Key Takeaways
- Integrate strategy, innovation, and marketing functions to break down operational silos and align resources for maximum efficiency.
Healthcare leaders across the U.S. are at a pivotal crossroads: costs are up, margins are down, and simply adopting new technologies or processes won’t move the needle without genuine change management. The conversation is shifting from “what’s the latest tool?” to “how do we actually solve for value, efficiency, and impact?” Nowhere is this more evident than at University Hospitals in Cleveland, where David Sylvan, MBA, serves as Chief Strategy, Innovation & Marketing Officer. In a recent podcast interview, Sylvan unpacks why the old playbook—where strategy, innovation, and marketing lived in silos—no longer works and how integrating these functions is not just a differentiator, but a necessity.
This article translates that podcast into a story-driven, practical guide for executive leaders, board members, and advanced students. You’ll hear direct from Sylvan, whose journey from investment banking to mission-driven healthcare offers lessons that are both sobering and inspiring. The takeaways: integration is hard, but it’s the only way forward; and real transformation means starting with the problem, not the solution.
Q: Why would a finance executive choose healthcare, an industry notorious for slow change and thin margins?
David Sylvan’s path to healthcare wasn’t linear. “I did work in professional sports… then I did go to a broker dealer and an investment banking platform known as KeyBanc Capital Markets. Candidly, never thought about joining the ranks of healthcare—largely for the reasons you point out. It’s not for the faint-hearted… there are crash-easier ways to make more money.”
But a consulting assignment at University Hospitals to help build an innovation platform changed his trajectory. “Something happened, Cole—I candidly found, not to get sappy, but I found mission. I found an opportunity to, as a non-clinician, impact lives perhaps. There’s a lot to be fixed in healthcare… and that’s what keeps me engaged.”
Takeaway: For top leaders, purpose trumps profit. If you’re wondering how to recruit or retain exceptional talent, mission alignment is not a “nice to have”—it’s foundational.
Q: Why do healthcare systems need to stop treating strategy, innovation, and marketing as separate functions?
David Sylvan doesn’t mince words: “The error that many of us made previously was thinking about innovation in its own bucket, strategy in its own bucket, and occasionally the two intersected. What we’re trying to do—what many systems are doing—is ensure there’s a common thread between innovation, strategy, and how we think about care delivery models.”
The argument is simple:
Outcomes are suboptimal when functions operate in silos.
Resources are wasted on duplicative efforts.
No organization has the bandwidth to support misalignment.
As Sylvan puts it, “Innovation and its marriage to strategy, I think, is an imperative. No system nationally can afford not to be innovative from the perspective of care delivery, physical plant, and the patient as the consumer.”
It’s partly financial, Sylvan admits: “If you’re living in a comfortable, positive net margin environment… you can afford to make a couple of mistakes. Now we’re all facing headwinds—efficiencies, throughput, collaborations, all these things need to be elegantly woven together.”
For U.S. healthcare leaders: The message is clear: Don’t wait for crisis to force integration. Proactively braid your core functions together or risk obsolescence.
Q: Why hasn’t technology—EHR, AI, automation—delivered the expected ROI in healthcare?
Sylvan is blunt about the myth of the “magic tool”:
“There’s this notion that if I just turn the tool on, it will create the outcome that was promised. What’s really needed is behavioral change. Users must adapt and integrate themselves with the technology so that it isn’t just quicker, faster—it’s quicker, faster, better.”
What’s missing?
User engagement in tool selection and design.
Alignment of process, people, and technology.
Ongoing change management, not just technical deployment.
He adds, “The combination of person and process, or person and tool, is where the secret sauce resides—not a false reliance on just the existence of the tool.”
Key insight: If you want sustainable ROI from innovation, you need to change hearts and minds, not just systems.
Q: How do you actually get buy-in and behavioral change at a massive organization?
University Hospitals manages over 200 physician offices across 16 counties, with revenues exceeding $6 billion. Sylvan doesn’t sugarcoat the challenge: “The biggest mistake organizations can make—and we made this mistake—is by cramming down, by forcing adoption of a tool or technology, disrupting workflows without pre-buy-in, and not having users at the table during the process.”
Instead, his team focuses on:
Relentless problem understanding through engagement.
Reverse engineering solutions starting from actual pain points.
Flipping the script: Involve users early in opportunity selection, not just in implementation.
