Latest / Becker’s Healthcare Podcast / Leading With Purpose Through Healthcare’s Affordability Challenges with Chris Van Gorder

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Leading With Purpose Through Healthcare’s Affordability Challenges with Chris Van Gorder · Becker’s Healthcare Podcast

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  - This is Scott Becker with the Beckers HealthCare
• 1:01
  - podcast.
• 1:02
  - It's truly a pleasure today to visit with
• 1:05
  - Chris Van Gorder.
• 1:06
  - Chris is the CEO of the Scripps Health
• 1:09
  - System.
• 1:10
  - He he's also the
• 1:12
  - the author of a book that I love
• 1:15
  - called The Frontline
• 1:16
  - Leader, if I'm remembering the title exactly correctly,
• 1:19
  - but just a remarkable career and person and
• 1:22
  - leader.
• 1:23
  - We get to visit with Chris regularly or
• 1:25
  - periodically to talk about what he's watching in
• 1:27
  - health care, what he's seeing, and more.
• 1:29
  - Chris, can you take a moment,
• 1:31
  - tell us a bit about yourself
• 1:33
  - and about Scripps,
• 1:35
  - and then I I I know you follow
• 1:37
  - so closely everything that's going on and have
• 1:39
  - incredible insight in what's going on in terms
• 1:42
  - of,
• 1:42
  - taking care of patients and and and and
• 1:45
  - populations.
• 1:46
  - And so we wanna dig into that some.
• 1:47
  - Chris, take a moment and introduce yourself to
• 1:49
  - anybody that has been under a rock and
• 1:51
  - doesn't know of Chris Van Gorder.
• 1:53
  - Thank you, Scott. It's great to great to
• 1:56
  - talk to you again.
• 1:57
  - Well, I'm Chris Van Gorder. I'm the president
• 1:59
  - and chief executive officer of Scripps Health. That's
• 2:01
  - a position
• 2:02
  - I've had now for twenty six years, long
• 2:05
  - time. I've been in the business
• 2:06
  - just shy of, I think well, I'm forty
• 2:08
  - nine years in now, just shy of 50.
• 2:11
  - I did spend a little bit of time
• 2:13
  - as a police officer. I was injured in
• 2:15
  - the line of duty and back into health
• 2:16
  - care again.
• 2:17
  - And, I run Scripps Health. It's a five
• 2:21
  - hospital campus system in the San Diego area.
• 2:25
  - We run two level one trauma centers. We
• 2:27
  - are academic. We have a number of residency
• 2:29
  - programs and fellowship programs,
• 2:32
  - 18,000
• 2:33
  - employees,
• 2:33
  - 3,500
• 2:35
  - physicians,
• 2:36
  - 2,000 volunteers, and a number of major medical
• 2:38
  - groups, including Scripps Clinic and Scripps Coastal and
• 2:41
  - those types of things. So, and then a
• 2:44
  - large ambulatory
• 2:45
  - footprint, as well in the area. So that's
• 2:47
  - Scripps.
• 2:48
  - And and and, Chris, I'd really love to
• 2:50
  - visit with you on two things today.
• 2:52
  - One is on sort of the current health
• 2:54
  - care situation and what you're watching, what you're
• 2:56
  - seeing there in California and generally.
• 2:58
  - And second is leadership because you've had this
• 3:00
  - amazing leadership career and have written on and
• 3:02
  - spoken on a lot as well.
• 3:05
  - First, talk to us a little bit about
• 3:07
  - some of the trends you're watching in health
• 3:09
  - care,
• 3:10
  - the good and the bad.
• 3:12
  - What's going good, and where are some of
• 3:14
  - the challenges?
• 3:16
  - The the way I look at it, we're
• 3:17
  - doing very, very well as an organization. I'm
• 3:19
  - very proud of Scripps Health.
• 3:21
  - We we've got a number of quality awards,
• 3:24
  - etcetera, but,
• 3:26
  - our our challenges are external to the organization.
• 3:30
  - We are in what I would call uncharted
• 3:32
  - times.
