Reimagining Healthcare Capacity: From Bricks to Bytes with LeanTaas & AdventHealth

Summary

Becker’s Healthcare Podcast Summary

Episode: Reimagining Healthcare Capacity: From Bricks to Bytes with LeanTaas & AdventHealth
Release Date: July 7, 2025
Host: Molly Gamble
Guests:

• David Banks, President and CEO of Advent Health
• Mohan Girardidas, Founder and CEO of LeanTaas

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Introduction

In this special edition of the Becker’s Healthcare Podcast, host Molly Gamble engages in a comprehensive discussion with two prominent leaders in the healthcare sector: David Banks, President and CEO of Advent Health, and Mohan Girardidas, Founder and CEO of LeanTaas. The focal point of their conversation centers on the persistent challenge of healthcare capacity, a critical issue amplified during the COVID-19 pandemic and continuing to impact health systems nationwide.

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Overview of Advent Health and LeanTaas

David Banks provides an insightful overview of Advent Health, highlighting its extensive growth and operational scope:

“Advent Health just celebrated its 50th year back in '23. Today Advent Health is a $21 billion organization serving nine states, with a network of 55 hospitals and numerous other healthcare facilities.” [01:04]

Mohan Girardidas introduces LeanTaas, emphasizing its role in optimizing healthcare capacity through advanced technologies:

“LeanTaas essentially optimizes capacity in health systems using sophisticated mathematics, AI, and machine learning. We serve 1,000 hospitals across the US, optimizing infusion centers, operating rooms, and beds.” [02:04]

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The Challenge of Healthcare Capacity

The discussion delves into the pressing issue of capacity in healthcare systems. David Banks reflects on his extensive experience within Advent Health:

“The focus on clinical throughput and the experience of our patients is at the top of the list... ensuring access for the patients who need it as well as creating more capacity.” [03:21]

Mohan Girardidas elaborates on the complexity of capacity management, drawing parallels with other industries:

“Healthcare is facing a perfect storm with pressured reimbursements, increasing volumes, and persistent staff shortages, creating a massive capacity crunch.” [07:06]

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Strategies for Optimizing Capacity

a. Capital Investments

David Banks discusses Advent Health’s strategic capital investments aimed at expanding capacity:

“In Florida, we have a hospital a year coming online for the next six years, including major rebuilds. These investments are essential to keep up with demand and ensure optimal use of capital.” [04:51]

He further highlights the importance of efficiency in these investments:

“We need to make sure capital is optimized to meet needs and not wasted.” [04:51]

b. Technology Integration

The integration of technology is pivotal in enhancing capacity. David Banks shares insights on Advent Health’s technological advancements:

“We're investing in smart room technology to enable real-time convergence on patient care, improving coordination among consultants, care processes, and family interactions.” [10:49]

He underscores that technology alone isn't a panacea:

“It takes people, process, and technology to make it work... reengineering some age-old processes is crucial.” [11:30]

Mohan Girardidas emphasizes the transformative potential of AI and smart technologies:

“Ambient listening and AI can fundamentally change patient-provider interactions, allowing providers to engage more meaningfully with patients rather than being tethered to data entry.” [13:33]

c. Process Reengineering

Both leaders agree on the necessity of reengineering operational processes to optimize capacity. Mohan Girardidas critiques the current reliance on Enterprise Resource Planning (ERP) systems:

“Healthcare operates as if in a pre-GPS world, reacting to problems instead of anticipating them. Sophisticated optimization and automation are needed to predict and manage capacity efficiently.” [07:06]

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Insights on AI and Operational Efficiency

AI plays a critical role in streamlining operations and enhancing decision-making. David Banks shares how AI tools have positively impacted clinician experiences:

“Ambient listening tools are likely the single most uniformly satisfying thing we've done for our doctors.” [10:49]

Mohan Girardidas builds on this by discussing the broader implications of AI:

“AI enables better patient engagement and supports physicians in making more intelligent decisions faster, shifting the centrality away from cumbersome EHR systems.” [16:11]

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Analogies and Models from Other Industries

To illustrate effective capacity management, Mohan Girardidas draws comparisons with the airline industry:

“Healthcare operations are like a hub-and-spoke network. By optimizing the hubs—similar to major airports—we can enhance overall system efficiency.” [23:19]

He further explains the concept of yield management used by airlines to maximize utilization:

“Delta moves 200 million passengers a year without increasing flights by focusing on yield management and efficient hub operations.” [25:47]

