Q&A with Anika Gardenhire, CDIO, Ardent Health Services: “Innovation Doesn’t Need to Be Flashy.”

As artificial intelligence continues to dominate strategic discussions, one of the biggest mistakes healthcare organizations can make is to jump too far ahead. Doing so, according to Anika Gardenhire, can result in incomplete data sets, which can then lead to bias. Instead, leaders must focus on ensuring the right infrastructure and repeatable processes are in place before turning on the tools. “Part of the difficulty of what’s happening from an AI perspective is that we keep wanting to skip steps,” she said in a recent conversation with Kate Gamble. “It requires real intentionality and work” – something she and her team have not shied away from.

During the interview, Gardenhire talked about the approach she has taken since becoming Ardent’s first chief digital and information officer in the fall of 2023, which started with a lot of listening and has progressed to exploring innovative initiatives such as virtual nursing. She also shared perspectives on what it takes to drive change successfully, what innovation should really be focused on, and what she loves most about being a leader.

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Bold Statements

I’m an operator, a nurse, and a technologist. And so hopefully, I get to bring all of that to bear in my daily life.

My opportunity was to come in and get an even deeper understanding of that; to understand the goals and business strategies of the organization. And then to say, how do we truly wrap a technology strategy, a digital strategy, a data strategy, and an EPMO strategy around that.

I think as we understand the things that we want to do from a front-end perspective, the backend becomes mission critical… we have this awesome art picture, and now we need somebody to create the actual city plan.

The biggest piece is ensuring that when we think about innovation and when we think about new technologies, we truly understand where they are on the hype cycle, and be prepared to understand how we’re going to support them.

Innovation doesn’t always need to be flashy. It needs to decrease friction. It needs to solve problems. And we need to think about ensuring that it’s doing exactly what it said it’s going to do, which is creating improvement.

Q&A with Anika Gardenhire, Chief Digital & Information Officer, Ardent Health Services

Gamble:  Hi Anika, thank you for putting aside some time to speak. I know there’s a lot going on, so we really appreciate it.

Gardenhire:  Absolutely, I’m happy to do it.

 

Gamble:  I’d like to talk about your role and what your team is doing at Ardent Health Services. It’s interesting; we’re seeing more and more chief digital and information officers in the past few years. That’s been a definite shift. But first, let’s get some information about Ardent. You’re a large system, about 30 hospitals and more than 200 sites of care, and you’re across multiple states, correct?

Gardenhire:  That’s right. We operate in six states across eight markets and have a very robust organization around caring for patients across the continuum. That continues to be the goal for [CEO Marty Bonick] and the executive leadership team and the board.

 

Gamble:  As far as your role, can you give an overview of what are your core responsibilities and what’s under your purview?

Gardenhire:  Sure. So, you mentioned there being more chief digital and information officers now. I find myself super excited about the formation of this type of role. I actually had a digital role prior to coming here which was all about the front end of digital and how people interact. It was app-based and web-based and focused on telephony and how you create experiences, which is wonderful. Of course, all of that sits on an important infrastructure, is surrounded by security, and has crystal clear compliance metrics. I think the role is evolving to bring that together.

Building on quicksand

The example I like to use is that if you can’t align those things, then you’re building really pretty buildings on quicksand. Because you have to shore up your infrastructure. You have to have enough bandwidth. And as you make the transition to cloud, you have to ensure that your network is going to comply.

I’m excited because I have responsibility for our consumer area, which is all about how we interact with people and consumer experience. I have responsibility for technology, which includes infrastructure, telephony, and network, and all the ways in which people think about it. I have responsibility for data and the EDW.

And so, it’s really looking at security holistically and how that works in partnership with internal audit, risk, and all of those places. For me, it’s an opportunity to bring the entire strategy together in partnership with the leadership team to ensure that there’s alignment all the way across. I have responsibility for our enterprise project management office (EPMO) to generate value-creation initiatives and look at how we’re managing our way forward. If you think about it, I’m an operator, a nurse, and a technologist. And so hopefully, I get to bring all of that to bear in my daily life, which is really cool.

 

Approaching the CDIO role

Gamble:  Ardent didn’t have this particular position before; you were the first. With that mind, how did you approach it? What was your strategy?

