#06 - Resilient Leadership: Building Trust, Equity, and Safety in Health Systems

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Krishna (00:25)
Today's guest is someone I'm especially excited to have on the show. Adrian Francisco is a healthcare administrator at Advocate Aurora Health in Wisconsin. He has spent his career navigating the realities of running complex health systems, balancing patient care, workforce challenges, finances, and also policy decisions that affect thousands of lives. He's been in the rooms where the tough calls get made, where the trade-offs are real, and where the gap between policy and practice.

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becomes very clear. But beyond the titles and the resume, Adrian is a very close friend of mine. He is someone that I've had countless conversations with, sometimes professional, sometimes personal, about what's working in healthcare, what's broken in healthcare, and what keeps people in leadership up at night. Because today's conversation, my friends, isn't just about strategy or administration. It's about the values, the real life experiences, and what it actually takes to lead in healthcare right now.

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I'm grateful to call him both a colleague and a friend. And so with that, I'm really glad to welcome Adrian Francisco to Connected by Health. All right, Adrian, tell us a little bit about yourself and what made you want to get into healthcare administration.

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Adrian M. Francisco (01:37)
Thank you, thank you for having me on first and foremost. Dr. Vidal, I really appreciate it. It's always good to get to catch up and get to talk to you as well. And I think really kind of to start, I didn't get into healthcare administration because of like...

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just the spreadsheets and the charts and getting the boss people around and things like that. The purpose behind it was probably a similar story to a lot of people. So I first was an undergrad with the mindset of I want to do the practice side of healthcare. I always wanted to help people and what was that going to look like? Okay, so I'm going to try to pursue maybe the practice side. And when I came out of undergrad, my wife was first going to grad school and I was going to study, try to maybe get into

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to a graduate program and go from there. You know, we kind of switched places. Well, while I was doing that, I was working in the College of Public Health at OU and started seeing, you know, meeting the administrators around that campus and I started to kind of notice a little bit more, obviously just the broken systems in general. And I realized that, you know, a lot of the patient outcomes, they're not determined solely by the exam room or by

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the clinician themselves. A lot of it is going to be shaped on the back end, the policies, staffing ratios, reimbursement rules. And I didn't understand a lot of that stuff, so I decided then to go for my master's health administration. While I'm in that program,

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you decide, okay, well, you can try to do a fellowship, know, get a little bit more of like a mile wide, inch deep type of look at a health system, you know. And so I applied for a few and was able to get one at Norman Regional Health System and...

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It's really where it all kind of started from there. So in other words, mean, administration just really determines what care is even possible. The clinicians make it all run and we're kind of a support system on that back end. so, yeah, it was really kind of just that leverage side of it of how I can have my stamp on the system that these clinicians have to work within.

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Krishna (03:39)
And it's at Norman Region where you and I met. And where are you practicing currently?

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Adrian M. Francisco (03:43)
Yeah, I currently practice in a well-known place called Sheboygan, Wisconsin. The system is Advocate Health. They originally were Aurora Health in Wisconsin, and then they merged with Advocate Health in Illinois. And then they had another merger back in about 2023 with Atrium Health. Atrium Health had already kind of merged with Wake Forest Medical School. So all of that now is this large health system.

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one of the largest nonprofit health systems in the US. So we reach everywhere from the Carolinas all the way up to Wisconsin. So my market is Sheboygan County within Wisconsin.

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Krishna (04:23)
So as you know, I'm a big football fan. How far is that from Green Bay, Wisconsin?

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Adrian M. Francisco (04:25)
you

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Yeah, so I like to say Cheboygan is the peanut butter and jelly between the Green Bay and Milwaukee, if they're the bread of the sandwich. So we're smack in the middle, right on Lake Michigan. But yeah, Milwaukee's to the south. Green Bay is just an hour north. So it's a quick trip, whichever way you wanna go, whatever you wanna participate in. But yeah, Green Bay is right there.

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Krishna (04:47)
So perfect for catching a Bucks or a Brewers game and also a Green Bay Packers game. Awesome.