David Banks echoes this analogy, noting the predictability of operational surges in healthcare similar to airline traffic patterns:

“We see the same predictable waves in ORs and ERs as airlines do with flight schedules. Sophisticated solutions can manage these patterns efficiently.” [28:15]

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Hard Truths and Future Directions

The conversation touches on several challenging realities facing healthcare leaders:

Mohan Girardidas identifies key areas needing attention:

1. Prioritization of Initiatives:

   “Health systems need to prioritize initiatives effectively—focusing on doing a few things exceptionally well rather than many things poorly.” [31:20]

2. Building vs. Buying Solutions:

   “Healthcare often tries to build solutions internally, leading to inefficiencies. Embracing a model of building, buying, and partnering appropriately is crucial.” [31:20]

David Banks concurs and adds:

“Systems with resources tend to rely on them rather than on resourcefulness. Challenging long-standing operational patterns is essential for modernization.” [34:33]

He highlights the need for operational sophistication akin to manufacturing industries:

“We need to adopt philosophies and technologies that allow for custom builds at scale, much like a car manufacturing plant.” [37:16]

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Conclusion

The episode concludes with both leaders emphasizing the necessity of innovative thinking and strategic investments to address capacity challenges in healthcare. Mohan Girardidas envisions a future driven by new companies and technologies, while David Banks reaffirms Advent Health’s commitment to consumer-centric care and operational excellence. Together, they present a compelling case for a holistic approach—integrating people, processes, and technology—to transform healthcare capacity management and improve patient outcomes.

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Key Takeaways:

• Capacity Management remains a critical and ongoing challenge in healthcare systems.
• Strategic Capital Investments and Technological Integration are essential for expanding and optimizing capacity.
• AI and Smart Technologies offer transformative potential, enabling better patient engagement and operational efficiency.
• Operational Reengineering is necessary to move beyond outdated practices and embrace sophisticated, data-driven solutions.
• Learning from Other Industries, such as airlines, can provide valuable models for healthcare capacity optimization.
• Prioritization and Strategic Partnerships are crucial for effective transformation and avoiding the pitfalls of overcomplicating systems.

This rich dialogue between David Banks and Mohan Girardidas provides invaluable insights for healthcare leaders aiming to navigate the complexities of capacity management and drive meaningful change within their organizations.

Transcript

[Molly Gamble]

Hello and welcome to a special edition of the Beckers Healthcare Podcast. I'm Molly Gamble with Beckers and today I'm delighted to broach a big topic with two leaders who have depth in the subject matter and scale to back it up. The topic at hand is capacity, which became such an A1 headline during the COVID 19 pandemic and remains a challenge that so many health systems across the country seem to still be grappling with. My guests to join me in conversation on this issue are David Banks, president and CEO of Advent Health, and Mohan Girardidas, founder and CEO of leantas. David Mohan, a pleasure to be in your company today. Thank you so much for joining me.

[David Banks]

Thank you. It's great to be a part of the conversation.

[Mohan Girardidas]

Thank you, Molly.

[Molly Gamble]

Absolutely. Well, let's get started and let's orient our listeners a bit. No doubt they've heard of Advent Health and no doubt that they've heard of leantas. You are both leaders of growing organizations in growing markets. But can you take a moment and just share a bit more about yourselves and the organizations that you lead? I'll turn to you first, David.

[David Banks]

Okay. Yeah. Advent Health just celebrated its 50th year back in 23. Although our legacy goes back to the late 1800s in terms of our origins come out of the sanitarium movement. But today Advent Health is about under management, about a $21 billion organization serving nine states. Last year we served about 9 million people through a network of 55 hospitals and all the other network assets you might expect from 60 urgent cares, numerous physician offices, ambulatory outpatient settings and the like. Florida is our single biggest market, but we're in other communities such as Denver, Kansas City, Chicago, Dallas, Fort Worth.

[Molly Gamble]

Thank you, David. Those are some fast growing markets too, that you just highlighted. I'm sure we'll uncover in our conversation today. Thank you, Mohan. Let's turn to you next.

[Mohan Girardidas]

Thanks, Molly. I'm Mohan Girdadas. I'm the founder and CEO of leantas. Leantas essentially optimizes capacity in health systems. What we do is sophisticated mathematics, AI ML and bring all of that to unlock capacity. We were the first to bring the concepts of yield management from airlines and logistics companies into healthcare. Today we serve 1,000 hospitals across the US belonging to 200 different health systems along three core product lines. We optimize infusion centers. About 30% of the chemo capacity in the US is delivered in an infusion center optimized by a Leantas product. Operating rooms about 6,000 ORs, so about 15% of the surgical capacity in the US is delivered in an OR optimized by US and about 30,000 beds across 100 hospitals. David, thank you. We work with Adventure Health on the infusion solution as well.