“It’s never an N of one. It’s always a team approach, bringing in people with the right vernacular and language to provide the interface between what innovation is seeking and what clinicians are solving for.”
Practical approach:
Include clinicians with a design mindset in every innovation team.
Use co-design and iterative feedback.
Be honest about “mixed results” and adjust as needed.
Q: Can hiring non-traditional leaders—those without a clinical background—work in healthcare?
University Hospitals proves it can. Sylvan, who is not a physician, credits leadership’s willingness to take a risk on non-traditional hires: “It was initially seen as an experiment… but as the experiment began to yield results, and we amplified the positive through storytelling and engagement, it took on a life of its own.”
He’s adamant about the value of industry diversity:
Prevents groupthink and myopia.
Brings in outside-the-box solutions.
Pairs non-clinicians with tight clinical thought leadership.
“My intention is always to look for those who bring diversity of background, experience, and thought—and then pair those with strong clinical leaders to get a better outcome.”
Advice for other systems: If you want different results, you need different perspectives. Pair industry outsiders with clinical leaders and foster intentional collaboration.
Q: How do you bring in outsiders without sacrificing patient care or turning into a profit-driven machine?
Sylvan answers directly: “It’s critical to always reinforce the true north. In University Hospitals’ case, the most needy or the most worthy is never far from our minds. We don’t turn down any patients. We’re consistently looking at our community impact.”
Practical advice for leaders:
Constantly communicate your mission and values.
Hire people who buy in to that purpose.
Use mission as a filter for every major decision.
When mission and margin compete, mission wins. But when you “inculcate the institution with that ethos,” you’ll also find financial sustainability follows.
Q: Why combine strategy, innovation, and marketing in a single executive role?
Sylvan is one of the few in the country with all three in his title, and it’s no accident. “One of our observations is that marketing can reside in a silo. Its role is to amplify brand and effectuate patient capture… but what we’ve chosen to do is find the commonality between strategy, innovation, and marketing—and that’s data and insights.”
How does this work?
Marketing campaigns are driven by real-time data on patient needs and service line performance.
Strategic vision is amplified, not diluted, by marketing efforts.
Innovation is grounded in what patients and communities actually want and need.
He summarizes: “If you step back and think about the common language of data and insights, there is a compelling ethos behind that.”
Q: How can one leader effectively manage multiple executive roles—and should your organization do the same?
Sylvan credits his executive assistant but also his own wiring: “I have no secret sauce or silver bullet… but I do need to be engaged and busy. I bring learnings and vignettes from one domain to the next, which keeps me in growth mode.”
He suggests:
Leverage a top-tier executive assistant.
Look for “overlap value” where insights in one domain inform another.
Recognize that this approach isn’t for everyone—but for some, it’s a force multiplier.
For organizations: Don’t combine executive roles by default. But if you find the right person, it can bring a level of integration and cross-pollination that siloed roles cannot.
Q: What is University Hospitals Ventures and why does it matter?
“The ventures platform is the investment and commercialization platform for the system. We look for opportunities within our own IP portfolio to see if there might be commercial viability—from licensing agreements to company formation.”
The process:
Start with the problem, not the solution.
Identify technologies that solve for real needs.
Pilot, trial, and measure outcomes—then invest if both ROI and impact are there.
Pursue both internal (spinouts, IP) and external (joint ventures, NASA agreements) innovation.
Sylvan makes a point to avoid “technology transfer” as a limiting concept: “We prefer ‘technology commercialization’—it’s broader, more encompassing.”
What’s the impact? UH is among the most active systems in the country for joint ventures, including major partnerships with technology firms and even NASA.
Q: How do you collaborate with non-healthcare organizations without losing your edge or wasting time?
Sylvan’s approach is refreshingly humble: “We don’t underestimate anyone. Healthcare is complex—but so are other industries. Knowledge is fungible. If you can figure out something in domain A, there’s a good chance you can figure it out in domain B.”
Two tactics:
Bring your clinical and domain expertise to the table—but listen and learn from partners’ domain strengths.
Shed the ego. Be open to solutions that may have been perfected elsewhere.
“Every company is going to have a health and life sciences component anymore—we’re all patients, we all need providers. But we also need tools, technologies, and offerings from other domains.”
Action for leaders: Cultivate partnerships with non-traditional players. Be open to being taught, not just teaching.
