The Future Ready Enterprise - Lessons From Healthcare

JOE CAHILL:

Hi, everyone. Welcome to the Center Stage podcast. My name is Joe Cahill. I'm the Chief Customer Officer of PMI. I'm really looking forward to our segment today. 

The changes we are accommodating from the COVID-19 pandemic are still reverberating across our work. Perhaps no industry has been impacted greater than healthcare. This is a practical conversation around responding to dramatic change, leveraging global teams of capability, and building resilience in a time of enormous uncertainty. 

This Center Stage podcast is with President and CEO of AssureCare and the Managing Director of AssureHealth, Dr. Yousuf Ahmad. Dr. Yousuf Ahmad has over 25 years of tripod healthcare experience, including health insurance, physician group practices, and multi-hospital health systems. For the past five years, he has been leading AssureCare, transforming it from a startup to a high-growth company with industry-leading care management technology platforms. 

Prior to joining AssureCare, Dr. Ahmad served as the President and CEO of Mercy Health in Cincinnati, Ohio, one of the largest health systems in America with over 150 settings of care. He is board certified and a Fellow in the American College of Healthcare Executives and also board certified in the American College of Medical Practice Executives. 

Dr. Ahmad is pursuing an MS in information and knowledge strategy from Columbia University. He holds a doctorate in public health, master’s in health services administration, and a master's in business administration. 

So I'd like to welcome Dr. Yousuf Ahmad here today to Center Stage podcast.

DR. YOUSUF AHMAD:

Thank you, Joe, and to you and the Project Management Institute for having me today. I'm excited to be here.

CAHILL:

So let's just jump right into it. I have a lot of questions that we want to delve into with you today. Your expertise places our focus on leadership that is necessary in our times of disruption, and the required innovation that's needed to get through it. As a senior executive leader in the healthcare industry, you are experienced in facing these disruptions and certainly, for the need for change. 

So let's start off with your leadership experience in healthcare and how you've built capabilities in your organizations. Tell us about your background and why this is a field of passion for you.

AHMAD:

Thank you for that question, Joe. It's a terrific, terrific question and kind of a question that has defined my career. I graduated with a degree in Computer Information Systems, and everybody except me went into other fields than healthcare. 

They picked aviation, banking, technology, and I was the only graduate who picked healthcare, with a lot of intent behind it, because I thought healthcare is the industry that allows you to make a difference in the lives of others. There's nothing more rewarding than being able to provide help to those in need. 

It was with a very, I would say, laser-sharp focus that I actually picked healthcare. It’s like being born into a religion and then converting into another. People who convert are a lot more convicted about it. So I charted myself a career path with health insurance, physician group practice and a multi-hospital health system, which is called the tripod of healthcare. 

But all my life, and I'm going to preface this comment with a statement that I never feel like I'm a victim of the circumstance. But I was a teenager immigrant, as a freshman in this great country. And my very first day in America, I was being asked to identify myself against an ethnic card of you know, are you a Caucasian, a Pacific Islander, and Hispanic, African American, and I had to pick “Other” for the first time in my life. 

And, you know, back 30 years ago, there were 6 billion people, and I was a little shocked. I'm like, there are 3 billion people that look like me, but for various reasons, I had to identify myself with other. But I also learned that I had to get better just to be equal. 

The reason I say that is because people of my ilk and background, they never really got to do things that I was privileged to do in healthcare. For example, you never saw a computer programmer become the president of a medical group, or the CEO of a multi-billion dollar health system. That just doesn't happen. So I had to really work hard, surround myself with a lot of strong critics and well wishers, to help me charter my career path. And it's been a blessing. I didn't get there by myself by any means of the imagination. A lot of people have helped me. And I continue to pay forward to do that right, Joe.

CAHILL:

Let me ask you, if you can just share with us some of the struggles that you faced in your career, because part of leadership is overcoming challenges, barriers, in order to really lead an organization. Maybe there's a story you can tell within your career, a leadership story.

AHMAD:

I have several to share, Joe. One I would like to share with you is, I was 21 years old and I was working for a large payer in the country and we were going through Y2K. If you remember back in the day when the world was about to end (laughs). And I had done that successfully, had programmed 40 million lines of COBOL code. 

And I asked my boss, said, Hey, I’d like to be the chief information officer. And this is where you can't help but sometimes people will stereotype you. And they're like, well, you're younger than my youngest son. And I'm like, you know, so what? Can your youngest son do COBOL programming? 

Maybe I was a little naive at the time. But what I learned was that I had to arm myself with the right didactic knowledge, as well as making sure that my experience kept supporting that didactic knowledge. 