[Moderator]

Fantastic. Thank you, Mohan. David, I'm going to turn to you first here. You're just a few months in as CEO of the system, but you've been part of Avent Health leadership for decades. How has stepping into this top role really sharpened your perspective on where the system needs to go next, especially as it relates to capacity?

[David Banks]

Yeah, I have been in the system for 31 years and moving over a seat. It's definitely a big move. But some of the things really remain the same. And especially in some of the states that you mentioned, we are in high growth states with lots of demand and high brand recognition, which drives a lot of demand on our services as we are on a 10 year strategic journey that gets updated more frequently than that. The focus on clinical throughput and the experience of our patients is at the top of the list. And when you think about the capital costs on a per bed basis, the imperative to be as efficient as possible while creating the best experience as possible is at the top of the list. As a faith based provider, our identity is in the provision of care. We're not a research institution or by and large an academic institution. We provide care to real people living in real communities and, and that's what they expect from us. So it's at the top of the list for us in terms of being available, having access when people need care and getting them through that care as timely as possible with the best experience possible.

[Moderator]

And David, you mentioned those capital costs. Are there any early major investments that you can point to that are either in motion or planned that are related to capacity? Right now?

[David Banks]

Yes, we have a number of beds coming online and if I just stick to our Florida market for a minute, but this could be true for Kansas City, it's true for Denver as well. But if we just think about Florida, because that's one of the biggest growth curves in the nation, we basically have a hospital a year coming online for the next six years, including the rebuild of some of our major institutions. These aren't necessarily 80 bed deployments. They can be in the hundreds of beds and it's to keep up with the demand that we're seeing built in, which also just places a premium on the efficiency of what we are deploying because some of that capital offset can be preserved through better clinical diagnostics, through better length of stay, through better Care management in terms of where do you put people into your continuum, how you think about who gets admitted out of the er. All of those things work together to ensure access for the patients who need it as well as we're creating more. And right now in Florida it's three to three and a half million a bed. So this is precious capital that gets spent and so we need to make sure it really gets optimized to meet the needs and not wasted.

[Moderator]

Absolutely. I remember reading one of the headlines out of Avent hall in May was this $1 billion, I think plus transformation plan at the flagship campus in Orlando, a new patient tower, expanded services. So David, I think when we see the headlines coming out of health systems today and the financial pressures they're facing, when you see a $1 billion transformation plan that is not to be taken lightly. To your point, Moha, I'm going to turn to you here. Avent Health, like so many other systems, you know, making some significant infrast and also I imagine technology bets. I'm curious, your bird's eye view here across the systems you work with, where can these kind of investments, as well planned and strategic and based on projection as they are, get stuck in the effort to expand capacity? What do you see really determine whether they actually move the needle on flow and access or just add more complexity to the system?

[Mohan Girardidas]

So as we look across our landscape, I think healthcare is facing a perfect storm in terms of reimbursements are getting pressured, volumes are going up and staff shortages are here to stay. So this creates a massive capacity crunch. And what a capacity crunch does is one of two things. You either figure out how to get more with your existing capacity, but there's only so far you can take that. At some point you can't put ten pounds into a five pound bag. So you then have to go and do the mega investments that David's talking about that are required. But it's obviously very, very expensive. It's several million dollars a bed by the time you're building out a multi hundred bed. But when we think about healthcare in the U.S. the clinical advancements in the last 20 or 30 years have been magical. If I think about genomics and precision medicine and proton beam therapy and robotic surgery, it's science fiction. If someone had told us 10 years ago that that would be a daily thing, we wouldn't have believed them. So the clinical advancements are brilliant. The operational sophistication hasn't kept up. Many of the operational processes are the same as been going on for the last 20 years, some of them have been digitized, but essentially it's the same thing. So as we talked about earlier, complexity is confused with unknowability. And so as the complexity has gone up, people are just scrambling and this is a vicious cycle. So health systems get stuck in this reactive mode where they're reacting to the crisis and problem solving it. To get ahead of the problem, you have to predict what's coming. Then you have to have sophisticated optimization that prescribes what to take and then the automation techniques to make it happen by pinging the right person with the right next action automatically. Think about how we engage a GPS in our car. It anticipates a problem, it offers up an alternative route. We sometimes accept it and sometimes we say we know better and we reject it because it's a bad part of town and we don't want to get off the freeway or whatever it might be. Health systems operate as if they were in a pre GPS world where they first learn about the traffic jam after they get stuck in it, and then they go back to figuring out from first principles how to get out of that particular situation time and time again. That's exhausting to the frontline and it causes burnout. What we've learned from all these investments is you can't throw software over the wall. People don't have time to learn new software, they don't care. They've got to take care of patients. It takes people, process and technology to make it work. And the other problem healthcare has is there are thousand vendors that are each with a good point solution. And you can see them wanting some form of logical consolidation. And this sometimes leads to a shortcut where health systems just say, oh yeah, the EHR will solve it and essentially abdicate the solution of what is their core problem in that manner.

