Workday Podcast: How a Culture of Innovation Creates an Agile Organization

Sarah Hickman Auger: Healthcare leaders are continuing to navigate change and opportunity across the industry, securing top talent, balancing cost constraints, and always pushing forward to innovate, taking advantage of the latest technology. And of course, they’re doing all this in an effort to fulfill the mission of their organizations. I’m Sarah Hickman Auger, industry director of healthcare solution marketing at Workday, and I am delighted for today’s conversation with Vanderbilt University Medical Center’s chief technology officer, Laura Bagus, and Workday ERP coordination director, Chuck Thresher. We’re actually on site at Vanderbilt University Medical Center today in the Workday Forever Forward Bus podcast studio for this episode. Uh, for background for our listeners, Vanderbilt is the most comprehensive health system in the southeast United States with seven hospitals, over 200 clinics providing care for both adults and children. Uh, and in today’s episode, we’re gonna dive into trends in the healthcare industry, talk about best practices for approaching innovation, and leading through change. So welcome to the Workday podcast, Laura and Chuck.

Chuck Thresher: Thank you.

Laura Bagus: Thanks for having us.

Hickman Auger: Let’s jump right in. Laura, we’re gonna start with you. You have been in information technology for 30 years with various organizations, uh, academic medical centers, children’s hospitals. Can you talk a little bit about that journey and your current role at Vanderbilt?

Bagus: Yes. I went to college for computer science, and immediately exiting college, I had the opportunity to get right into a healthcare position, where I really started off as a network engineer, frankly, and made my way all the way up to CTO at that organization, just taking various leadership roles throughout my career there. And after 17 long years there, I had the opportunity to join an academic medical center in Chicago, which I did. Spent six years there helping to stand up their new hospital, and then joined another children’s hospital in Chicago. So I’ve had a great opportunity to work for a number of really great organizations in Chicago. And then this opportunity at Vanderbilt presented itself. And one of the best things for me was that at the last organization I was at, the children’s hospital, we implemented Workday. And when I joined Vanderbilt, we were in the process of kicking off our Workday implementation. So it’s been a really great journey joining Vanderbilt, along with, you know, being able to do another Workday implementation. I have the opportunity to work with a great team, and we get to support all of the enterprise administrative systems throughout the organization, as well as the chief technology role, which is a lot of infrastructure, project management, development.

Hickman Auger: Absolutely. Well, and I’m sure they were thrilled to get your expertise in the middle of a project like that. So, Chuck, let’s talk with you. You have been at VUMC for over two decades, so you have a broader viewpoint there. Can you talk a little bit about your career journey leading up to and at Vanderbilt? And then how has your approach to innovation changed over that time?

Thresher: Sure. I kind of stumbled into ERP work. Coming out of college, I signed up with a consulting company. The first job they put me out was backfilling at an HRISC for an implementation of Dave Duffield’s original ERP. Within two weeks, they said, “Do you wanna learn this? We need more people.” I said, “Sure. I don’t know what it is, but I’ll be glad to do it.” And I’ve been doing ERP ever since, essentially. So, did consulting with that ERP for a decade. And that’s how I ended up at Vanderbilt. Came to do an upgrade here, and just never left. I’ve been here 23 years now. Don’t tell Laura I’ve just been hiding out in the corner. So I’ve been the IT owner for the ERP systems, for student systems back when we were a merged company with the university for philanthropy systems, various administrative systems throughout the medical center, and before that the university as well. As to what I’ve seen change over the years, back when ERP was on-premises, I think a lot of what we did was build around it, was customize it within. And that made it really cumbersome and hard to upgrade. The amount of money and time investment to do upgrades made us stay static, and we just didn’t upgrade near as much, so we didn’t take on the innovation. And, I think what we’ve seen as we’ve moved to Workday and to other cloud apps is we’ve really started setting our dials a little better—setting the dials right to the things that are common across companies, we can get products to do that, like Workday. We can do payroll. Everyone does payroll. There’s no reason for Vanderbilt’s payroll to be different than other people’s payroll. But there are things that are unique to an academic medical center that we need developers for and we need to develop custom for. And that’s where we focus our development time too.

Hickman Auger: For sure. That makes a lot of sense. It’s a great thing about the democratization of software, right? Like, we can streamline a bunch of the things that everybody has to take care of in the cloud and then let you guys have the time to really focus on what’s unique. So, on that topic of what’s unique, Laura, you’ve had experience at Vanderbilt and at another academic medical center. What do you think is unique in terms of the challenges that AMCs face today?