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Adrian M. Francisco (04:52)
Absolutely,

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absolutely, and you get shamed if you're not going to do one of those things or be a fan of one of those sports teams for sure.

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Krishna (04:59)
that's okay. That's all right. There's nothing wrong with

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that at all. So you mentioned two words that I think have become really prevalent over the last couple of years, and that is broken system. Healthcare, specifically since the COVID-19 pandemic, has really not been the same. So how has the role of healthcare administrators evolved since the COVID-19 pandemic, and what lasting changes have leaders have to prepare for?

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Adrian M. Francisco (05:25)
Well, it's still changing, honestly. COVID permanently changed the job. And I always say healthcare, we're chasing a moving target. And so you really have to kind of enjoy that pursuit and that run. But before the pandemic, think...

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Administration was really focused on optimization, know, so looking at like throughput, looking at growth, margins, and there's always going to be that aspect of it. That's, you know, the whole point of, you know, the administration side. But after COVID, it really is about resilience. You know, we're expected to lead through constant uncertainty. We're expected to manage workforce trauma and burnout. know, burnout is a huge deal right now.

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And it's, I don't even want to say that that's, it's been a thing that's grown since COVID. I think that it's just, it's more at the forefront since COVID probably more so than anything. But we got to navigate public health. Politics is a huge thing. Misinformation, whether that's about healthcare in the US in general, that's misinformation about vaccines, that's about just your actual health system that you're working within. So then the lasting change, a part of that, I would really

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say the expectation of moral leadership. your staff now is going to look to executives not just for direction but also clarity and safety.

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If you're a leader who's going to think like we're back to normal and things are how they already, then you're already going to be behind. I think the future really belongs to those administrators who can operate in disruption, be comfortable in disruption, be comfortable in discomfort in general. Financial pressures, workforce shortages, rising acuity. Handle all of that and lead through all of that. Support your teams through all of those things without losing trust is really the key.

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Krishna (07:09)
Wow, that sounds like a tough job.

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Adrian M. Francisco (07:13)
Okay.

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Krishna (07:14)
So, you you've mentioned, you know, a couple of amazing points there. But one of the other things you also previously talked about is just even within the system that you're working with is the number of murders, whether if that's the situations that are forced at. But I kind of feel like, you can correct me, you and I, we're not that old, just everybody else knows that out there. But I feel that especially during the pandemic, hospital systems,

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merging has become a trend. Is that because of the pandemic or is that something that's happened even before then?

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Adrian M. Francisco (07:48)
I think it's happened before then.

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And, but I think what is kind of a trigger, usually the trigger for it is just how can we be remain financially viable as a health system? and so that has probably worsened probably a little bit since the pandemic for a lot of health systems, especially, smaller ones, know, lot of, independent nonprofit health systems are, that's not as common anymore. If you're going to stay a nonprofit health system, then you're probably going to need a large footprint to be able to keep your doors open. so.

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Yeah, I'd say since COVID, yeah, that's probably just grown a little bit, but it's definitely a thing that's always been there cuz finances has always been a thing, so.

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Krishna (08:25)
Yeah, yeah.

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So moving on, what strategies do administrators use to balance operational efficiency with the patient centered care, especially when budgets and staffing are really being constrained?

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Adrian M. Francisco (08:39)
Yeah, yeah. Well, first, I would say that I probably reject a little bit of the idea that efficiency and patient-centered care are opposites. It's not a polarity. I think inefficiency is often what hurts patients the most. So how can we make the approach just be...

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Krishna (08:49)
Thank

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Adrian M. Francisco (08:58)
obviously first and foremost protect the frontline ruthlessly and then just simplify everything else. So eliminating that low value work, reducing administrative burden, and that's for everybody, aligning workflows with how the care is actually gonna be delivered. So a lot of times I'll say to people like,

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If I'm going into a urology clinic, let's say, I'm meeting those doctors for the first time, I'm gonna tell them, like, it is not my job to teach you how to be a urologist. Can't do it, you know? But it is my job to make sure that you can practice urology at the top of scope and as efficiently and as well as possible, you know? And so, trust me to be able to do my part in removing some of those barriers, and I'm gonna trust you to do your part of just practicing high quality medicine, you know, and being fair to every patient that's gonna come in those doors. And so, I think what kind of gets difficult

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into your question is just like when resources are tight every decision is paramount. Every decision comes on one question. It's just if it makes it harder then it's not efficient. It's just cheaper in the short term and that cheap side in the short term is going to produce cheap care and low quality care and it's not going to sustain.