[Moderator]

To operate in a pre GPS world. I think everyone can understand exactly what you're describing there, Mohan. I'm going to turn to you, David, because I think you laid out some of the bricks and mortar investments and strategy you have in place at Advent Health. But I imagine to Mohan's point, people process technology. And another big lever that you're probably looking to hit is technology. You've noted in past interviews with us at Becker that ambient listening tools have had a major impact on physicians daily experience, saying it's likely the quote, single most uniformly satisfying thing we've done for our doctors, end quote. That's a big claim from your seat. What has that taught you about where AI is truly moving the needle for clinicians?

[David Banks]

Yeah, I think the ability to solve those routine and repeatable tasks is obviously a big lift. Next investment is going into our smart room technology which will allow much more real time convergence on a patient room from consultants and other sorts of care processes that today, and I completely agree with what Mohan was saying, for all the advancements that happen, there's still so much in hospitals that you could turn the clock back 50 years and physician consults are one of those. They're going to serially go room to room and it's just if you're at the end of that line, your length of stay just went up. Smart room is going to create a different ability to do much more real time consults, care coordination, pulling the as well as family activation because that's often the other issue. The doctor's there, the family's not, the family's there, the doctor's not. These are all factors that start to complicate. And if you've ever had a family member in the hospital and you've been sitting in your parents room, you know how this, you know how it goes, getting all of those things to coordinate in sync. We think the smart room will be the next iteration and helping simplify the way families interact, physicians interact as well as staff interact. Now. Mohan also makes a good point. It's not a magic solution. It's going to take re engineering some age old processes in terms of how clinical results get into the EMR and how those get assessed and how those affect treatment decisions and in the cadence, because you could just automate a process that just creates new cues, if you will. So I think the technology will be really helpful and there's a lot of process re engineering that's got to happen in order for the providers, the family members and our physicians to take advantage of what those new GPS instructions might look like.

[Moderator]

And what I really appreciate, Dave, about what you just outlined there, those smart rooms, is that you're not just thinking about technology or AI deployments in terms of freeing up time. I think time back is usually a really good thing for physicians. For instance, it can help their practice, it helps with retention, career longevity. But I think I'm going to turn to you here, Mohan. It can also raise some questions about where that freed up time is going and how, if at all, it's actually helping access across the systems you're working with. Where are you actually seeing tech and AI shift how care is delivered. It's not just oh, this can do the work for me faster. It's in your opinion, really separating Operational gains from some of the noise that can be out there about AI.

[Mohan Girardidas]

I love the way David's describing it because I think the smart rooms and the ambient listening, et cetera, give you an opportunity to reimagine as opposed to just take a process and make it faster with technology. So this notion of an opportunity to reset and rethink how collaboration and coordination and what has to happen concurrently versus asynchronously is a gift to have that. I do think ambient listening, ambient scribes, AI, smart rooms, vision, et cetera, have a potential to be a game changer for one very simple reason. It lets providers engage with patients. That's what they signed up to do, to engage with patients. But today half of them are acting like data entry operators while they're dealing with the patient. They've got their face in their laptop and their hands on the keyboard and they're engaging more with their laptop than they are with the patient. That's not what they signed up to do. That's not why they went to medical school and got specializations or nursing school. The EHR was supposed to have made life easier for the providers. And this is what has gotten stuck with getting the frontline chain. So in my mind, it changes how the engagement of patients work, which will be a better care experience. It'll probably have better outcomes with the AI, you'll support the physicians more, so they'll have the ability to make more intelligent decisions faster. But interestingly, it changes the centrality of the EHR and the lives of the hospital staff. Today the EHR is core to it. I mean, that's where they are. So think of the flat screen in your family room today. That's the centrality of your entertainment at home. You sit on the couch and you engage with the flat screen tv. Now think of the furnace in your basement. You don't engage with it. Twice a year somebody comes, services it and you don't think about it for the rest of the year. That's what's going to end up happening to the ehr. The data. It's going to hold the data. It's certainly an important aspect, but you're not going to engage with it in the same way. You're going to talk to it through ambiently. You're going to engage with the TV screen in a smart screen sort of a way. And so nobody's going to get stuck on the keyboard and the screen the same way. And that's what's creating the relevance challenge for EHRs where they've realized that they're going to have to amp up their claims to do and solve every problem, regardless of whether or not they're the natural owner of solving it. It's a relevance, it's a fight for relevance. And what ambient does is it reduces the relevance. And so it's a very interesting inflection point in the way technology engages in the caregiving process.