The lesson from David Sylvan’s leadership at University Hospitals is stark: the days of siloed strategy, innovation, and marketing are over. The only way to thrive—financially and missionally—is to integrate, co-design, and relentlessly focus on real problems, not hypothetical solutions. Technology alone will never save you; change management and humility will.
If you want to build a high-performing, mission-driven, and financially sustainable health system, start by breaking down your own silos and seeking partnerships—inside and outside the industry. True transformation, as Sylvan models, is a team sport.
<p>hello everyone this is Cole from the American Journal of healthc care strategy joined by a very special guest this afternoon David uh David can you please introduce yourself and your rule sure happy to call and uh thanks for having me David Sven I am with University Hospitals in Cleveland Ohio been here for for about nine or so years I currently sit in the role of Chief strategy Innovation and marketing officer for the system and I also lead our Venture Capital uh platform known as uh [Music] FRS how I want to ask you know first of all because looking at you know your resume you looks like you went to Case Western NBA and finance executive NBA and finance but you have a lot of experience over many many years um how and why did you end up in healthc care because it it looks like based on the resume you could have probably had a very successful career uh on Wall Street or or leading you know Financial companies um in healthcare of course is not always the most profitable uh you know Venture for people so what led you into Healthcare yeah it's a great story and uh not the first to have asked me exactly the same uh call so I um I did work uh in professional sports with an organization known as International Management Group IMG from there I did go to a broker dealer and a uh Investment Banking platform known as keyan capital markets uh so very involved in uh financial instruments known as derivatives and taxes and bond insurances uh and candidly never thought about uh joining the ranks of of healthc care largely for the reasons that you point out it's uh it's not for the faint-hearted it's very difficult uh it's at times glacial in terms of the pace at which it moves and uh there are uh to be crash easier ways to make more money if you if you will but then something fascinating happened I um I had my own consultancy practice after I left uh Investment Banking um I was uh uh and still involved with my El mamata with weather had School of Business where I teach in an adjunct basis and executive in Residence and had my own small consultancy practice largely self-servingly uh because I'd also begun to uh deploy my own monies as an angel investor and I thought this was a good way to get inroads into opportunities and pipeline Etc uh there was an opportunity with the University Hospitals looking to start up an innovation platform and uh perhaps selfishly I thought this would be a good idea for me to really understand the workings of the provider environment so that I could start to make better choices when it came to Angel Investing because there's so many wonderful tools Technologies and processes out there and then something happened Cole I uh I candidly found uh not to get sappy but I found Mission I found an opportunity to as a non-clinician impact uh impact lives perhaps and uh there's a lot to be fixed in healthc care not just American Health Care but that's where we are uh and there's a a lot of opportunity there are there's Perpetual unfinish business and that's what kept me very focused and engaged and uh that's what that's what keeps me uh keeps me uh uh you know awake at night and keeps me coming into work in the morning and sitting on podcasts like this so that's the sort of short answer thank you for sharing that because it is impressive right after you know a 20y year career um in various Industries you end up staying with University Hospitals for for quite a long time so far and then currently you're you know you're the president of the the uh Ventures and then of course Chief strategy Innovation and marketing officer those are those are impressive roles uh a lot to do with the Innovation a lot to do with strategy what what is going on right now with University Hospitals in terms of or even the healthcare spaces at the larger um Spectrum with with the strategy in Innovation space What are you seeing right now that's just going on yeah well I think the error that many of us made previously was thinking about innovation in its own bucket thinking about strategy and its own bucket and occasionally the two you know intersected or bisected and I think what we're trying to do which many systems are doing some further ahead than others is ensure that there's a Common Thread between Innovation between strategy between um uh the way in which we think about uh perhaps Capital deployment or uh care delivery models Etc there's a commonality between all of these things and if you attempt to do these things in a silo first of all outcomes will be suboptimal second of all uh potentially duplicative efforts and third of all no one has the the the the bandwidth either you know intellectual or mind share resourcing or Capital to to run the risk of not being aligned across all of these spectrums so Innovation uh and its marriage to strategy I think is an imperative I don't think any system nationally can afford to to not be Innovative from the perspective of how it thinks about care delivery how it thinks about physical plant how it thinks about you know the the the patient as the consumer and uh that's where Innovation and strategy can can can really dovetail nicely together why has it been siloed in the past why has it been separated for in in the healthc care space for a long time I don't think the um the financial pressures were such that it forced the alignment I think I think for many Systems Innovation as a an offering or innovation as a department was seen as a nice to have call um I don't think anyone can afford to to see it as a as a diance anymore I think it's an imperative and I think margin also