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Krishna (10:09)
Wow, definitely cheap quality care. That is something that...

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Unfortunately, think at certain times in certain places has become the mainstay just because of the pressures, the external pressures that have been placed on the healthcare industry. You know, one of the things that I was reading the other day, and I really didn't realize this until I actually read this, which is the United States healthcare industry is worth about $5 trillion, which if you really look out and compare it to national GDP is actually the third biggest economy.

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in the world. And it's just impressive just how much far we've gotten with our healthcare system, but the pressures that are out there and the times how quickly decisions have to be made and how to react to those external pressures, it's really just mind blowing. But you've also touched about something earlier today and that is about ⁓ culture, right? So how can healthcare leaders build and sustain

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a culture of psychological safety that encourages frontline workers to speak up about safety and quality concerns.

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Adrian M. Francisco (11:17)
Yeah, know, kind of, guess, tying in your previous statement into this one a little bit too, physicians don't go to school, clinicians in general don't go to school for a decade plus.

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with the goal of I'm going to give really bad care. know, like that just, doesn't happen. And kind of on the administrative side, always will say like, people don't come to work wanting to do a bad job. You they work within a poor system if they're doing a bad job.

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most of the time. Yeah, there might be some outliers there. So when those negative outcomes happen or when some low quality aspects start to present themselves, I really think that psychological safety isn't from just like the slogans or the things on the front end. It really is about what are we going to do after someone speaks up? It really kind of starts to build within your culture when they start

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Krishna (11:48)
Thank

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Adrian M. Francisco (12:12)
to know your response to them being willing and brave enough, I mean just being brave enough to speak up and say like something is not right about the situation or I noticed something that I think needs to be addressed. So leaders really have to kind of do a few things consistently. ⁓

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Krishna (12:27)
Thank

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Adrian M. Francisco (12:29)
Not being very defensive, ⁓ especially when things are brought to you. It's not a personal attack and that's, I get it, that can be easier said than done, but just respond without defensiveness. Close that feedback loop. Everybody wants some follow up. Everybody wants, yes, they come, they report something to you and they give that to you to, they hand that football off to you if you will, but keep them in the loop and follow back up. Close that feedback loop to them.

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And then I think kind of last just protect people from retaliation. And I say those three things not in order, cuz that's probably most important is just protect from retaliation first and foremost. Your reaction to bad news, it's gonna teach the entire organization whether honesty is safe.

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Krishna (13:14)
it.

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Adrian M. Francisco (13:16)
is that actually important to you or not? And if it is, then yeah, you know, gotta really show that. If staff only is gonna speak up when something goes wrong publicly, then you've already, you know, lost the plot, if you will, you know? Like the goal is not there anymore. So safety culture is really just, it's built on those quiet moments. It's built on those small things. built when, you know, it's just that nurse and a physician together and the nurse notices something, you know? So then as a leader, yeah, how we list

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Krishna (13:28)
Yeah.

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Adrian M. Francisco (13:44)
how we follow up and how we share accountability. That's what's going to be most important.

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Krishna (13:52)
And you really mentioned about leadership there, right? And the responsibilities that is placed upon leadership, but the impact that ⁓ leaders can have on a variety of different factors, including on safety and creating a culture where retaliation is not something to be worried about. But in terms of measuring leadership impact, what metrics do you consider the most meaningful when you're measuring leadership impact, especially on clinical

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outcomes and on patient experience.

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Adrian M. Francisco (14:24)
Yeah, I had a mentor one time who told me...