[Moderator]

A flat screen TV in a furnace. Mohan, you have a real gift from Metaforce. I can't remember the last time I even looked at my furnace. Not just because it's a heat wave in Chicago, but so well put that the centrality of the EHR will shift. I think that's a really smart way of looking at it. David, you mentioned your ten year plan. You helped shape this as a Strategist Vision 2030. Now you're leading its execution and I wanted to get real, if you'll let me, about when you're navigating the day to day demand, you're running the system. Is there a certain part of that vision that in execution has proven most challenging to keep on track, A component that you just find yourself need to advocate for more and more than maybe you would have expected?

[David Banks]

The benefit we've had is we started with a very specific progression of what we wanted to build upon. And our vision statement includes really two key phrases which is consumer focused and clinical care. And so building the systems that set you up to do that have been a lot of the front end work, such as establishing a new primary health division that brings new rigor to the care that gets provided outside of the hospital through our primary care systems as well as in home systems as well as Covid really slowed down and set back now we've recovered from it. But the team development, we've made significant investments in our team and expressed through six promises to our workforce because we know we deliver care to people through people. And so getting all of that investment and the systems that run that deployed really sets us up for the next phase. And what I'm excited about is the ability to really push the quality of care and the experience of that care to the next level. Healthcare gets lazy sometimes. Healthcare has the attitude of and said Crassley, we saved your life. What else do you want? Well, there's no one else that would get away with that. The airlines don't get away with that. Hey, we landed the plane. It's you expect safety and you expect a certain level of experience and quality in that. Healthcare owes that to the people it serves as well. So the pivot for us that's probably been the biggest challenge is when you go to consumer centricity in a healthcare space. Nothing about historical healthcare is built around the consumer who becomes a patient. It's built around our processes, our waiting rooms, our complexity which we can be so proud of, our complexity, our referring physicians. And it's been a big lift to say, you know what, we're going to put the patient front and center in a different way. Now listen, our clinicians love the patients they take care of. I don't want to create the impression they don't. But when healthcare really becomes consumer centric, it looks different to the way exactly what Mohan was talking about. The way you run your operations through your hospital that is committed to get patients home earlier in the day, to decrease the wait times, the delays, how they're communicated with. Imagine leaving with a plan of care you understand and is actionable. Those are all things that in consumer centric businesses they deliver on. And healthcare, we're committed to making that better for the patients we serve. So yeah, that's why the vision is we have a lot of lifting to do as we get into 25, 6 and 7. But we're very committed and I think we're positioned well to do do it.

[Moderator]

David, sounds like one of the pieces you might be needing to advocate for. More than one would expect is just the simplicity. Can you expand on your remark? We can be so proud of our complexity.

[David Banks]

Well, it's, you know, listen, healthcare and I've been in it a long time and I started as a psychiatric social worker. I still. What I love about Mohan's comments is I was a discharge planner in a hospital early in my career and everything he's saying is true and we just get caught up in our complexity and sometimes forget there is a person in the middle of the story and no patient wakes up in the morning, no person wakes up in the morning and says I hope I get to go to the hospital today. For 95% of who we serve, we are an unplanned interruption in their day. Now trust me, they're grateful for the care. They're looking to be cared for, rescued. I agree with Mohan. The rescue system that we have built in the US is, and I'll use his words, is just, it's magical. The technology and the interventions that can happen. The problem is healthcare will sometimes objectify the person in the process and loses sight of. It's a person with a story and a family and a community and they're very eager to get back to the Things that matter most. And we need to make sure we're managing our complexity, handling our end of the bargain so they get what they showed up for and get back to the things that matter most.

