about nine years ago. I think It was called This Week in Health IT. Bill had just recently left St. Joe's during the Providence Merger in Southern California.

He'd historically been a consultant, Amazing outcomes from the work he Had done in the past. He's like, I'm going to do the podcast as really a Feeder for some of his consultancy work. Well, what ended up happening is he has All these healthcare leaders on there All the time and he's interviewing Us and I was one of the people he Interviewed and we would chat with Him and I'm like, gosh, this guy's Talking to everybody has a pulse on What's happening in the organization. Well, lo and behold, you had COVID And February 29th, 229, 2020, First reported COVID death to the CDC.

Bill's phone starts ringing off the hook. We're all calling him like, hey, Can you do these Zoom pop-ups? We need help with drive-through clinics, Isolation rooms, PPE, like staffing Models, telemedicine, you know, Scheduling, like all the things. What are everybody doing? He said, call Each other. We're like, we don't have each Other's phone numbers. He's like, I see You together at major conferences. We're Like, yeah, but we don't necessarily, I don't have Terry's phone number, but You just talked to Terry two weeks ago. So Bill would put us on Zoom sessions And we'd collaborate and share ideas.

Well, that led to, hey, when we can be Back together in person, will you host us? And he said, sure. So, February of 22 Was the very first time he had a 15-Person CIO Summit come together. I was one of the inaugural attendees. I was with Tivity Health at the time, And we literally were like, help us Solve problems in smaller groups. Why? Because that small group is going to have, We're going to create community. It's not a soft benefit. We're in a complex industry. We need to have trust relationships As part of, I think you could call it, Our decision infrastructure. Short learning cycles, surface our risks Earlier, validate our challenges or vendor Claims that we're hearing and seeing, Reduce being alone. He has said that Leaders in isolation will fail. And so No longer isolated, you have community.

30:08 And you can help organizations avoid Repeating one another's mistakes. So he did that for a few years. Well, All of a sudden there's demand for more. When you're an N of one, how much can You handle? So he brought myself and Drex DeFord on in 2024. And we have, now We're at 20 people in this organization. We host almost 80 events a year. We do four-hour dinners, all-day Roundtables, and two-and-a-half-day Summits, in addition to all the Media conversations that we produce, And so it's that constant ability to bring People together and not the platitude Of a stage at a major conference.

You're in a room with trusted peers. You and I are going to have really Candid conversations when we know that It's not being sold for insights, We're not being put out on someone's Website, and we get to really learning, Seeing, and hearing together. So 229 community is all about transforming Healthcare together in these smaller Environments that allow the sharing Of information to be something that Is utilized for good for clinicians, For patients, for employees, and beyond.

Yeah, it's great that you're building An ecosystem where people can have A safe place to exchange and share. And talk about failures too. I mean, I think that's one of the big Things that doesn't happen enough, Is that in today's world, we all are Living in this Facebook or Instagram Society where everything's perfect, right? And nothing is. And so it's refreshing To find where people can come together And actually share pain and help Each other get through that pain.

And healthcare is a tough place, man. It's when you think about all these Tough decisions, and I know that from A supplier manufacturer community Perspective, and I talk about this often, Is that healthcare systems have designed A complexity, I think intentionally, For new things to come into the system.

I never really understood it fully, Probably until the last maybe 12 Months or so, and that operating with Very thin margins of 2 -3 -4 percent, Most hospital systems, and that's On a good day. And so when you think About like making a bad decision and Having a $10 or a $20 million mistake, That for most healthcare system is not a Recoverable miss. Yeah, it depends on The size of the health system as well. And so what we do in our summits, Specifically, is we have two prompts. This Drives all the conversation we facilitate.

32:49 First one is, what are you proud of? We give people about five to seven Minutes. What is something going well? We spend the bulk of our time, About 15 to 20 minutes per person. Where is someplace you are stuck or need Help and we bring up the real problems Not just to lament like misery loves Company But what are you doing about it? And that's where the wind comes in I Mean we just had a revenue cycle event In July that group still is getting Together to talk about The things That they are doing from either tries Price transparency or some of the Automation capabilities or the partners They're using to bring certain views And perspectives and efficiencies Into the workflow and these are Organizations are already, you know, They're already aligned on similar EHRs.