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The metrics to trust are the ones that are forming a pattern. So follow the trends. You don't necessarily just lock in on dashboards and always just watching a dashboard, but just really as far as a metric goes, the most important ones are the ones that are gonna show a pattern and tell a story.

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Staff turnover, vacancy direction, you know, so are we losing staff a lot? And then is the communication that happens outside of the health system, is ⁓ it a communication of like, don't want to work here, you know, it's not a safe place to work or it's not a supportive place to work. And so now we have vacancies for a long time.

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Krishna (14:48)
See.

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Adrian M. Francisco (15:03)
Patient access measures, it's always going to be a really big one. So leakage, time to appointment, safety event reporting volume. So coming back to psychological safety is like, more reporting often means there's more trust. Patient experience, obviously it's always going to be a big one, but can you even drill some of that data down a little bit ⁓ by demographic groups?

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Krishna (15:15)
Hmm.

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Adrian M. Francisco (15:24)
So if outcomes improve but turnover spikes, then we probably didn't do our job very well. If margins improve but access is really poor, well then did we really accomplish what the goal is? Because we can make quality scores look good, but.

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Is your staff happy then? Are your staff honest and open? Do you really have that open door policy at that point? So good leadership is just consistency. It's not just going each quarter and then kind of changing who you are as a leader. It's just being consistent in who you are.

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Krishna (16:01)
You know, you talked about turnover and this is a question that I've personally always had, is, especially after the pandemic, I feel that there has been this great gap specifically when it comes to the healthcare workforce, especially regarding the times of lack of sufficient employees and staff. Is that something that we have seen only after the pandemic or is that something that we've seen even before the pandemic had occurred?

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Adrian M. Francisco (16:25)
Yeah, I mean, not to throw it back on to you too, you know, I'd even just say like you were in residency. How many openings did you see all the time? And I think that it's, it's again, people kind of pivoted once COVID happened as far as like, were their career aspirations then at that point? know, we, everything kind of went virtual and nothing has stepped away from that. Honestly, it's just kind of like poured gasoline on that fire of like,

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Krishna (16:41)
Okay.

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Yeah.

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Adrian M. Francisco (16:55)
Well, you know, everyone wants remote work even more so now. again, yeah, I think that shortage were always there. Like we were, you know, you're always going to look for nurses. If you're trying to recruit to Sheboygan and you're competing with Milwaukee, there's probably going to be just the pool that you're fishing in is a little bit bigger in Milwaukee than you are in Sheboygan. So yeah, that's always been there, but it's definitely just grown now. And I think that a lot of that is just do people really want to go into healthcare as much?

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Krishna (17:19)
Yeah.

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Adrian M. Francisco (17:25)
Do nurses want to be a nurse? Do doctors want to be doctors?

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Krishna (17:29)
And I think that's

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a very frightening scenario to really look into. there's been quite a few other, I think, political ramifications that have also probably made healthcare a little less appealing compared to what it used to be.

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Adrian M. Francisco (17:41)
Yeah.

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Krishna (17:42)
coming from just the medical perspective, even for me, I'll admit one of the reasons I chose to go into outpatient and not inpatient is because of the strain of having to work all those hours on the inpatient side. And inpatient, you're looking at increased acuity, which means more difficulty in terms of the patient panel and the care that we have to provide. So definitely for me, I do think it made a significant impact. It also helped me

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helped encourage me to not pursue fellowship because working through the pandemic as a resident in internal medicine was difficult and I could only imagine doing another two or three years of fellowship. But you know...

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The issue I really think is I've always wondered how healthcare was in right after the Spanish, the Spanish influenza after World War I, because I think we kind of faced very similar challenges or facing some very similar challenges now. And I always wondered how long it took for the healthcare system at that time to really recover and whether if they've even had to face the challenges that we've had because a century ago there wasn't this much of an impact or this much of a

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need to focus on quality and safety. And nowadays, today, we have much greater ⁓ emphasis on them, of course. But kind of changing the topic a little bit, what is healthcare equity and should it be a priority for healthcare administrators?