Gardenhire:  I tried to approach it from an understanding of what the organization was about. For Marty [Bonick], it was taking his vision of technology and his vision of experience, and creating a digital experience and permeating that into human interactions that can support the strategy and vision.

He’s definitely a forward-thinking, visionary, and technologically adept CEO. And so, my opportunity was to come in and get an even deeper understanding of that; to understand the goals and business strategies of the organization. And then to say, how do we truly wrap a technology strategy, a digital strategy, a data strategy, and an EPMO strategy around that so that we can execute?

“Now it’s time to drive our strategy forward”

And so, I started the way most leaders start: with listening. I did that and there were some big items along the way that allowed me to do some rapid learning. Then, I had the opportunity to get with the leadership team and say, ‘now it’s time to drive our strategy forward. It’s time to be crystal clear about how we’re going to execute. It’s time to understand exactly how we’re partnering and help leaders realize how that vision is coming to life, which has been amazing.

 

Ardent’s new CDO – “creating a data store”

Gamble:  You mentioned the leadership team. I saw that Ardent recently added a chief data officer and a chief technology officer. Is that a reflection of where the organization is headed?

Gardenhire:  Absolutely. I’ve been incredibly fortunate to have great leaders and to hire great leaders, and I had the opportunity to think about what the leadership team looks like now that I had a good understanding of the vision and where the organization wants to go. It was getting crystal clear about data and creating that data store and data foundation where people can come in order to answer questions, create information that’s required, and create analytics products. Having that laser focus there was incredibly important.

We had incredible support around filling the role [of chief data officer], and it’s been super exciting to have that leader on our team.

New CTO to “round out the team”

From a technology perspective, prior to this we had a different structure. But as we looked at what’s happening in the market, we saw that the chief technology officer role is incredibly important. And I think as we understand the things that we want to do from a front-end perspective, the backend becomes mission critical. The way that I think about it is, we have this awesome art picture, and now we need somebody to create the actual city plan. This is where the buildings are actually going to go. This is how traffic is going to move. This is how we’re going to create enough bandwidth in order for things to work. And so, I’m incredibly excited to have our new chief technology officer on board.

To me, both of these leaders round out the team from a cultural perspective. And so, we’re incredibly fortunate to have an amazing group of leaders on this team with varied backgrounds, from deep business to super deep technical to policy. That creates an opportunity for us all to learn from each other. I’m humbled to get the opportunity to call myself their leader. Every day, I learn something from them.

Security at the forefront

Gamble:  That sounds like a great situation. So, what are the really big things on your plate right now?

Gardenhire:  The big things for us probably aren’t dissimilar from what most leaders in my role are thinking about, but with some nuances. I’m always thinking about security at the forefront. Healthcare leaders have a huge responsibility to keep our patients’ data safe. We’re working really hard to ensure we have a robust strategy there.

From a data perspective, our organization has grown a lot through acquisition, which is a lot of work. The interesting thing is, as we look to the future around things like artificial intelligence, it’s top of mind to ensure we have the infrastructure required to do that and that our data is in the right place in order to make best use of what’s happening with large language models and the new compute power that’s going to drive machine learning algorithms to the next level. I think we’re doing a good job keeping pace with the industry.

Uptime goals

It’s also thinking differently about how we make best use of that work in our consumer experience. We have a chief consumer officer who is an incredible visionary. For me, I get the opportunity to watch our chief consumer officer and chief data officer get together and talk about what is the infrastructure required? How do we create trust frameworks with our patient population so they have an understanding of how data is being used? How do we bring that power to life for them in order to create differentiated experiences?

That’s top of mind for us: everyday execution. We want to achieve 99.9 percent uptime and reliability, and think differently about how we make sure our data is coming together from a value perspective to improve human life.

 

Creating opportunities with AI: “Focus is important”

Gamble:  It’s really exciting. There’s so much potential with these tools, but one area that’s really starting to gain traction is to improve automation.

Gardenhire:  Absolutely. This is where focus is incredibly important. Most of us have moved with the industry when it comes to things like robotic process automation, removing repeatable tasks, and finding opportunities to reduce redundancy and do more with analytics. That’s been our approach. One thing that’s a bit more unique is that we’re thinking very specifically about how to support the clinical experience and the broader consumer experience. For instance, something like virtual nursing, with computer vision and all the things that support that.