Bagus: Yeah. Chuck and I were actually talking about this conversation earlier today. And while I don’t find them to be challenges. Uniqueness, I think, is the right word. And an academic medical center is unique because of the research component of it. And our job is really to find the right support from an infrastructure perspective, from an application perspective, from a support perspective that aligns nicely with where the researchers are going. And so there’s a big difference between the part of our job where we have to wear a hat, and we have to follow all the regulatory compliance and then supporting another whole portfolio of researchers that don’t have those same requirements on them. And how do you balance that and, and provide them the same type of experience, where it’s secure, where it’s easy to use, but they’re not under the same restrictions that we are when we’re under regulatory or compliance requirements on the clinical and administrative side. So I would say that’s unique, and it’s somewhat challenging, but not in a bad way. I think it’s challenging just in an exciting way. And it really, for us, it just has us think about how we treat these populations differently.

Hickman Auger: You’re almost supporting two different businesses under one umbrella.

Bagus: Exactly.

Hickman Auger: As we think about opportunities, right, you said, it’s kind of exciting to think about treating the populations differently. AI is one of those things that everybody’s excited about. And we’re always talking about how it’s going to make a difference for these people or these people? So how is AI impacting you and your team? And then more broadly, where do you see AI going in healthcare?

Bagus: Great question. We’ve been working on AI for the last year, just I think as every other organization has been, specifically healthcare. And, you know, it’s exciting. AI is built into almost every application now automatically, so it’s not by choice. But we’ve used a very controlled, measured approach to AI at Vanderbilt where we initially started off creating a safe Azure AI space for our researchers to work in. And then as products such as Microsoft Copilot have become available, we’ve really measured what’s the right amount to provide to our end users, what’s gonna provide the greatest amount of value. And so we’ve slowly been introducing different aspects of that to the team. And as AI continues to grow, you know, our organization is really thinking about how we’re gonna have to grow too, how my team is gonna have to grow to support that. We’re doing a lot of really great proof-of-concept work in the clinical space with AI. And obviously, you know, that’s my team working with our clinical health IT team as well. And we’re gonna continue to do that in the development space. And when we think we’ve got a safe and reliable product, then we’ll make it more available to the rest of the organization. And we’ll do that both on the clinical side as well as on the administrative side.

Hickman Auger: That’s exciting. Do you mind sharing with us what pilot you’re working on or, or some of your most exciting or your favorite AI initiatives that you’re looking at right now?

Bagus: I’ll share one on the clinical side. We’re doing some piloting around ambient listening. So really to help our clinicians, as they’re talking to the patients the ambient listening is capturing components of that that we want to be part of the medical record. And obviously, that will be reviewed by the clinicians before it becomes part of the medical record. But it’s just a way where we’re allowing our clinicians to have more face time with the patients, and their head and their hands are not all over a computer, entering that information. So that’s one on the clinical side. And then on the administrative side, my team is really working on looking at different agents that we could utilize chatbot agents to help us in our call center space. And so how we could capture some of those calls and help guide it to the right place so that we can actually use the real people to have more in-depth conversations with the patients. So that’s another just really exciting example that we’re working on today.

Hickman Auger: That is exciting. And thinking about how far technology has come, the idea of using those agents to not just automate a process, but actually guide folks to the experience that they need when, when they’re calling in vulnerable. That’s great. Let’s talk a little bit about the mindset of continuous innovation. At VUMC, you guys are always innovating. How do you keep up that momentum to, to drive new initiatives, especially while the folks you’re supporting are m-managing the pressures of patient care and patient outcomes? Can you tell us a little bit about your approach to that, Chuck?

Thresher: Sure. It’s a balancing act for us because we want all the new innovation now. But we have limited capacity, and people have work they need to do, so we need to control that. So we need to really bring in that change in a controlled manner. And we need to make sure it’s tested and we have a quality product. So that’s a lot about what we do in the governance space. That’s kinda my role. You know, my title’s coordination director. That’s kind of what I was tasked with when I took this role on was to find the way that we could build that governance structure to make sure that we are bringing in this change, managing it, making sure things get tested, making sure that everyone understands when and where and what’s moving forward. As we’ve been live for, what, 18 months now? Is that right?

Bagus: Yes.