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Adrian M. Francisco (19:06)
Good question.

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short answers and simple answers it's yes. I mean, obviously healthcare equity is it just means that everyone has a fair and just opportunity to achieve their best health. know, be as like as well as you possibly can be. And that's regardless of what you look like, how much you make, where you live, know, what languages you speak, you know that.

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Krishna (19:18)
Mm-hmm.

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Adrian M. Francisco (19:31)
when we kind of go into social determinants of health, right? That's kind of like the basis of public health in general. And that is just, which was always so fascinating, that literally where you were born, the zip code you were born into, that as a baby you don't have any choice of, is gonna determine what your health looks like. That was always very crazy to me. Because, again,

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Krishna (19:51)
Mm-hmm.

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Adrian M. Francisco (19:57)
going literally by the definition of equity, the fair is the most important word there. How fair is that for a baby then? You have to differentiate between equity and equality. And I think that that's...

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maybe sometimes easier said than done because equality is giving everyone that same resource and sometimes it's a lot easier to like, okay, well here's exactly like we're going to provide this food to all of our patients or you know, we're going to, we've just implemented transportation services, you know, and like that's going to be great for everybody, but it may not actually be what everybody needs to get to the same outcome. And we have to focus in on what's the outcome that we want here for our patients because then equity is just, we have to address

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what each person is going to need to get to that same outcome. know, and so from an administrative standpoint.

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Krishna (20:42)
Mm-hmm.

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Adrian M. Francisco (20:46)
you have to look at the practical ways that you can try to make that show up. Can patients get to their appointments when they need them in general? You hear all the time about like, what's the window from check-in to a no-show when we can just mark them as no-show or we even just can tell them they can't come in. There's a lot of stuff that probably happens between that 10-minute window from them getting to that appointment. But can patients even get to their appointments? Do they understand their care plan?

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obviously can they afford their medications that we have to prescribe to them? Can they have physically...

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get into the clinic? Is the clinic on a second floor or a third floor? And maybe they're not ambulatory. And so are we able to connect to them virtually? So obviously, you go through a lot of those questions all the time. And you have to just ask, OK, if the answer is no for certain populations, well, then maybe the system is working as it's designed, but it's not working as it's intended. And we have to be intentional about what we want for

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patients and their outcomes.

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Krishna (21:46)
So with Telegram Equity, you're basically leveling the playing field for everyone. So I think I'm going to equal.

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Adrian M. Francisco (21:50)
Yeah, that's exactly, absolutely, absolutely.

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because of that, should you prioritize it? I think maybe moral reasons, absolutely. But then even from an administrative standpoint, the financial reasons too. You gotta look at like, okay, let's look at the business case, for instance.

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Krishna (22:03)
Mm-hmm.

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Adrian M. Francisco (22:11)
Inequitable care is going to be very expensive. It just is. When patients can't access you for their preventative care, then they're only going to show up in a sicker state. They're going to be even more acute. They're going to need a higher level and higher cost of care. And so then that ends up driving ED use and probably overuse. We're going to miss out on the

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Krishna (22:13)
Mm-hmm.

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Adrian M. Francisco (22:34)
those avoidable admissions, we're gonna have a higher readmissions, which means then you're not gonna get like your shared savings. You know, have poor quality scores, so then your leapfrog scores for your health hospital and your health system are gonna go down. You have lower patient satisfaction. We talked about trust earlier. Who's gonna, you know, from the patient standpoint, they're not gonna trust you, and from your clinician standpoint, they're not gonna trust you. So even from a financial perspective alone, inequity just creates waste. And so...

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the quality and outcomes case that you need to make is like, okay, well.

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we're not gonna claim to deliver high quality care if outcomes are gonna vary so much by zip code. You asked at very beginning the importance of a merger or the importance of these smaller health systems needing to join with larger ones. And again, it's just about footprint. How much can we reach patients and improve the access to those patients? But if outcomes vary dramatically by zip code, by race, by income.

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then you're not really a center of excellence, it's just inconsistent. yeah, so equity is not just another initiative that you need to take part in, it's a quality strategy. Yeah.