From an analytics perspective, we’re thinking very specifically about creating those personalized experiences across the web in a very compliant way with some of the changes from a regulatory perspective that have happened recently. It’s also being able to create unique differentiated experiences — some of that comes from our broader strategy to become a partner for the consumer across the lifespan.

Well health, not just sick health

And that means from a digital engagement perspective, I’m looking for more at different times. In addition to having those things be aligned to when you need what I consider our ‘sick services,’ it’s also being part of your well journey. How we create experiences that allow us to do is very important to the overall mission of the organization.

 

Involving nurses

Gamble:  You mentioned virtual nursing. That makes a lot of sense to me, but it’s only of those things where you need to make sure all the pieces are in place.

Gardenhire:  One hundred percent. It’s amazing when you think about the number of things that have to come together in order to make virtual nursing effective. I think the biggest piece is ensuring that when we think about innovation and when we think about new technologies, we truly understand where they are on the hype cycle, and be prepared to understand how we’re going to support them.

I’m incredibly fortunate to have really innovative partners. We know that you can’t do virtual nursing without nurses. Nurses have to design virtual nursing. I’m a nurse by clinical background, but I don’t practice at the bedside. We have a really innovative CNIO and CMIO who help drive change management and ensure that we’re getting the voice of the customer inside of these projects. They’re helping us design and test new processes and ensure we’re keeping patients safe.

Solving “actual business needs”

Anytime we’re thinking about these new technologies, having a business partner with a super innovative growth mindset is the crux of success so that at the end of the day, whether it’s in our revenue cycle department or finance, we’re thinking about opportunities to utilize these new technologies — for example, fall prevention or virtual nursing. It’s ensuring we have alignment with the business and that we’re solving an actual business problem; that’s the most important thing for our team.

Everyone feels good when we can point to things like patient outcomes, nursing retention scores, or nursing engagement scores and we’ve lightened the load — or we’ve been able to retain someone who was going to exit the profession. That’s what we’re looking for. That’s what it’s all about.

 

Data bias – “We keep wanting to skip steps”

Gamble:  That’s the ideal scenario, right? One of the other things I want to talk about is data bias. There was a speaker at ViVE who said something along the lines of, ‘data bias is nothing new. It’s been around a long time.’ What are your thoughts on how to address that?

Gardenhire:  I agree. I think that part of the difficulty of what’s happening from an AI perspective is that we keep wanting to skip steps. One of the cool things about new technology is that in order for it to work, these 17 things have to be true. You need this infrastructure, you need this compute, you need these types of massive data sets, and you need to make sure that all these people are included. You need to be able to do A/B testing, and you need bias-checking in your algorithms. All of these things need to be true for you to have a really effective solution that has passed the science rigor to be able to be used on humans walking on the earth every day. For me, it’s about making sure you have that infrastructure and those repeatable processes inside of your shop; that you’re not assuming there’s an opportunity to skip steps. Because there are not. You cannot skip the steps.

What’s missing?

One of the things I’m always concerned about is, what’s missing from the dataset? As we think about where we’re sourcing the data and how we’re utilizing it, we need to think about what might not be there. And so, as you’re running algorithms and gaining new knowledge, how do we ensure we’re also thinking about the completeness of our data sets? It’s one of the easiest ways to cultivate bias. There’s bias in the development of the algorithm — you can test for that. There’s bias along the chain that math can transparently help you figure out. Having an incomplete data set is harder to test for; it’s harder to figure out.

Driving toward collaboration

My hope is that we’re going to then have that drive us toward more data collaboration. If there’s a big, urban market that has a certain type of data, we’re going to get to a place where we can sanitize and create trust frameworks and appropriately share data for the betterment of outcomes for our populations. Because I do think we really struggle with traditionally not having the most inclusive data sets, and then we draw incomplete inferences. It requires real intentionality and work. It’s not an accidental phenomenon.

That’s the other part that I think is so important to help get to a place where we don’t have bias. It’s overcoming a human reflex, right? We all walk through life with bias. It’s not a denigration. Engineers are not immune; product teams are not immune. I am not immune. And so, in order to overcome what is so natural to us as humans, we have to be very intentional. And I think that the places where we often suffer or find it on the backend is when we haven’t been intentional enough about ensuring we’re going to overcome it.

 

Gamble:  I agree completely with what you said about not skipping steps. It’s so important.