I'll give you a specific example. So I enrolled myself into the master's program of health administration at Xavier University. Prior to me enrolling at Xavier, no individual with a computer background had pursued that degree because it was unheard of. But I said, listen, if I want to be a strong student of healthcare, I must understand healthcare as a discipline, right? 

We are so complicated in America. Healthcare is not this complicated in the rest of the world. But we spend the most money on healthcare compared to any other industrialized nation and we have the least satisfied citizenry. 

And so I said, hey, let me go and arm myself. didactically understand healthcare. So anything that I pursued after my undergraduate was to make sure I understood the industry better. So I did a master’s in health administration, I did a doctorate in public health. 

But I think some of my professors, some of my colleagues, who really helped me think about, hey, if you want to further yourself in the industry, you’ve got to pick a different lane, you’ve got to change your swimming lanes. And that has actually helped me. You get a doctorate in public health, you can have a lot of conversations with, whether it's physicians, healthcare administrators, government officials. That has served me well.

CAHILL:

Let me talk about knowledge management as a general topic. How have you personally managed as an individual and then helped your team members build knowledge capabilities?

AHMAD:

We forget 50-80% of what we have learned after one day, and we and we forget 97-98% of what we have learned after a month. So when people ask, well, Yousuf, you have so many degrees, I can't believe you kept educating yourself. And my answer is a little facetious. I'm like, I can't believe you didn't, because there's so much to learn. 

And I feel like things are changing fast because of the advent of technology, automation. And we as a society are less tolerant. We want things perfect, we want things fast. And I feel like, for me, that's a driver, because knowledge doesn't get repleted. You multiply knowledge as you share.

So I have always had that focus. Some of that was my parents, with, hey, you’ve got to get yourself educated. But I've used the same sort of encouragement with my organization associates I get to work with, where you have to give them an environment where there is psychological safety. They can learn, they can fail and fail frugally. 

They should have what I call the obligation or the expectation to dissent. Only because I have an idea, and I'm the CEO, doesn't mean it's the right idea or the best idea. But if you empower them enough to challenge the idea, the end product is that much better.

CAHILL:

Let me understand, from your perspective, how can teams better practice resilience and risk taking. You kind of touched on a couple things there, they have to have that psychological safety. But once you establish that, which is a hard thing to do, how do they then better practice resilience and risk taking?

AHMAD:

This is my experience that once you get past psychological safety, and you've created a congenial environment of learning, you have to communicate through multiple aspects, multiple fora, because 1/3 of all projects in the world fail due to poor communication. No matter how good the strategy is, how strong people's will are, how talented the team is. But if you don't communicate, 1/3 of projects fail due to that. 

And I feel like you also have to encourage honesty and transparency. You have to decentralize knowledge sharing. One thing I learned the hard way, Joe, is, I was never taught that you should pair somebody's talent with their passion and purpose. And I have seen all my career that you can get an A player, but they'll perform as a B player if their will and their passion don't jibe with their talent base. 

We work as a healthcare technology company. And sometimes I get to interview some of the brightest people in the world and some of them tell me, listen, Dr. Ahmad, I don't care if you're selling hot dog or curing cancer. 

But to us that matters. You have to have an affinity. You have to have a passion for healthcare. You have to have a passion for improving a human life. Especially in healthcare, you know, they come to seek care with a stranger at the most vulnerable time, often. 

So I feel like I would say communication is big. I would say pairing passion with talent is big. I would say decentralizing knowledge sharing is good. I think you should provide updates with regularity. Because if you don't communicate often, people will make up stories in their mind.

There's a concept I learned, I would just leave the answer with this point. It's called threat rigidity, which means during times of stress or anxiety, we stop listening to more intelligible forces. We are drawn towards things that we are used to. 

And that's what kind of happened with COVID here, right? We are, I would say, arguably the best country in the world from talent, technology, people, processes. But it was like we were like a deer with the headlights. Because we had what I call threat rigidity. 

You know, there are three basic T's in public health, we are taught when there's a pandemic. The three T's are testing, tracing and treatment. And we happen to be deficient severely in all three of them.

CAHILL:

Let's go a little deeper on COVID-19. You know that there was a need for a rapid vaccine solution. And it's certainly revealed the need for collaboration across the board, collaboration across countries, organizations, sectors, disciplines, roles. I mean, it could have been the best example of where collaboration was needed for success. How can greater collaboration be achieved, particularly for complex projects like these?