[Moderator]

Yeah. So well said. So well said. And I love your note too, about pilots don't just land the plane and say, okay, we've arrived. And Mohan, you often compare health systems to airports. In this ideal state where every health system is running like the most efficient airport. I know you have your favorites, where every gate, every crew, every plane just so tightly orchestrated. When you look at these large integrated systems, where do you see the greatest risk of them falling short on that level of coordination?

[Mohan Girardidas]

I mean, the complexity is real. We can't just wave a wand and say, make the complexity go away. Because at the end of the day, what healthcare accomplishes is unimaginable. Right. Imagine they cut open people and do stuff, and the people walk out of there that day. That itself is magical. Right? So respecting that things can be simplified, but at the end of the day, it's a very complex thing that healthcare does and deserves all of our respect and gratitude. But if I look at it operationally, hospital operations is like a hub and spoke network for the airlines, right? So if you think of it as nodes being the big centers ors inpatient, et cetera, and edges being the connecting, every patient has a unique path through the nodes and edges. Some bounce through labs and then pharmacy and then care. Some bounce through ed surgery and then a bed. So everyone's got their own flight path through. Now, when you think about optimizing a network of nodes and edges, the cardinal rule is you have to do the nodes before the edges. This is why Amazon will automate the warehouses before it tries to do drone delivery. This is why Cisco will make its routers faster before it makes its pipes fatter. Healthcare got it wrong. They tried to do edges before nodes. What they try and do is hold the patient's hand and coordinate them through. That's why you've got case managers and coordinators and coordinators who coordinate the coordinators.

[Moderator]

Right.

[Mohan Girardidas]

You cannot navigate your way to heaven. The nodes have to have capacity. The simplest way to think about it is we all go to the grocery store. Pretend you're not in the pandemic where there are shortages in hand sanitizer, etc. But the grocery store. The nodes are the bakery node, the dairy node, the cheese node, whatever. When have you ever waited to reach the bread on the shelf? Never. There are 200 people in the grocery store. They're all flying through with nodes and edges in their own unique patterns. The nodes have capacity. The edges are not a problem. No one needs to coordinate you to go from one aisle to the other. So when you think about why is nodes and edges and hub and spoke so brilliant? Delta serves 200 airports in the US. 200. Do you know how many hubs they have? Nine. That's it. Nine across the U.S. now here's the interesting thing. Compared to 10 years ago. 10 years ago, Delta moved 160 million passengers a year. Today they move 200 million passengers a year. That's 3 or 4 million more per month. Hundred thousand more per day. Let's talk about how you might pull it off. You might say, I bet they have more flights. Nope. They had about 5,000 flights then. They've got about 5,000 flights now. You might say, I'm sure they got bigger planes. Nope, they got out. They got rid of some super small planes and they put slightly bigger planes. But the average number of seats per plane is roughly the same. Faster planes? Nope. Same old planes that were flying 10 years ago are flying today. So what did they do? How did they move 3 million more passengers a single month? They did two things that are stunningly brilliant and are stunningly applicable to healthcare done the right way. One, yield management. Okay, so they know how to fill their planes better now. They've got pricing as a lever, which healthcare doesn't have. But think about the sophistication. Every day Delta flies a million people. You can buy a ticket 300 days into the future. So there's a 300 million seats of inventory up for grabs every minute of every day. They know the supply, demand, balance for every seat. They can tell you right now the 7:00am flight on June 1st, Jacksonville to New York, is running hot. Don't give away award seats. Don't give away discount seats. It'll be fine. Because every flight has got an S curve projection for how it'll fill. And they know it's filling ahead of plan or behind plan. That's how sophisticated they are. We've all noticed the planes are more full. What does that have to do with healthcare? It's utilization. It's better filling the planes better. It's filling the ors better, filling the beds better. It's utilization. The second thing they do is they don't care about the outlying airports. They don't really care how quickly Tuscaloosa turns people through the gates. They just don't care. They focus on the hubs. What do they do in the Hubs, they run the hubs tight. So if you go into Atlanta and watch hub operations, they run what are called banks. Eight or nine rolling banks a day. So what's a bank? In a normal 15 minute period, there'll be five arrivals or departures.

[Molly Gamble]

Five.