• 3:33
  - As as you know very well,
• 3:35
  - we've got,
• 3:36
  - HR one or the big beautiful bill or
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  - o b three, whatever you wanna call it,
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  - with $1,000,000,000,000
• 3:42
  - in cuts to hospitals over the next ten
• 3:45
  - years.
• 3:46
  - We're already seeing the
• 3:48
  - impacts of the Affordable Care Act subsidies being
• 3:51
  - reduced.
• 3:52
  - We're estimating right now, and it's an estimate.
• 3:54
  - It's too early to tell, but a loss
• 3:56
  - of around $800,000
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  - a month,
• 3:59
  - in income just from the ACA subsidies.
• 4:02
  - We know we're still taking care of the
• 4:03
  - patients. And we expect,
• 4:06
  - starting probably into early two thousand twenty seven,
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  - $100,000,000
• 4:11
  - a year in reductions
• 4:12
  - coming from HR one. And then we're in
• 4:15
  - the middle of this affordability issue,
• 4:18
  - and it's interesting.
• 4:20
  - We've always been concerned about cost, etcetera, but,
• 4:23
  - now it's somehow hospitals are the focal point
• 4:27
  - for affordability, and I often say that's very
• 4:29
  - interesting since we're at the end of the
• 4:31
  - food chain when it comes to cost of
• 4:33
  - health care.
• 4:34
  - We're the organizations that actually take care of
• 4:37
  - patients,
• 4:38
  - are required to take care of patients in
• 4:40
  - our emergency rooms by
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  - Of course, we would do that morally anyway.
• 4:45
  - And so,
• 4:46
  - you know, every everybody else's cost, insurance cost,
• 4:49
  - medtech cost, pharmaceutical cost, all the other supply
• 4:52
  - cost, employee cost, all of those things we
• 4:55
  - have to bear. And yet,
• 4:57
  - I'm not sure if it's the media, but,
• 4:59
  - certainly, the government is looking at hospitals
• 5:01
  - as somehow the issue when it comes to
• 5:03
  - affordability. And, in fact, now in California, we
• 5:05
  - have the California Office of Health Care Affordability
• 5:09
  - that is established,
• 5:11
  - starting this year. This is the this year,
• 5:13
  - we're already in a penalty year,
• 5:14
  - that we're not supposed to allow cost to
• 5:17
  - go above three and a half percent, and
• 5:18
  - that'll drop down to 3%.
• 5:21
  - And as you know, that's less than in
• 5:22
  - general inflation, much less health care inflation,
• 5:25
  - and half the hospitals in California are already
• 5:27
  - losing money. So
• 5:29
  - these are challenging times.
• 5:31
  - On the good side, this the quality of
• 5:33
  - care that we are,
• 5:36
  - giving our patients these days is unbelievable.
• 5:39
  - I mean, with with genomics and new infusions
• 5:42
  - and new new chemotherapies,
• 5:44
  - new radiation
• 5:45
  - technologies,
• 5:47
  - we're giving some unbelievably,
• 5:50
  - high quality
• 5:51
  - health care
• 5:52
  - that's incredibly expensive health care. And,
• 5:56
  - there's going to be a bump in the
• 5:57
  - road here when that quality
• 6:00
  - gets impacted by affordability
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  - for those of us at the end of
• 6:04
  - the food chain. And so
• 6:06
  - No. Talk about that because I you know,
• 6:08
  - we talk about this often in terms of
• 6:09
  - the Triple Aim.
• 6:11
  - Cost for family of four for insurance had
• 6:13
  - gone up to $30.30, 40,000 a year.
• 6:16
  - Median income in our country is only 84,000.
• 6:18
  - So those numbers on affordability
• 6:20
  - just really don't work for at least half
• 6:22
  - of the population
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  - without lots of subsidies. But but we know
• 6:25
  - that the subsidies also cause challenges, but there's
• 6:28
  - no way around them.
• 6:29
  - In terms of quality and access,
• 6:32
  - access get it's challenging.