masks um uh opportunities I think if you're if you're living in a comfortable positive net margin environment um candidly you can afford to to to to make a couple of mistakes and uh you know whether that's tuis or or oversight uh can be debated now we're all facing a bunch of headwinds uh and we can you know I think they're well documented that put us in a position where efficiencies and throughput and relationships uh collaborations all of these things need to be very very elegantly woven together and that's where the combination now uh it becomes so important I I agree I was at a conference uh recently where I where I heard heard it spoken about and it was in the context of AI and how you know AI is not really going to just be able to solve a lot of the problems that exist on its own can you speak at all to why we've we've tried this with technology we've done this with epic implementations we've done this with um even just moving to EHR from from paper and then now everyone's moving to Epic and now they're implementing AI in the Epic or they're implementing these uh you know listenting systems so Physicians don't have to transcribe their notes why are all these individual pieces of Technology not actually producing um the amount of savings and the amount of efficiency that that people expect I think because of the false positive associated with the manner in which they they are represented or presented this notion that if I just turn the tool on in and of itself that's going to create a the the outcome that was promised what's really needed is behavioral change what's really needed is for the users to actually adapt and adjust to they themselves becoming integrated with their technology so that it isn't just quicker faster it's actually quicker faster better and so that combination of person and process or person and Tool person and Technology I think is where the secret Source resides and not this false Reliance on just by virtue of the existence of the tool or the integration of the tool that it in and of itself is going to be the uh the solution so I think it's really this notion of are we also bringing the the users along at the same Pace as the adoption of the of the tech uh because both have to to to align at this you know meet at the same point if you will I'm sure a lot of the executives listening along are saying like yes that makes a lot of sense or like yes we need to do this but when it actually comes to to implementing the the use users and getting the users to change or or having them be involved in the process of implementation of these systems the actual process of doing that is really challenging right especially from an organization like yourself you have a a massive organization right I mean 5.4 billion dollars in in revenues incredible larger than um a lot of the the institutions that that we've had on even even some of the larger hospitals and so I think the scale of that is challenging right how do you how do you actually include the user and get users to change when you're dealing with you know 200 Physician Offices across 16 different counties I mean how have you been able to do that um mixed results to be quite candid and you know Cole will we'll eclip $6 billion do this year which makes us a you know a solid Middle Market you know size size institution if you will I think the biggest mistake organizations can make and we made this mistake is by cramming down by by forcing you to adopt a tool technology by impacting and disrupting your workflows without getting your pre- buyin without having you at the table uh during the process of opportunity you know selection and adjudication and not having you as part of the architecture and the design of how this solution is going to you know make make your life better create a different outcome for your patients Etc so this notion of forced adoption I think is a folly and I think you know we and many others have fallen prey to that I can't say that we have perfected it yet but what we do do is spend a lot of time relentlessly understanding problems and we do that through engagement and once we understand your problems clinician or administrator uh Etc we can then reverse engineer where there might be potential Solutions versus starting with a solution that we jamine you you know in in the first place so it's really flipping of the script in terms of how we get acknowledgement Buy in an adoption you know versus just uh stipulation and and that makes a lot of sense I I I I wonder though you know you're not a a physician yourself of course your your experiences in the finance realm do you ever find it challenging to understand the problems especially when dealing with you know these Physicians who've been practicing for 20 or 30 years they have so much history in in the clinical space do you ever have challenges yourself understanding the processes I know for me it sometimes it's challenging to grasp every day so what I need to do is make sure that I have on my team clinicians who have an Innovative Innovation or design mindset and can act as both the translation mechanism as well as the the point of potential influence when it comes to you know steering steering towards an outcome so uh it's never an N of one it's always a team of approach and we bring to the table the folks with the right vernacular and the right language set to be able to at a very sophisticated level you know Pro provide that that sort of interface between what Innovation is looking to discover and what the clinician in in your use case and your example is looking to solve for and act as that sort of bridging mechanism back in 2015 when you started there as the Director of strategic Innovation what do you think was unique about you know University Hospitals that allowed them to have some of these Innovative kind of job positions open and then allowed you to really want to stay there over nine years and I ask this because you had mentioned it earlier but Healthcare moves very slow sometimes it can be very aggravating to get Innovation or change to happen um and I think an individual like yourself with experience right if if you had not been able to impact change