[Mohan Girardidas]

In a 15 minute period during a bank, there will be 25 arrivals in a 15 minute period. That's how they're coming in. So what happens? They have a bank of arrivals, which is like a surge on arrivals. 25 planes land, 5,000 people descend into the terminals, they run around like hamsters on the treadmill to find their departing flight and 45 minutes later there's the surge of departures that all take off. And they do this rolling bank eight times a day, nine times a day. What that's done is it's got the hubs moving faster. When the hubs move faster, people move and the whole system moves faster. So the hubs in the hospital are the ed, the or the inpatient the imaging. Get the hubs right, get the utilization right through math and you can move this. The spokes in a health system are the feeder points, ambulatory clinics, surgical clinics, off campus imaging centers, et cetera. So the mathematics of hubs and spokes and nodes and edges is doable, it's knowable, it's predictable. But it's not going to happen by gazing at a dashboard. Scoreboards don't win football games. Better players win football games. And so it takes the crazy math to do that. And healthcare is addicted to its dashboards. And so the dashboards get distributed. We could have given everyone at the super bowl an iPad with the current score and the Chiefs would have still lost. It wouldn't have changed the outcome. So that's kind of how we think about it.

[Moderator]

I would love to hear from you here, David. I think Mohan, as you were describing, the banks use 25 arrivals, these 25 departures, eight times a day. You described it as a surge. So often in healthcare, surge is not a positive term. You know, you mentioned it's tightly coordinated plan surges can pop up in healthcare and it's usually a rather concerning context. But David, let me just turn to you and see if there's something you want to react to based on what Mohana just shared.

[David Banks]

He's absolutely right. And just the routine surges that happen, everyone wants a 7:30 start time in the OR. And so you want, you're going to have in a big place like Orlando, 50 surgeries, 75 surgeries, wanting to start at 7:30 by 3:00', clock, no one really wants to be operating other than what's coming through the ER. We see the same thing in the ERs in terms of at 8am, you're going to walk in, it's probably going to be quiet, and there's just the curve pattern of it. It's very analogous, I believe, to what Mohan, you're talking about inside of airports. Much like the airlines, they know when people take off and land, they know when the flights are booked. There's a lot of predictability in those waves in hospitals, but to the earlier point, that was made without the sophisticated solutions, every day you're kind of putting out the same fire. And it's a predictable fire for a lot of systems. And so these kinds of technologies that we're talking about, we do run a large command center in our biggest facilities. But there's a lot to learn from the things Mohan is talking about in terms of the predictable patterns, the tide coming in and going out. And I completely agree. If the ORs, ERs and ICUs are moving, probably the hospital's fine.

[Mohan Girardidas]

That's exactly right.

[David Banks]

And so those, those zones are very analogous.

[Mohan Girardidas]

It's interesting that, you know, when you talked about the every surgeon wants to operate at 7:30 and no one wants to operate at 5 o'. Clock. Understandably, healthcare has ended up designing its operation around its people, right around the surgeons. So imagine if I tried to apply for a job as a pilot at Delta Airlines and said, guys, I fly Monday through Friday, 7 to 3. Right. You don't get to be a pilot because that's not how the operation works. Not suggesting that we should be operating at midnight, but there are things you can do on the margin. For instance, recruiting a new surgeon. Rather than just saying, when would you like to operate? You'd say, congratulations, Molly, we'd like to offer you a surgical position in our neurosurgery department. We'd like you to operate on either Tuesdays or Thursdays. Which one works better for you as opposed to, when would you like to operate? Little things like that can start to shape the.

[David Banks]

The cuff, no question. That's a great idea. Great thought.

[Moderator]

I want to wind down here by asking both of you, you've kept your remarks. I appreciate how candid you've been and how I appreciate all the metaphors and the analogies that you've used to talk about this issue. It's a really big one. It's a thorny one too. I think complexity is real. Like you noted, it also can't be the reason that we don't try to innovate and find new ways and redesign when we talk about this transformation with capacity. You've both seen it from inside the health system, one at the strategic partner. What would you say is the hardest truth about this topic that healthcare leaders need to hear, but maybe too often don't, or maybe just don't want to hear. What comes to mind for you, Mohan?