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Krishna (23:33)
Yeah.

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To me

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healthcare equity to me makes sense. And the reason why I say that is, is even just not coming to us from a non-medical background or non-medical perspective, if you want to create a healthcare system that works, a healthcare system that emphasizes on cost cutting, you have to create a system that is affordable. And in order to do that, you have to create a system that levels the playing field for everyone. That's the way that I've looked at it. And I think that's the way that it really needs to be emphasized.

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Now I know things always are a little difficult to achieve and practice, but I do think creating a healthcare system that emphasizes healthcare equity really would be a system that would work better than some of the shortfalls that we're seeing right now. You talked about, you've already kind of touched base on this with equitable patient access. And so how do you think leaders should approach digital transformation specifically with

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whether it's electronic health records or the new implementation of AI. There's always been kind of a frightening and an impressive transformation that's happening. And of course telehealth in order to ensure clinical adoption and equitable patient access.

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Adrian M. Francisco (24:52)
Yeah, yeah, mean, healthcare administrators, we...

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aren't just looking at operations, we have to design systems. And every system is, it's gonna produce exactly the result it's built for. I had a professor once who, when we were talking about just technology and healthcare, he was like, the technology isn't only as good as the human who built it or the human who created it. It's like, they're still, yes, these are very, very smart. AI is very, very smart system, but it's built by a human.

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Krishna (25:03)
He

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Move.

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Adrian M. Francisco (25:23)
it's technology is going to fail if a leader is going to treat it as another IT project. And instead, they need to just use it as a change management problem. first things to look at, are we allowing those who are going to be utilizing it in practice? Are they helping us design it?

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Because if they're not, if a doctor's not gonna help me figure out how do we need to make this be used in practice, then they're probably not gonna use it. If I bring you something, again, it's not my job to tell you how to be an internal medicine physician. Workflow is gonna come before features. So.

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you know, how, again, how are we going to use this in practice? What are we using in practice? And then training is ongoing. It's not just, you know, we're gonna roll this out, show you how to use it, and then kind of not touch it anymore. It's gotta really kind of be ongoing, because, you know, I guess the thing about AI is it's always gonna be learning, you know, it's always gonna be adapting and changing, so we always have to be training on it. ⁓

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Krishna (26:12)
Yeah.

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you

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Adrian M. Francisco (26:34)
Just got in talking about equity and equity is gonna matter here as well, right? So, telehealth, AI, they can either help us close some gaps for some of these patients or they're gonna help us widen them. And that's gonna depend on broadband access, can depend on language support. I have a physician right now who...

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she has cochlear implants but they also are like on bluetooth connectivity so when when she is needing to talk with a patient and use a language interpreter she has to have somebody live in person because simply the cart we have doesn't have captioning for her to be able to like read what the interpreter is saying because then it doesn't connect to her you know her cochlear implants and it's like we have like it's it's awesome that we have these interpreter carts we you know we can provide

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to any patient that comes through the door, but then we can't even put captioning on it. know, it's like, I don't know, that's the way you really just kind of have to ask, like, if that question isn't answered upfront, then the transformation isn't really ethical or sustainable. And you have to be able to sustain it. Because again, it's like, do you want that short-term, cheap care, or do you want sustainable, high-quality care?

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Krishna (27:48)
That's exactly, exactly correct. Especially when it comes to that question, short sustainable versus high quality. that is, it seems like it should be an easy decision. But I know that it can be also very difficult just given all the external pressures that the healthcare industry sees. You've already kind of touched base on this, but can you share an example of the difficult organizational change that you led? What you learned

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about that particular scenario, specifically when it comes to communication, and what would you do differently?

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Adrian M. Francisco (28:18)
Yeah.

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Perception is reality, know, so I think kind of whatever is going on at the time is probably like the hardest thing we've ever had to go through. This is like the biggest change that we've ever had to go through. So, I mean, I think kind of in general, one of the hardest changes that you kind of have to lead through is...