Thresher: We’ve really been working on stabilization for a long time, but we’re really starting to pivot toward roadmap now. And that’s a big thing for us. It’s like understanding the next 18 months at any given time. What’s important to every workstream and all across the medical center that’s gonna impact Workday, that’s gonna impact our other products within our, our work stream. And how do our resources align with that? Do we need to bring in additional resources? Do the functional teams have the right resources to be able to collect data and to test and all of these things as well. So that’s a big part of how we’re managing that change and what we’ve built out. And that continues to evolve. I mean, we built this structure 10 months before go-live. We started working on it. And, you know, then we went live, and then we learned, “Hey, this isn’t quite working and let’s keep moving. Let’s keep moving.” And to this day, we’re still evolving that.

Hickman Auger: I mean, you have to be agile, right?

Thresher: Right.

Hickman Auger: Evolving your approach to things as you see how the system is getting optimized and how folks are interacting.

Thresher: Mm-hmm.

Hickman Auger: I love what you said about capacity, right? Like, we all know there-there’s capacity realities on the technology team side in terms of what you can take on deploying. But I love the thought of, you know, that is even more urgent on the clinician side. So thinking about: Do the business teams and, and the other users have the resources to adopt what’s coming, and how do you make them successful throughout that process? So, Laura, what about you? Anything to add to that approach to continuous innovation and, and getting people to embrace that, right? Even when folks have the bandwidth, some of us are resistant to change. So talk a little bit about that.

Bagus: Yes. Well, Vanderbilt is extremely innovative. And so that’s one of the great things about joining the organization was really that energy around innovation. Chuck’s exactly right. You know, as it pertains to our ERP, really Chuck is helping to manage that, that aspect of it. But outside of the ERP, we have an innovation center here at Vanderbilt. We have a test lab at Vanderbilt. So we are very open to trialing out new technology or new processes. We bring our clinical partners or our administrative partners into that space to really test out the, the different technologies that we’re gonna be using, uh, which is really, really great. Um, and I’ll share one innovative thing that I do for my team is we meet regularly. We’re talking about our strategy, but we’re also talking about challenges. And so one of the things that we’ve gone out and done is we’ve started rounding to really understand how the community is using the technology that we put out there, both physical technology as well as systems. And one of the challenges that we heard from our clinical partners is that they’re very busy. We’re, we’re always 100% at capacity. And when things aren’t working, it’s very hard for them to stop their job and, and reach out and call a help desk to get support. In our normal meetings with the team, we talked about this challenge, and we talked about, “Well, what can we do about it?” And we started putting QR codes on assets so that our clinical partners, if they’re busy caring for patients, the only thing they need to do is snap that QR code. And on the back end, we’ve coded it so that it knows what configuration item it is, knows where it’s at, and can dispatch somebody to fix the problem. And so we’ve got thousands of devices now at Vanderbilt that are QR-coded, and that is to really free up the time for the clinicians so that they don’t have to worry about contacting us that something’s not working. We’ll get to it now even quicker through this process. And those are just examples. I think the thing that we feel confident about is like, “Let’s try this. What’s the worst that can happen?” We’ve invested a few dollars in QR codes, and it doesn’t work. And so we’ve been measuring it, and we’ve, we’ve seen a lot of value so far, so we’re gonna continue to do it. And I think that’s, that’s the spirit, I think, that we have at Vanderbilt, that we are not afraid to try different things. We’re okay with failing and moving on. But if you don’t bring that kind of philosophy forward, people aren’t gonna bring those challenges forward, or they’re not gonna bring their ideas forward. And, and that’s not, you know, moving forward in itself, right? We want people to really be excited about, “Look, I know that there’s something we can do about this problem.” And if they can bring it to a team and we can work together and, and try to solve for it and know that, like, we’ll try things, and if it doesn’t work, we’ll try something else. And we can work together and, and try to solve for it and know that, like, we’ll try things, and if it doesn’t work, we’ll try something else. I think that people get excited about that. I know that certainly excites me.

Hickman Auger: Absolutely, right? The idea that we’re focused on solving a person’s problem. This is going to make a difference for them, just like the clinicians are focused on making a difference for patients. I love that idea that you’re partnering with folks, not just in your innovation center, but where they are on the floor, observing what’s happening with them. They must be so much more open seeing the team, uh, you know, in that space.

Bagus: Yes.

Hickman Auger: Especially when you’re, you’re willing to try something, right? I would imagine seeing that you guys are willing to put in the effort and experiment makes them feel more comfortable trying something new.

