0:01:02 Dr. Muthu Alagappan: You're a physician. What got you first interested in health care and becoming a doctor?

0:02:04 Dr. Muthu Alagappan: How would you describe how you kind of transitioned from practicing medicine into administrative and leadership positions and eventually becoming the CEO of the health system you work at today?

0:03:23 Dr. Muthu Alagappan: I've always been really interested in whether there are certain skills you learn from practicing medicine that then translate into leading health systems or leadership positions in general. Are there certain skills or experiences from your sort of practicing days that you've then drawn on a lot in your leadership positions?

0:04:48 Dr. Muthu Alagappan: When it comes to technology and digital transformation, some point out that rural communities are less likely to engage with technology and digital approaches to care than individuals in non-rural communities. Have you found that to be true in your health system?

0:06:50 Dr. Muthu Alagappan: Are there specific techniques you've used to engage the population digitally. Marketing strategies, patient education? How have you been successful in getting this population to adopt technology as a medium of care navigation?

0:09:19 Dr. Muthu Alagappan: When people talk about digital technology, digital transformation, there's often a split view on whether it's helpful or harmful to rural communities. So some people say that it actually further entrenches and reinforces some of the digital divide and can actually make health disparities even more pronounced. Whereas other people say technology can actually be a great equalizer and provide multilingual support and access to care for folks that are otherwise marginalized. I have a guess, but where on that spectrum of helpful versus harmful do you tend to stand?

0:11:56 Dr. Muthu Alagappan: That's fantastic. And thank you for sharing that. I like to think about technology as a mechanism, as sort of an agent of change. And so when you think about the problems that are facing your patient population, your community now, if you had a magic wand to sort of create a technology that could solve those problems, which problem do you think needs the most attention? Or what is the problem you'd want that sort of magic wand focused on?

0:13:40 Dr. Muthu Alagappan: You mentioned one piece there around technology to improve communication for patients and their families. One thing as a potential downside of technology we've seen is in cases with bi-directional chat or messaging where patients can message back and forth with providers, it's often very convenient for patients and families, but leads to a huge number of messages and increased responsibility on the care team, which may or may not be contributing to higher levels of work stress and burnout. Have you seen that play out at Marshfield? And is that a concern of yours at all, that technology could maybe make the patient experience better, but at the detriment of the amount of work that staff now have to do?

0:16:10 Dr. Muthu Alagappan: We talked a bit about health care disparities. And I want to touch on health care equity as well. So you are a founding member of the Carol Emmett Foundations Equity Collaborative. Would love if you could tell us more about that and what inspired you to be a founding member of that organization.

0:18:12 Dr. Muthu Alagappan: Are there lessons you've learned from your own journey into leadership or advice you'd have to women who are hoping to take on those types of positions in terms of how to navigate their careers

0:19:48 Dr. Muthu Alagappan: On the topic of health care equity as it relates to leadership and management, would love to talk a little bit about the future of work and how the workplace will perhaps transform as a result of the pandemic and what we've seen over the last few years. One trend that has become very pronounced are the labor shortages across different service lines and roles. Are you seeing that at Marshfield? And in what specific roles or areas are you feeling the labor shortage to be most pressing? And how has that sort of presented itself over the last few months?

0:23:42 Dr. Muthu Alagappan: How much of the labor shortage is pressure from outside industries raising wages, taking employees that used to work in health care in administrative roles, support roles, and now are moving into food service, Amazon? Are you seeing that shift out of health care just given the wage pressure?

0:25:52 Dr. Muthu Alagappan: What is the time frame in which you'd expect a health system like yours to adopt automation in a way that really makes a dent into this problem?

0:28:36 Dr. Muthu Alagappan: You mentioned a point there at the end of choosing or deciding is it something that we can do on our own or do we need to partner with an organization on this capability. How do you make those determinations of when you want to solve a problem with technology, how do you decide if it's a problem you're going to try to tackle on your own versus look to the market at vendors or partners that can help you solve it?

0:30:49 Dr. Muthu Alagappan: There are certainly local dips and inflections as you're adopting technology, but the long-term trend hopefully is very, very positive. When you're thinking about the partners that you like to work with, what are some of the characteristics of those partners that make them good partners to you? What are the intangible qualities of the team or of the partnership that make an organization feel like a good partner to Marshfield?

0:32:13 Dr. Muthu Alagappan: I'd like to leave by asking you, what do you think the rural health system of the future will look like or should look like? What's your grand vision for where we should try to get to?

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