AHMAD:

I think for complex projects, I would say you have to unite people through facts. Because if you go back a year and a half ago, as new facts are being revealed, we are taking positions accordingly. And not to make a political statement, Joe, but you know, some of my friends say, well, you know, masks were not good. And then they became good. Yeah, because as you follow new data, you have to follow that trend. Any public health individual will tell you with a modicum of intelligence, that Public Health 101 tells you you should wear a mask, irrespective of your political position. That's science. 

But I think you have to unify people around facts. You have to articulate, during a pandemic like COVID, what is the most important things that matter? For example, people’s safety matters, right? You have a healthcare system that got overburdened. There was burden to begin with. There's maldistribution of clinicians and people where we live and a lot of people were not given their regular primary care, because hospitals were full of COVID patients, right? So we’re now behind the eight ball. 

And then there's a concept in in healthcare that I subscribe to that's called “take care of the caregiver.” You have a doctor and a nurse, or a social worker or a care manager working 10, 12, 20 hours a day. Fatigue kicks in, then they're prone to medical errors. Did you know that medical errors is the third leading cause of death in America? It's shocking. And it's unconscionable, despite all the electronic medical records we have. But there's a lot of other confounding factors that lead to that. 

So I would say, from a pandemic perspective, are we are we doing better now? Absolutely. I think communicating around facts, communicating frequently. 

I think being vulnerable, I would say, is a strategy that I have used, and I say, vulnerability with a lot of genuineness. It's okay to not have an answer. It's okay to say, hey, we will be embracing a little chaos while we are innovating. Because most of life is not black or white, it's gray. A lot of times people will say, oh, is it this answer or is it this answer? Well, it's not so black and white, you know? 

So I would say, those are some of the learnings that I have had. And I would also say that, follow the science when it comes to the pandemic. There's no argument, at least in my mind, whether it's masks, whether it's vaccines. I certainly respect people's religious preference. And I think we are blessed to live in a country where we get to decide for ourselves a lot. 

But when you have a pandemic - and if you go back, because I'm a student of public health, whether it's small pox or measles or the Spanish flu - unless you address it head on, you can actually worsen the situation. And I believe, had we done a better job in communicating - of course, hindsight is 2020 - but as a nation, had we done a good job communicating, we would have lost less lives. I'm convinced of that. 

CAHILL:

I think there's no doubt about that. It's a discipline, the communication discipline, is, when you do it at your best you're leaving stuff on the table. It's an ever evolving thing, particularly when the facts keep rolling in, and you have to pivot and adjust. 
So let's touch on project skills within this context. How do projects skills help organizations, teams, successfully implement some of the changes that are needed?

AHMAD:

So project skills are salient and extremely critical, because we all have finite time and finite money, and we have to make sure we are maximizing that. We also have to make sure what is expected of us. I often ask my project teams, what is the larger goal? What does success look like? Can you define that? Some of the success can be objectified - time, dollars, efficiency, effectiveness. Some of the success is a little intangible. 

And I feel like that's where some of the technical project managers have difficulty on the gray area. If you are building a hospital, or you're implementing an application, a large enterprise application, do you know what success looks like? I feel like that's an area where we are doing a better job, could always do a better job, but identifying and I would say quantifying that has been often hard for project managers. 

They get the basic tenets of project management - on time, on budget, but there's so much more behind it. Meaning, are you motivating your team as a project manager? What are the tips and tricks to motivate people, and people get… there's no monolithic recipe for motivation. Motivation comes from… people prefer motivation that's customized to them. All my life, I liked to be recognized privately with my boss, behind the back. I never liked the big public recognition. That's just me. But a lot of people like it. “Hey, give me an award in public.”

So I feel like we have to understand our teammates a little better. We have to also make sure, what is it that matters to our customer? So when implementing the project for a customer, what is the 20/80 Pareto? Do you know what 20% of this application you are implementing, what 80% bangle will it deliver? And I feel like that sort of focus helps, that sort of focus on project teams is critical. 

I think we have to honestly help each other out more. Gone are the days when the day ends and, okay, I'll talk to you tomorrow and it's all about work. I think it's changing where, I see this in my organization where, and maybe we can thank COVID for this of the pandemic. It used to be that all my career, my private life revolved around my work. And I'm seeing a change. 

And I feel like that's one of the reasons why last week, we heard four and a half million American workers left their jobs. Because I think people are figuring out what's the higher priority. I can tell you this, I can be replaced at work and not too many people will miss me. But I can’t be replaced at home, and people will miss me.

CAHILL:

You're touching on what we call power skills at PMI. Leadership, collaboration, communication. These are all those soft skills that, without which you're not really going to have high success rates with projects. 

So I want to talk to you about… you touched on your background at the top of the podcast. With that technical background coming in, layering in all the application of the healthcare profession, so technology, healthcare, then leadership. Can you give us some insight into the world of automation as its applied to strategic talent initiatives, so we just talked about the great resignation. It's a perfect segue. 