Bagus: Yeah. And it also makes them more comfortable bringing challenges to us.

Hickman Auger: Right.

Bagus: And so I think that’s important. It’s like a two-way street. And I think the more transparent we can be with them, the more transparent they are with us. And that just leads to success.

Hickman Auger: Absolutely. Another thing that’s happening right now is every health system in the country is trying to retain employees, right? So, one of the things you can do is give them excellent support. Another thing you can do is give them an opportunity to grow. So talk to us a little bit about your approach to employee learning and growth. And, you know, how does that dovetail with optimizing performance but also career planning for, for employees?

Thresher: I’ll talk about a real, real granular thing on this is that when we went to Workday, we had a lot of legacy developer people for this old ERP system. Excellent employees, excellent skill sets, very strong technical people, technical background, but their roles were going away. And that ERP is kind of not out in the market so much anymore. So it’s not even like they could go somewhere else to work with that skill set. So we took it upon ourselves as a leadership team to make sure that they had a place to go. So we gave them the opportunity to, to learn, to go through Workday learning, to apply for jobs within our sustainment model that weren’t technically technical roles. They weren’t development roles anymore for a lot of these folks. So it’s a whole—I won’t say a different career path, but a changed career path. And I’m a perfect example of it. I was a technical development manager up until Workday. I was the person on call writing code and running SQL statements and things like that. And I don’t do any of that anymore. But we gave everyone the opportunity to apply for roles. We posted all these roles, and I would say all but one of our people stuck with roles within our Workday model. Another one went to a different role within our different products. And people who wanted to be true developers, we still have Java teams and things like that within our administrative teams. And there was a place for folks to go that really, truly wanna be developers. But I think that is part of what we found within our groups where we wanted to give that opportunity, but we didn’t wanna lose that institutional knowledge people had of UMC.

Hickman Auger: Oh, for sure.

Thresher: We didn’t want to lose those people that met our credo, that really understand what VUMC is. And, of course, we brought in a few people from the outside. I don’t mean the outside but people that knew Workday, and that supplemented and people could cross-train. And that was important as well. But we really wanted to make sure we retained a lot of those folks.

Hickman Auger: Well, even bringing additional people in, that’s an opportunity for folks to learn from, from other people. I love that story because IT organizations are competing just as hard for talent in healthcare as clinical organizations. And the idea that there is a place for you here. And also, we’re going to equip you with some knowledge that can serve you if you end up not staying here, right? That’s really investing back into your employees. Laura, anything to add to that, especially on the clinical side?

Bagus: Absolutely. Yeah. I’ll, I’ll actually share more on the administrative side, but, yeah, Chuck really said it well. And I think Vanderbilt is better for it because of the people that were working for the organization for years that were happy to transition into new roles to support Workday sustainment. That was a definite win-win for us. We apply that across our entire system, though, in terms of IT. And I have examples of where we’ve taken business analysts or customer relationship managers. We knew we needed more project managers, and so we really looked at them and said, “Can we put you through a six-month training program? And at the end of it, if you like the job and you’re successful at it, we’re gonna promote you to project management.” We were very successful in doing a number of those conversions this last year. And I think we continue to look at as positions change because technology changes, how do we take our teams that are extremely talented, come with incredible institutional knowledge, and how do we bring them up to be able to fit the next need from a technology perspective? And so in the cloud space, in the AI space, even in the data center space we have plans for all of these folks to continue to grow them as the technology changes. And so we like them to know that you don’t have to worry about your job disappearing because maybe the way we managed storage five years ago is gonna change. We’re gonna bring you along and teach you the new ways of doing it. And your role may expand or you may decide that’s not the right fit, but there certainly are a lot of opportunities at Vanderbilt to continue to grow. And that’s one of the things that I’m most proud of our leadership team doing over the last couple of years.

Hickman Auger: That’s fantastic. And when you think about a culture of innovation, that security of knowing that the organization is going to support me and my growth makes you much more open to embracing those new technologies. So, Chuck, you were talking about moving folks who were, at one time, developers really focused on customization. And then having a cloud platform where you didn’t need to do that. It was more about configuration, moving them over to support that technology. But then you also mentioned the importance of being able to free up their time to focus on the things that are truly unique about VUMC. Can you talk a little bit about, like, that wasn’t the last move that some of those folks made, right? Tell a little bit about how they’re continuing their careers.