Gardenhire:  It’s funny; when you think about the historical conversations around data, there were times when we talking about master data management. Then it was data quality, then data lineage, and then understanding your data supply chain. Now we have AI; but in order to make that work, we need all those things we’ve been talking about for the last 10 years. We need all of those to have happened in order to be here.

 

Change management “is critical”

Gamble:  Really interesting. So, judging from the way you’ve answered some of these questions, I feel like change management is really important to you. I want to get your take on how you’ve made that part of your philosophy.

Gardenhire:  Absolutely. One thing I always hope for is that change starts with the voice of the customer and that we deeply understanding the problem. To do that, we need to ensure customers are incredibly involved in how we move forward. Clinicians, providers, operators, administrators, revenue cycle teams and broader digital teams and technology teams are all serving ourselves to make sure that voice is there. At the end of the day, change management and adoption is critical.

My team hears me say this all the time, but the goal is to have a human do something different tomorrow than they did today, because we did something different. At the end of the day, that’s the target. You want whatever you’ve done or implemented to have an impact; in order to have an impact, it needs to be adopted.

That could mean you need people to stop doing something they’ve done, because now technology will do it for them. Either way, getting people to actively change is at the crux of being able to deliver outcomes and being able to realize any type of value or improvement from what we’re producing. That’s so important. We have to think about that in the design of these solutions. That’s why we need customer involvement.

Improvement over flash

I’m a big fan of the Calm Technology books. I think innovation doesn’t always need to be flashy. It needs to decrease friction. It needs to solve problems. And we need to think about ensuring that it’s doing exactly what it said it’s going to do, which is creating improvement.

And so, whichever change management process you choose — it could be Prosci or Bridges or something else, be very intentional about having a methodology, and follow through in aligning it with your project management methodology and resourcing the actual change management functions within whatever it is you’re trying to implement. At the end of the day, that will make or break the ability to be effective.

 

“Lifetime learners”

Gamble:  For sure. I know we’re running up on time, but there’s one more area I wanted to cover, and this is something I really like to ask leaders. What attributes do you look for in people, and when you see potential, how do you work with those individuals to help them grow as leaders?

Gardenhire:  That’s such a good question. I guess it depends. If I’m looking for someone for a particular role, I think first about what they will bring to the team, in a holistic way. My perspective is that, especially at leadership levels, most skills can be learned. I’m looking for folks who want to continue to learn new things. I’m looking for those lifeline lifetime learners; folks who ask questions and who want to cultivate and build great teams.

When I think about trying to create sponsorships or grow leaders, I’m thinking about what that fit looks like. Can that person gain something from me, and do they have an openness to share with me so that I can learn from them as well? That’s what I’m looking for with mentorship or sponsorship relationships.

I love growing and cultivating teams. I think it’s one of the best things that we get to do as leaders. When you look at your team, you might find that you have one person who lives out the checklist manifesto every day, another who is the best accountability partner, and another who could be coach of the year because they’re so inspiring. When you bring that together, you cultivate a team-first spirit among that group, and there’s literally nothing that that team cannot accomplish. For me, I’m looking at how does an individual come together as a part of that team? What are the missing pieces in order to cultivate the ability for that group to go to the moon? Once you figure that out, there’s no stopping them.

 

“This is a team sport”

Gamble:  I really like how you answered that. It really is all about building the right team.

Gardenhire:  Right. And if that dynamic is disrupted, it’s so detrimental. It’s so difficult to overcome that. And so, ensuring that a person sort of fits into a team is really important. Individually, when I’m mentoring or sponsoring someone, I try to help people cultivate who they are so that they can clearly articulate what they bring to a team. This is a team sport. Period. There are no individuals here. At the same time, you need to be able to cultivate and articulate what you bring to an organization. ‘This is how I fit. Here’s how I like to work.’ Being able to do that for yourself is really important.

I often tell mentees, figure out those places where you’re willing to bend but won’t break. There’s going to be a lot of cultivation along the way. I am not who I was 20 years ago when I entered the workforce. And there are some things about yourself that you want to keep true; they align to your values and your personal mission statement and how you want to show up every day. Figure out what those are so you can hold tight to them while you have the benefit of folks forging you in the fire.

 

Gamble:  Wow. This was great. You’ve given me a lot to think about. Thanks so much for your time. I’ve enjoyed speaking with you!

Gardenhire:  Absolutely. Thank you for having me.