or to at least you know be productive I feel like you would have left the organization right so what what do you think about the environment University Hospitals allowed you to do meaningful work Cole I think it was very brave on uh's leadership side to think about non-traditional folks in non-traditional roles I think it was initially seen as an experiment to be quite candid but then as the experiment began to yield some results and we began to to amplify the positive results through through through story telling telling and through you know engagement with a with a broader audience it began to take a life of its own and we carried that forward a good percentage of uh and and leaving aside strategy and and and and and marketing for at this point but true in both of those cases as well the the intentionality around looking for folks who come from industry Beyond health care I think can be very powerful diversity of thought diversity of experience you high those things effectively you get out of the group think and perhaps even the myopia that often you know uh stifles uh Health Care this notion that we can solve for all of our own problems in a vacuum I think I think it started with a little bit of a brave experiment from a leadership perspective and candidly took a life of its own and you know my my intention is to always look for those uh individuals who bring diversity of of background experience and thought to the table and then pair those with tight clinical thought leadership to come up with a with a better M trp you know University Hospitals is is ranked very highly and it's also in a competitive environment in Cleveland one of the concerns about incorporating individuals from the industry who are not familiar with healthare is that we're going to decrease the quality or we're going to turn this into um you know much more of a of a profit seeking Venture these are just things that I've heard right that we're gonna we're gonna sacrifice patient care for profits but clearly you know University Hospital has not done that they they've gotten better at patient care while also um improving their margins why do you think they were or what what could you say to other hospitals who are looking to implement this type of innovation by bringing other people together um from out in the industry but who are facing some challenges and some concerns in the area of of how that's going to impact quality this episode of the strategy of Health was sponsored by modality Global advisers modality global advisors optimizes Hospital Revenue enhances patient experience and delivers proven results visit modality Global advisors.com to learn more I think it's critical to make sure that you um always reinforce the the the the base true north and you know in University Hospitals Case the the notion of the most needy or the most Worthy is never far from our minds and it's for that reason cly we don't turn down any patients and we're consistently looking at the magnitude of our community impact and um I think once you have a uh a mantra Around Mission and the purpose that you're here to serve and solve uh and you make sure you inculcate the institution with that ethos um you attract like-minded folks um who have this uh desire to be part of a a a mission focus and and it self-perpetuate so I think it's that Relentless reminder of of the the true north on the why we hear Cole as a as a differentiator I like that a lot I'm gonna I'm gonna use that that true north expression I think I like that um I noticed another thing interesting is you said integration of of strategy and Innovation it has to happen but then there's this other piece which is also in your title which is even more unique which is the integration of that marketing end of things and so why are you also the marketing officer I mean this is also a personal question because I'm interested in you know how these roles work but I notice a lot of hospitals struggle with marketing uh you look at even things as simple as SEO and institutions really struggle with this so why are those three roles combined you know one of one of our observations has been that at times marketing can reside uh in a silo uh of course its role is is is to um amplify brand and to effectuate Patient capture and through uh through monitoring and surveillance understand uh how care delivery might need to to be adjusted or supplemented or augmented on a either a geography or or service line basis I think what we've chosen to do is find the commonality between strategy Innovation and marketing and that's data and insights and use that single thread that single base layer to make sure that there's complete alignment so that the efforts that marketing is put putting forth absolutely overlays the Strategic Vision which is also powered by Innovation so it's um it's a little novel from the standpoint of bringing the three together but if one were to step back and think about the common language of data and insights there is a compelling ethos behind that when it comes to your time management this is also a question for me as somebody who's still early in their career you have a few different roles as well as board memberships you're on the part a member of the board of Tres of Ohio Life Sciences uh Southwest General Health Center as you mentioned you still teach with Case Western um how do you manage all of this and and should that be a concern for institutions who are looking to to combine some of these seite rules I mean how how is the time management like that to me that would seem very challenging it's very challenging not uh I I have no no secret Source nor Silver Bullet in this one and I'm fortunate to partner with an in an incredible uh executive assistant by the name of rose and uh Rose Pratt and uh she tries to keep me on the straight and narrow and building time for me to to breathe and walk so to speak um but it is a challenge you know I'm wired in a certain way call that I do need to be engaged and busy and and that's perhaps not for for everyone I do find commonality between all of these activities so try to bring learnings and insights and vignettes from one domain to the next and uh that um