Thresher: OK, well, we’re starting to take baby steps into Extend development. And I think that’s where a lot of the people who have the itch to scratch about being developers. It’s not hardcore development, but it  definitely leans a lot more to that than some of the other roles. So the folks that really want to be involved more in a more developer-type role are starting to train in Extend and looking at what kind of opportunities we have in the Extend space to kind of customize, for lack of a better term, Workday for some of those unique things we talked about earlier, some of those things that are maybe more unique to VUMC that aren’t in the core Workday platform. And we’ll see where that heads for us at this point. But it’s exciting that we can still offer that kind of work for folks, and that we do have that kind of capability, but we’re not going to explode the customization world like we had in the old ERP.

Hickman Auger: Right. In one of our other conversations, you had mentioned, you know, being customized to the point of no return. Like, certainly—

Thresher: Correct.

Hickman Auger: —no one wants to go back to those days. But, for our listeners, tools like Workday Extend and really any open platform that allows you to create custom apps that sustainably integrate to the core, is certainly a practical way to solve those really unique use cases that aren’t gonna be adopted by a bunch of folks, and an exciting opportunity for your technology staff. I’m curious also on the clinical side of things, do you have an example of your approach to education and skill transference that might be useful for folks to hear about there as well?

Bagus: Yeah. There’s been a number of really great examples in the clinical space, specifically in, in our health IT organization. And so we’ve got a lot of clinical—they may have been nurses or CRNs that have stepped into roles as informaticists or programmers. And so that’s been really, really great for all of them. One of the other things that my counterpart, Dr. Patel, says at Vanderbilt, is that Vanderbilt is one of the only organizations that has the most physician developers in our ERP. Or, I’m sorry, in our EMR.

Hickman Auger: Oh, wow.

Bagus: And so, that also is another way that we can grow that leadership because there’s oftentimes physicians that are also very interested in technology. And we give them a really great opportunity to be a part of that. And again, we’re better for it because who better to know how to customize or implement different aspects of our EMR than the physicians themselves that are working in it all the time.

Hickman Auger: Absolutely. And talk about partnership, right? Like, that is the opposite of throwing tech over the wall, right? As a physician, you know what problems we’re trying to solve. Please help us solve them. Here’s the technology available. That’s a great story. So, as we’re thinking about other organizations out there who are looking to adopt some of the innovative practices that Vanderbilt’s adopting and really even just the mindset of continuing innovation, what advice would you give to your peers? And maybe we’ll start with you, Chuck, and then come back to you, Laura.

Thresher: I kind of touched on this before, but if you haven’t built a strong governance model, build a strong governance model. The work we’ve done to build out how we’re managing change through our product and being able to be accountable to our auditors, to be able to understand the product and knowing that it’s quality and that it’s tested and everything, that’s been key and important to us, and it continues to grow.

Hickman Auger: Great advice. And, I have to say that among other customers that I’ve worked with, that strong governance model is a theme for some of the most successful and, and most innovative customers. So thank you. Laura, what about you? What advice would you give to your peers who are sort of trying to get to where you guys are?

Bagus: Sure. I’ll stay small and then kind of go large. At your department level or your responsibility level, look to your teammates. Ask them what’s working. Make them feel comfortable that they can try different things. Don’t be afraid to fail. Failure doesn’t mean that it’s not successful. It just means that you have to try something different. And so that’s one of the things that we do. And then at a broader level, at the enterprise level at Vanderbilt, we really do share with our clinical partners or our research partners what we’re doing to encourage them to bring ideas as well. So that’s something we’re constantly doing with them and we’re trialing out, and again, we offer our lab for them to try different things out on. We invite them into meetings with some of our strategic vendors so they can talk about the challenges from their purview and not just regurgitated from an IT perspective. And so I would say that Vanderbilt’s very successful because we’re very open to trying different things, and we’re very open to listening to all of our population about opportunities.

Hickman Auger: I love the idea of bringing people in to talk to your vendors. Honestly, they probably love that, right? Hearing directly from some of those end users what the challenges are, that leads to innovation on the vendor side that makes products better for everyone. 

Thank you so much, Chuck Thresher and Laura Bagus, for joining us on the Workday podcast today. For those of you listening, if you’re interested in hearing more conversations like this, be sure to subscribe. We are always happy to talk about innovation with our incredible customers. And for everyone out there, have a great workday.