[Mohan Girardidas]

I think one is health systems have to just get better at prioritizing the initiatives they're going to do because doing 10 things in a half hearted way is less effective than doing two things really well and then picking up the next two things to do really well. So that's kind of one. Second is I don't think healthcare has had an opportunity to learn how to make the right trade offs between building, buying and partnering, because that's a hard thing to do. Well funded health systems tend to want to build a lot themselves because they can do large complicated things. So they assume, hey, we should be able to build it ourselves. And then what happens is they end up with a team of data scientists and some application developers and suddenly there's not a problem that they cannot do internally without fully appreciating that even a small software solution takes tens of millions of dollars to build, to support, to maintain, to enhance, to have customer support, et cetera. Think about JP Morgan. They've got a $10 billion IT budget, they have 20,000 software engineers. Do they build their own spreadsheet program? No. They pay Microsoft 200 bucks and they use Excel. That's what they do. They focus their engineering resources on things that are uniquely something they can do as opposed to something they can buy. So this trade off between buying, building and partnering, you know, is, is one thing, then what happens? Because of this prioritization, healthcare gets overwhelmed and does a shortcut. As we talked about earlier, the EHR can do everything. So we hear Epic first or you know, Cerner first or whatever the EHR is. I think that's a fine strategy if the solution is equivalent to the best in breed. Otherwise it's a bad idea because accepting an inferior solution just because the EHR has it is actually more expensive to the healthcare than not. You might save a buck on an external vendor, but then you're losing five bucks or what you could have got had you had a better solution. And so it's the fallacy of the sunk cost logic, right? So from finance school, if you make a sunk cost, it's behind you. You shouldn't use that to Influence a go forward decision. It's a bit like saying I spent $50,000 buying a car, so by God I'm going to teach my kids to water ski using the car by driving along the side of the lake. No, it wasn't built to go water skiing. I should get a boat if I want to teach my kids water skiing. And so that's the thing I think about. Eventually the transformation will come from 1,000 companies that haven't been born yet. Think about the early days of the Internet. If we had said IBM will do it, we don't have to worry, we'll have an Internet and IBM is in charge, we would have nothing. The thousands and thousands of companies that have given us the Internet that we know and love and take for granted and hate is because of all of those companies. The same thing's going to happen in healthcare. The next wave of transformation is going to get driven by literally 10,000 companies and I would say 9,950 of them have not been born yet. That's kind of how we see it.

[Moderator]

David, I think that's about three or four hard truths there from Mohan. Let's turn to you. A hard truth about transformation as it relates to capacity or more that you think healthcare leaders like you need to hear, but maybe too often don't.

[David Banks]

Well, I think there's a couple and I would endorse what Mohan said as well. I heard a quote the other day from someone that said, you know, systems that have resources tend to rely on resources before resourcefulness. Right. So they think they're going to capitalize their way out of a problem when in reality there's a couple long. Especially for community based hospitals. I'm not talking about academic institutions, but if your hospital has historically relied on a medical staff and in the old passive workshop model, these are some deeply ingrained operating patterns that go back 10, 20, 30 years. It's a little bit like the roads across the country are built where the wagon ruts are. Much of that is the same in terms of the way med staffs functions and the way hospital operations have built up around those. And so there's just some old patterns that Mohan is right need to be challenged to. We have put millions of dollars of new technology to change the way we treat your heart. We still run some of the operating things the way you would have seen in 1970s, 1980s, 1990s, House supervisors running schedules, clearing beds, making rounds, doing huddles. There's just a much more sophisticated way. I had an opportunity to be in Overseas not too long ago and I saw a car manufacturing plant. This plant made 330,000 cars in the previous 12 months. Only two were identical cars. And that's because the person ordering it ordered the same thing twice. And this includes paint booths, body assemblies, wheel and you watch the factory floor. They have completely automated and pre planned what custom builds, but they've done custom builds at scale, highly efficiently and there's just that philosophy and technology has got to make its way more into the way we do CoreOps. And I think Mohan's concept around hubs is exactly right. A proof point of that is when I look at our freestanding ERs, our ERs away from a hospital, they run so much more efficiently. A lot of the patient mix look similar but so why does that hub work so much better than a hub that happens to be connected to hallways of beds, ORs and ICUs? It's just the sophistication of how the logistics are managed through that. And there's just some modern modernization that's got to come to it. And it's challenging old dogmas. It really is challenging old dogmas about what you can do and what you have to be willing to do.

[Moderator]

Right? David, I love that relying on resources versus resourcefulness quote. That is a great one. I wrote that down. I want to thank each of you, Mohan and David. I mean this is just a very rich and thought provoking conversation. The wheels are certainly turning in my head, I imagine for our listeners too. And it just underscores capacity. It's not just a buzzword. It's going to be such a defining issue for health systems now and only more to come in the years moving forward with aging populations, growing demand, especially like you said in Florida and other high growth markets, David, and this constant pressure to do more with less. So I really appreciate how you're approaching this work. One from the helm of a large and growing system, the other as a strategic partner to many. And thanks for offering your perspective on this topic for healthcare leaders everywhere.