uh helps me consistently stay in learning learning mode and growth mode and uh I think that's what motivates me to be to be highly engaged and busy I learn something from someone every single day and uh you know when that stops it's probably time to to think about doing something else but clearly I'm nowhere near the end of that road what what is and this is a kind of a question as well um what is University Hospital Ventures and more specifically in in the resume it says 21 hospitals including five joint ventures this is something I don't see a lot when when reading through resumes or hospitals can you just explain a little bit of what that is sure so the ventures platform is the investment and commercialization platform for the system so we are an academic healthare system we have a large research portfolio and we're we're applicable we're feasible we look to uh find those opportunities within our own IP portfolio to see if there might be could be some commercial viability either from the perspective of a licensing agreement or royalty Arrangement or company formation spin out opportunities which we uh which which is an area where we're fairly active some folks refer to that as technology transfer we prefer technology commercialization is a little bit more broadly encompassing we have the equal but opposite view in terms of our side in we we look at hundreds of early stage companies a year again not just looking for Solutions we start with the problems we find potential Technologies to bump up against those and then we effectuate the the proof of Concepts or the pilots of the clinical trials to determine if in fact we we can get to a positive outcome that then also enables us to think about the due diligence associated with the investability is there a a pathway from a capital deployment perspective which could yield both a return financially but also impact the problem were being sold measured via you know net patient revenue or some other some other threshold the Strategic Partnerships call are um our intentional desire to have those entities who are experts in a particular domain where we're not perhaps lean in and uh do it better quicker more efficiently than we can and we have opport we have joint ventures with other Health Care Systems as you called out uh Hospice of the Western Reserve is a is a partner some are small tools and technology companies where we do co-design Cod development and some are opportunities at scale we we uh we we've just signed our most recent space act agreement with NASA for example so micro and macro opportunities when it comes to partnership it it makes sense how that time management works when when you explain that so the strategy Innovation and marketing that goes together and then of course how the the ventures you need that kind of like you said that Common Thread and that does make a lot of sense I mean like again props you're your assistant there for keeping all of that straight um but it makes sense why you'd need an individual like yourself to handle those kind of four different things together uh because when you're dealing with these Partnerships that are not necessarily just in healthcare you need those those strategy Innovation and marketing lenses in the industry sometimes there's a reluctance to work with organizations outside of healthc care because we're afraid that they'll lack the domain knowledge or that we're going to spend a lot of time re-educating uh individuals on how they can assist us how how have you and the the executive staff there at University Hospitals been able to overcome some of that resistance and be able to make you know really beneficial Partnerships with nonth healthare related organizations yeah two two Pathways there called it's a good observation first of all we don't underestimate anyone yes healthc care is very complex and complicated but so too are their Industries and knowledge is fungible and if you can if you can figure out something in domain a there's a good chance you you have a running started figure it out in domain B so we will bring the clinical wins we will bring the the the uh demystification of healthc care to that table whilst our partner will bring their expertise in name name the problem to be solved where they've already perhaps already perfected a solution that we're looking to to to ameliorate so it's really finding common ground from the perspective of opportunity it's finding common ground from the standpoint of uh intentionality every company around the world is going to have a a health and Life Sciences component to it anymore because um we're impacting everyone's impacting the day in the life of and so we're all patients uh we all we all uh need providers but by the same token we also need the tools Technologies and offerings of these of these OB L entities and there is a better mous trrap to be had in certain domains through through that combination it does take a little bit of shedding of the ego to to uh to ensure that we are receptive to to to feedback from the outside um not always easy in healthcare as I know you've experienced probably uh to date but again being good listeners and meeting folks where they are from the perspective of Designing Solutions around well well defined problems I think is the is the path line I really appreciate that uh some things that I need to to think about myself there when it comes to to shedding of the ego even myself right I mean it's uh it's challenging because we we take a lot of pride in our in our work right in being experts in our work and uh and I think we need to like you said shed the ego and and learn to collaborate because I don't know if we're going to be able to make the the changes that we need to make unless we we do that and clearly you guys are really moving ahead in an impressive way at University Hospitals uh I think that's a great place to leave off I couldn't be more appreciative for you coming on David it's it's been very informative for me and I think our audience will find it very informative as well appreciate you having me Cole wish you best of luck and uh let's stay in touch</p>
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