AHMAD:

This is a question that is near and dear to my heart. And I'm not sure I have an exact answer, Joe. But what we are looking at at AssureCare and beyond is where automation is 100% proven, including machine learning and artificial intelligence. I'll give you an example. Did you know that mammograms read by AI are more accurate than a human radiologist? And that's proven. 

So I'm thinking, okay, that's not even debated. Let's not even have a debate about it. That's done. But there are certain aspects of medicine or healthcare, that is still art , that is a combination of art and science. So I would say areas where AI and ML and even NLP - natural language processing - have proven themselves, we should use them. We should use them.

In the in the world of law, you can run AI ML and have a computer read the legal case, and give you the most salient points from it. There's nothing wrong with that. And so I feel like it is here to stay. You see some of this in our in our everyday lives. I think in the next five years or less we will have self-driving cars. Certain countries are already testing aerial taxis. You can take a taxi in the air and cross the river from Kentucky to Ohio where I live. So that is already happening. And I feel like we will use more of that with our everyday lives. 

And I am seeing this in healthcare. I'll give you an example that we see a lot in healthcare. Take a condition like multiple sclerosis. So MS is an autoimmune disease. It's a Caucasian disease. People are mostly vitamin D deficient. It's confirmed through a spinal tap or a scan of your brain because you show spots. But other than your very costly infusion drug that contains MS, the only other way to contain MS is through a gluten-free diet. 

So it's no longer the wheelchair sentence it used to be that, oh, I have MS I'll end up in a wheelchair. No, there are ways to guard against it and I think we have to use AI ML to make sure as a clinician is seeing an MS patient they’re also inculcating AI ML to predict what their diet should be to match against their chronic disease. And I feel like that's here to stay because if you ask me as a healthcare guy I think obesity is the pandemic that we need to fight with in America.

CAHILL:

The thing I struggle with, among other things in the healthcare system, is just creating focus personally. What you just described to me is a way, a mechanism, to create focus on a diagnosis and a solution. And if that's there, it really provides clarity for a patient, right? Because that's what the patient really wants at the end of the day - clarity.

AHMAD:

Absolutely, Joe, and I'll give you one more statistic that I'm not proud of as a leader in health care, but I believe AI ML will help. An African American male diabetic in Cincinnati, Ohio - everything else adjusted for, household income, education - is six times less likely to receive the proper diabetic care compared to his Caucasian counterpart. 

And the sad part is that the same statistic is true in any metropolis of America. And we as a society should be unaccepting of that. And I believe artificial intelligence, machine learning and algorithms will help us with racial disparities in healthcare.

CAHILL:

I have supported the American Diabetes Association as a board member in the past, and know much about those statistics, but the way you just described it, with all of the control features of it, it's amazing. It's an amazing statistic. And it certainly should focus on, talking about focus, should focus energies on making it different, taking that out of the system. 

Let me ask you a little bit about… back on the talent topic. People that are listening today are keenly aware of what's going on with the Great Resignation and the changes in the talent pool around the world. It's not just isolated to one country or another. There are big shifts happening. 

Given all the top-down approaches that are out there, whether it's approaches to management or approaches to talent development, do you view that there's a bottom-up approach that is a better approach to really getting outcomes in the talent development space?

AHMAD:

I think so, and the way I would answer that, Joe, is I look for natural inquisition. In my life, you could be somebody who majored in horticulture, and you come to me as a health tech CEO and say, I’d like to work at AssureCare, or even in my prior life when I ran a health system. I want to know, are you naturally inquisitive? Where you don't just want to challenge the status quo but really want to improve things at its core. 

You should ask why. Have you ever seen a healthcare bill? It's complicated. Have you ever seen a hospital bill? It's complicated? And can somebody simplify it? As an example, when I look for talent, I look for being respectful of what we have accomplished, but when a new blood comes in, you know, can we learn from other industries? You know, aviation is a very safe industry, and has all kinds of checks before a flight takes off. But how can we still amputate the wrong limb in America? 

So I feel like the bottom-up approach can definitely work. And I think maybe for me, the truth is a combination of a top-down and a bottom-up. Because you also want to make sure you're pairing somebody's career against their personality. So I have made the error in my life of promoting an amazing, amazing surgeon as a leader of a surgery group. And he or she failed miserably. They were a great surgeon. That does not equate for them to be a leader of a medical group. That's a different skill set. 

And so what I try to focus on is, while you're trying to pair people's passion with their talent, as I mentioned earlier, you also need to pair people to career path that their personality supports. And I feel like that is often less talked about when we do career planning or talent development. 

