This is Scott Becker with the Becker's Healthcare podcast. I'm joined this week, which we often are, by Laura Dierda. Laura is the editor in chief at Becker's Healthcare. Just a phenomenal leader. She serves with us weekly some of the stories that she's watching closely. Laura, let me tee you up and ask you, what are some of the stories that you're watching closely currently? Thank you so much, Scott. And, you know, there's so much happening right now in the health care space, especially, you know, getting towards the end of the year and looking into what's gonna be important for hospitals and health systems to plan for and, really get rolling for 2025. And so it's just been really fascinating to see all the different, projects and initiatives and hear about the things that health systems are are really planning to, focus on in the next year. And I think one of the things that actually, was a big area of focus for health system executives this past year was looking at labor expenses in workforce redesign in some ways to try to control those costs and figure out how they can make sure they are approaching their labor workforce management, etcetera, in a thoughtful way so they can really control the cost there. Of course, that's been, the biggest area of expense for years years, but particularly since the pandemic, those labor expenses have increased at a rapid pace and grew at really high percentages. And so over the last few years, there have been a lot of projects and initiatives that health systems have gone through to try to really control those costs, including recruitment and retention efforts as well as trying to improve efficiencies, incorporating AI, and really doing some different things, to redesign their workforce, to make it more efficient and effective. And looking into whether those initiatives have worked or whether hospitals across the board have meaningfully been able to reduce their administrative spend and, labor costs is a little bit of a mixed bag. Fitch reported recently that labor expenses are still above pre pandemic levels, potentially a new normal, but the rate of growth is declining. So those labor expenses and and payroll have continued to grow for the last several months for hospitals and health systems. Hospital payrolls have increased every month for the past 35 months, but in the past, you know, those increases have been large, 4, 5, 6%, whereas when we're looking at hospital employee average hourly wages, that increase for this year on average dropped to about 3.2% per month. And so you're seeing a little bit of a a drop in slowdown with some of those expenses and some of the payroll increases that we have seen in the last year, but it's still relatively high. And so, you know, a lot of hospitals and health systems are keeping a close eye, and trying to continue to figure out ways within the next year that they can continue to, ratchet down some of those expenses and, if possible, really get themselves in a place that they are a bit more stable where growth is a little bit lower, so they can focus some of their those resources into other areas, along the patient care side without, of course, compromising quality. I I know, especially thinking through clinician shortages and staff shortages, really are are pressures that can make those expenses increase even for full time staff members as you're recruiting in new teams and even if there's low turnover, it's still so important to, have competitive salaries as much as possible. And so, you know, I think that's something that a lot of health system leaders are grappling with and trying to continue to to figure out. I think there's some good news again, you know, looking at the way that growth has slowed, but it's still a huge, huge challenge for health system leaders and executives going forward. So so take a second there. Are you seeing sort of, cost staffing costs are coming more in line but still a challenge? Is that the take home, or what's your sense of that? I mean, people are relying as much on outsourced labor as they were, travel nurse as they were. So so staffing's getting a little bit better, but still challenging. Is that the take home? Yep. Absolutely. That summarizes it perfectly, Scott. So, you know, we're seeing, things improve a bit. We're seeing those costs initiatives are definitely working, and we're we're seeing those costs lower. It's just not low enough, to kind of return us back to the pre pandemic levels or low enough to where, you know, most organizations aren't feeling a pinch because of their labor expenses. So as a result, hospitals and health systems are not only continuing to focus on the workforce and trying to find new waste control costs there, but they're also, you know, looking at the other departments trying to figure out how, they can focus on supply chain management, engage in revenue cycle improvements, as well as reduce length of stay so that they can bolster their financial performances, you know, and make sure they can still have that pay their teams and really be competitive on the staffing side, you know, without cutting corners on quality of care. Thank you very, very much. So besides staffing and the cost there, what else are you watching closely currently? Well, you know, this year has been a fascinating year for d suite leadership and in particular CEOs. I mean, we've seen some really, really inspiring and, engaging titans in in the health care space, you know, continue to bring their organizations forward and be successful. However, we have also, especially in the last week or so, seen some big, announcements of health system CEOs retiring or, leaving their organizations after