And so if you've seen one implementation Of a platform, you've seen one Implementation of a platform. Everybody's using some of these things A little bit differently. And so the Ability to say, here's what I've tried, Here's what I'm looking to go do. And we're also finding is if You're a partner trying to get in The door, if you're a vendor, The CIOs talk to each other. They're not going to respond to the email. They're not going to respond to the Cold call. They may or may spend Time with you at a major conference.

But if their friends are using you Or they're getting word of mouth Through that, or you meet them at One of our events when there's only 15 People in the room, then there's An honest dialogue and conversation That's occurring at the same time. So you're not going after them with a Sales pitch. You're coming towards them With a relationship that you're being Built based on industry perspective. Your solution may or may not be The right one. You understand the Things that they're thinking about In their day-to-day operations.

Which builds trust and authority over Time and and I think at the end of the Day it may not it may not be the right Moment for your product or your service In that system but you know understanding Over time and people talk to other People and not everybody's not everybody Has the exact same problem as well and That's where I think the exchange and the Community really is a refreshing piece. We have partners who have said all Of their pipeline comes from the Relationships they build at our events And that's because, to your point, You may not need it right now, but you May need it a couple years down the road.

Your teammate decided they need it or You move to another organization and you Already have that relationship built. And so often, because let's be honest, Healthcare is a very small community. Leaders switch organizations or they're Moving up from inside their orgs. And so the exposure that you get at Any particular interval is usually Going to carry forward with you. And I've done it. I mean, I've been At multiple healthcare systems. I tend to bring some of the same partners With me everywhere I go because of That long-term trusted relationship.

35:27 And they may have switched partners, Like their vendors as well. And so somebody that I bought XYZ From maybe is selling something new, But because I already have that Relationship with that human, then I'm Like, hey, well, what are you selling? And so there's a lot of different ways To solve the problem. Could be an ERP System, could it be an EMR system, All those kinds of things. But it'll Always be about trust relationships, Exactly what you mentioned. That's great. So I have one more question for you, And I'll ask it really slowly Because it's sort of a curve ball, And it's a question I ask all my guests Actually. So Sarah, I thank you.

I appreciate you being here. The question really revolves around, You've had a great career professionally, You've moved in different places around The country, and the question revolves Around, what would current day Sarah Go back and offer 22-year-old Sarah? If you just had one piece of advice, not Two, not three, but one piece of advice. It doesn't have to be professional, It doesn't have to be personal, but just Anything that you've learned and said, I wish I would have known that when I was at 22 that you know today.

What would that one piece of advice be? It's funny because I ask people this Often. I would say build the relationships You need before you need them, Before a moment of crisis or opportunity Arrives and really get close to The people that you serve in your Organizations and your communities, And listen thoughtfully so that you Can be a resource they can count On when they need you the most.

That's great advice. Listen, empathy, Be connected to the right people that you Need to have support you all the way. Very good. Well, Sarah, Thank you so much for being here. Your delightful, brilliant, Excellent executive leadership career And working in that arena that you Work in from an IT perspective, building And delivering all that transformation Is a wonderful exercise to have. Well, thank you. It's fun to do it. I love every moment of it. Even 30 weeks a year on the road, It wouldn't change a thing right now.

How would our listeners get in touch With The 229 Project or you if they Wanted to follow up and learn more? Yeah, I love that. Thank you. The 229project.com is our website. You can go there and sign up to receive Our signal reports and different Clip notes that we have from all Of the information that we gather. And also, I am very active on LinkedIn. I do respond to two messages, So I would find me there. Also, Sarah at 229project.com. Although I tend to answer email last In my influx of ways to reach me, But I do get to it, I promise.

38:22 Sarah, thank you so much. Great to have you. Thanks, Terry.