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realigning provider schedules and expectations for them because you you have to try to better match what's the patient demand right now and also what's going to be sustainable and helpful for the organization and then on the other side yeah you know you have these relationships with your clinicians you want to do what's best for them you need them to sustain personally as well and so I think kind of what I learned really quickly around it is like the the numbers alone the data alone

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isn't really going to change behavior. That's all super important. It's all the back-end work that's very important. And we always make data-driven decisions, yes, but people don't resist change. They resist the feeling of being devalued.

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you know, with that change. So, if change is coming and they feel like they haven't been heard, no one is listening to me, or this is now, now I don't feel as important, or I just feel ignored in general, you know, then that's when that resistance starts to creep in. And so think kind of what works is just transparency about everything. Be transparent about constraints. Be transparent about...

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Krishna (29:37)
Mm-hmm.

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Adrian M. Francisco (29:40)
one-on-one listening, you know, before a group decision, frame the change around what's the patient impact and not just like what's gonna be the productivity impact, you know? So I guess, yeah, what I do differently is I just slow down during the listening phase and even when you just, even when you know that...

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that decision is right. You know this is gonna be the correct thing. How people experience that process is gonna determine whether trust is built or it's burned. Again, that perception is reality. And so everyone's perception is important in that process.

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Krishna (30:17)
You're definitely right. Perception is reality. And that's something that we really have to always take into consideration. And not just in the healthcare administration side, even myself and from the medical side too. So speaking of ⁓ perception and just curious, do you think the bucks will ever recover after trading Giannis?

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Adrian M. Francisco (30:34)
For my colleagues and neighbors, guess here in Wisconsin, I'm say absolutely. They will persevere. It's a resilient fan base up here. It's a resilient organization, so they will be okay.

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Like, you said, you know, when we lost Lincoln Riley, you said, you know, one man doesn't determine the organization. One man doesn't determine the system. You know, and so I, yes, I think that they will, they'll bounce back and they'll be okay.

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Krishna (30:56)
Yes.

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And I hope so too. And you're

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right. The Bucs fan base is very, they're very resilient. Just an amazing fan base. And Milwaukee itself, I've been there and it's just a beautiful city. And I really wish the best for Milwaukee and for the Bucs. And you know, they've won a championship with Giannis. I was really happy for them. I think the last time they won one was with Karim Abdul-Jabbar, right? When he was Lugol Al-Sindor. So, always wish them the best. Just before we conclude,

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Adrian M. Francisco (31:22)
Hmm?

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Krishna (31:30)
Do you have any words of wisdom or advice for anyone that's listening to this episode and wanting to get into healthcare administration?

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Adrian M. Francisco (31:38)
Yeah, well if you're listening as a patient then I think that Go to where you trust your doctor go to go and trust your physician trust what they say

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Again, the doctors aren't going to school that long wanting to cause harm. They're trying to build that relationship with you. So I think that just not avoiding their care and not avoiding their advice is the best advice. And then for anybody, maybe I guess for healthcare administration, I'd just say, be a system steward, you're not just a manager. Everything, every decision that we make is gonna shape who gets care, how fast they're gonna

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get that care. At what quality are you going to get that care? Because we're managing all the back stuff that happens to make it easier for the clinicians to provide it. this is an era of budget cuts. This is an era of workforce strain. And this job is not about the control that you have as part of that. It's about just the clarity, courage, and the consistency that you have to lead through all those things. And so if we get that piece right, then

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We're not just treating illness at that point, so we're gonna really strengthen communities.

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Krishna (32:47)
Awesome. Well, once again, Adrian, thank you so much for coming on by to Connected by Health and we really appreciate you. We'd love to have you back again sometime in the future. Thank you.

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Adrian M. Francisco (32:57)
Absolutely.

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Hey, thank you for having me and I wish you the best of luck. And, you I am in Wisconsin, but I am still a Thunder fan, so we'll also close out with just saying Thunder up.

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Krishna (33:08)
All right.

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Well, Thunder up and boomer sooner. So thank you all.

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Adrian M. Francisco (33:11)
Thank you, sir.