long tenures. In in particular, AdventHealth CEO Terry Shaw announced recently that he plans to retire next July after 40 years with the system. He shared in a video message with his team that he wanted to depart, and leave so that the next generation of leaders could step in and guide the system forward. Mister Shaw took on the CEO role in 2016 after spending time as a CFO and COO. He unified the system under a single brand during his tenure and created a a 10 year strategic plan, the systems division 2030, which has really been, you know, instrumental in some of the, ways that AdventHealth has been able to weather the last several years and then continue to grow and develop and, be successful in its markets. And so, you know, just really, you know, looking at, his leadership and and has been a great partner with Becker's as well. Just really fascinating to see his then handing the baton onto the next generation of leaders to really carry the system forward. We also heard from, UC Davis Health CEO, doctor David Lubarski, announcing plans to retire from his role in February, and then he will become CEO of Westchester Medical Center Health Network in New York. While he was at UC Davis, doctor Lubarski oversaw around 60% growth in patient volume and spearheaded several community based initiatives to expand access to care and underserved populations. And, again, this is continuing a trend from this last year. Another big CEO who announced earlier this year he was going to retire was Providence's, CEO, doctor Rod Hochman. He'll be wrapping up his, tenure as CEO at the end of this year and sticking with the system, you know, in a emeritus position in, you know, providing guidance. But it it's fascinating, time in health care right now, especially with all the dynamics we've been talking about on this podcast all year, those clinician shortage, cybersecurity risks, incorporating AI into organizations, and, really compounding some of the financial challenges and really big headwinds with, payers and more over the next year or so. So just seeing those, big CEOs then passing on to the next generation, it it got me thinking into what it will take to be a leader, within, you know, the next few years and really shape the health industry going forward. I've been asking c suite executives just that question of how they're evolving as leaders during this kind of incredible moment of health care, and, you know, they're telling me that they're really, planning to just continue bringing the energy and passion to stay abreast of how quickly health care is changing. That's no small feat, to really have your finger on the pulse of everything that's happening on the state, national, and local levels, as well as staying connected with within their broader network of executives to help guide their organizations forward. The leaders also are seeing the need to be, you know, really super connectors and have ability to form meaningful relationships and find those win win middle grounds with either former competitors or, adversaries within the market so they can take that creative spirit they have, to forge new and interesting partnerships and and development so that they can thrive in the future, especially among so many uncertainties with a new administration coming in next year. And as always, I'm hearing a lot of folks say, not new, but the humility and ability to listen, certainly is going to be paramount in the next year, you know, not really valuing necessarily the leadership style that, would really be, more of a of a, figurehead, but being able to actually, incorporate, you know, who they are into their leadership and be genuine, passionate, in in making sure that their organizations feel, that they can be connected and heard and are part of the growth of their organizations going forward. No. It's a fascinating, fascinating point. Because you look at the jobs of these people, like, you know, some of them are running organizations. Tens of 1,000,000,000 of hours, 70,000 or more employees, and the point of being able to provide leadership strategy, stay centered, build teams, build relationships. It it just is an incredibly challenging challenging job and effort. It's it's it's it's it's all encompassing together. I mean, I remember a very long time ago, early in my career, I spent a lot of time with physicians, and the physicians were often quite negative towards hospital administrators. And at some point, 20, 30 years ago, I started to work really closely with some of the hospital leadership, hospital administrators, and realized what a full time job they have. It felt like it was 247, and it was really eye opening for me. And the job today of running these multibillion dollar systems or running a unit, it is just a real, real job and a lot of hard work. So that your point on turnover of leadership, what it looks like in the future, what leaders look like, how they act, how they deal with it, I mean, that complexity is incredible. Let's hope we got enough leaders in the next generation to take care of it. Oh, absolutely. Absolutely. It's, you know, paramount for us to keep this access to care and continue to, evolve the health care system forward in a way that's gonna be meaningful for all of us, our families, and our communities. So I'm hopeful and incredibly excited about, some of the new leaders coming in, but I know, as you mentioned, it's a big challenge, and so grateful for them as well. Thank you very, very much. Laura, always fantastic to visit with you. Thank you so much for for joining us on the Becker's Healthcare podcast. You're always remarkable. Thank you very, very much. Thank you, Scott. It's always a pleasure.