CAHILL:

So let's talk about experimentation. And we talk about at PMI, with our agile practitioners specifically, and then certainly with project managers, the importance of experimentation. A big part of experimentation is understanding and recognizing that all experiments do not succeed, many fail. What is the role of experimentation in your organization?

AHMAD:

The role of experimentation for us, in my organization, is around, is this test being done to make things better? Could be people, process, or technology, really. So like I said, we try to give a psychologically safe environment. We encourage them to have naive questions, especially under the guise of experimentation, which also includes the obligation to dissent, the expectation to dissent, but also includes that there will be chaos while you're innovating. There will be ambiguity. 

And like you said, most experimentations fail initially, right? But do you have the perseverance and the environment to get back on the saddle? And try a little differently, improvised from your learnings. 

But I always say, what are you trying to do? What's the why? What are you trying to address here? Before you experiment, you have to be clear on that. I lose patience when people are not clear on the why. It's okay, we may struggle with the how, we may refine the how. But can we please align on the why. 

And I've seen a lot of projects get started where they got the funding, and everybody is hunky dory and rah rah, but their why was weak? Not everybody was aligned. There was a definitional gap in the why, and we just can't have that. 

CAHILL:

How do you think project leaders strengthen their focus on business value or even value beyond business value, like beyond financial value, I'll say non-financial measures as well?

AHMAD:

I think they have to understand how the industry works first. And I've learned this the hard way. I've hired a lot of great project managers who knew how to do a project, but they didn't know the broader context of how the industry worked and how their companies fit in the industries. 

So I feel like I would encourage your subscribership, anybody listening to this, to say, okay, do you what's the purpose of your company? What are the five things they are best at? What are the next five things they get beaten by the competition? How do they make their money? What's the Pareto? What's the cost structure? How do you drive people? What motivates people in that industry? What's the reimbursement look like? 

And I feel like those, I've seen time and time again, Joe, where project managers who understand industry knowledge, are just that much better at their job, because they can answer questions like the why. They can connect people to a higher purpose. They can reinforce the business purpose frequently. I feel like that's something that should be non-negotiable.

CAHILL:

So I've heard quite a bit, a nice thread through the whole conversation, I heard a lot about lifelong learning, whether it's yourself or within your organization. And I would suspect that you'd want to encourage that on the audience here today to really pursue that. We definitely heard it today. So how could you, what kind of advice could you offer our listeners on future-proofing their capabilities and their careers?

AHMAD:

I would say there are three things, if I would conclude this conversation, Joe, that have again served me well in my life, and I believe all three of these things are under your control. And those are your attitude, your preparedness, and then effort during game time. And I teach this to my children, at least I try to. For anybody who has kids, you can only say so much, and then they make their own decision. 

But I feel like those are the three things that have been under my direct control. And when it comes to preparedness, yeah, I try to improve myself every day. Every day is a learning and the more I learn, I feel like, I've so much more to learn. 

And I think as to future proofing people's capabilities, it also comes with these three things. If your attitude is not right, you really can't future proof anything. If you're not prepared, you will always have lack of confidence. And if you're not putting in the right effort, you know that you're not being truthful to your to yourself and your teammates. 

So I feel like attitude, preparedness and effort are things that are under one’s direct control. And I learned that the harder way, because in the beginning of my career, I was like, well, why is so and so not happening to me? Or this this promotion? Or how do I apply at this? And then I realized that there's a lot that I had to invest in myself, and then go compete against the best in the world.

CAHILL:

You know what, it boils down to one thing, one word: choice. You have a choice to do these three things, and to do them well. 

AHMAD:

Oh, that's well said, Joe. Yes, you have a choice.

CAHILL:

It’s often missed, right? Because we make choices constantly every day. And you choose to do something else instead of these three things. Don't lose sight on that. You're making a choice to do something else. So choose these three things and you're going to find yourself in a better position, is what you're telling us.

AHMAD:

And have fun. Have fun in your career. It's okay to be around people who inject humor. Who you can lay your guard down. They get to know you as your true self. I feel like those are things I wish I knew earlier when I was younger and naive.

CAHILL:

Me too. So that's a fourth, we’ll add fun to the list. I really appreciate your insights today. It's been fantastic. I’d like to spend a lot more time with you but I know your time is very challenged. And everybody in the audience, I'm sure, learned something today. And we'd like to have you back some time, and I’d certainly like to meet you. Thank you again.

AHMAD:

Thank you, Joe. It's been my honor and privilege, and thank you for having me today. I appreciate it. 

CAHILL:

Thanks again, Yousuf.