• 6:34
  - If you hold hospital rate increases to 3%,
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  - there's nothing holding the cost drivers to hospitals
• 6:40
  - to 3%. So that's an impossible
• 6:43
  - that's just impossible math quite frankly. And that
• 6:45
  - that math just doesn't work. If you say
• 6:47
  - it at the hospital, you can't raise raise
• 6:48
  - by 3%,
• 6:50
  - but
• 6:51
  - your labor and equipment and supplies cost are
• 6:54
  - going up more than 3%,
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  - and you've got 40% of hospitals below zero
• 6:58
  - in terms of margin.
• 7:00
  - Those numbers just don't work from that's an
• 7:02
  - access standpoint, a cost and access standpoint. And
• 7:04
  - then quality's
• 7:05
  - hard to keep up where it's gotta be
• 7:08
  - if you have so many cost and quality
• 7:10
  - cost and access challenges even if it's even
• 7:12
  - if places like scripture doing so remarkably great
• 7:15
  - care. I mean, that's just a really challenging
• 7:17
  - fulcrum of challenges.
• 7:19
  - Exactly.
• 7:20
  - We we had the opportunity to actually meet
• 7:22
  - with the leadership for of OCA,
• 7:24
  - came down to visit us at Scripps Mercy
• 7:26
  - Hospital,
• 7:28
  - HCAI, which is the California,
• 7:30
  - health care,
• 7:31
  - access and information agency now, formerly used to
• 7:35
  - be OSHPD and another name, and and OCA
• 7:37
  - falls underneath it. And we've been
• 7:40
  - up in Sacramento a lot testifying
• 7:42
  - that,
• 7:43
  - the direction we're going with affordability
• 7:46
  - isn't gonna work in the long run. And,
• 7:48
  - to the state's credit, they came down to
• 7:50
  - visit us, and we had a a chance,
• 7:52
  - a very candid conversation,
• 7:54
  - my CFO and I. I I said I'm
• 7:57
  - I'm an ex cop, and,
• 7:59
  - we had a person in the room that
• 8:01
  - it was observing that said that it was
• 8:02
  - a good cop, bad cop. The good cop
• 8:04
  - was my CFO. The bad cop was me.
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  - But
• 8:07
  - but we got the point across, and and
• 8:09
  - we've invited them back. So come and spend
• 8:11
  - a few days with us. So you can
• 8:13
  - see how supply chain really does work in
• 8:15
  - a hospital, to see how costs really do
• 8:18
  - work in in a in a in a
• 8:19
  - hospital, how accounting in health care in a
• 8:22
  - hospital works,
• 8:23
  - because,
• 8:24
  - as we told them, we're very concerned about
• 8:26
  - affordability,
• 8:28
  - but there's limits to what we can do
• 8:30
  - at the end of the food chain.
• 8:32
  - I said, we can't just ignore the rest
• 8:33
  - of the food chain and expect somehow the
• 8:36
  - hospitals at the end are gonna be the
• 8:38
  - solution to this affordability issue, which is genuine.
• 8:41
  - It's real. It's a problem. We've gotta we've
• 8:43
  - gotta find a way of doing it, fixing
• 8:44
  - it. But we've got drugs coming in, for
• 8:46
  - example. We now have a new,
• 8:49
  - so literally, like, it's like putting an a
• 8:51
  - little tiny
• 8:52
  - robot in an eyeball,
• 8:54
  - to help with macular degeneration
• 8:57
  - that cost something like, you know, couple $100,000,
• 9:01
  - to to put in. We have patients calling
• 9:03
  - us demanding that technology, of course, not expecting
• 9:07
  - to have to pay that kind of money
• 9:08
  - for it, and Medicare is just approved this
• 9:10
  - drug. That's just one of many things that
• 9:12
  - are coming down
• 9:14
  - that the patients want,
• 9:16
  - but they somehow at the same time want
• 9:17
  - it to be affordable.
• 9:19
  - That's not gonna work. Something is something's gotta
• 9:21
  - change in the food chain.
• 9:23
  - Yeah.
• 9:24
  - A a 100%.
• 9:26
  - And and the people that you speak to
• 9:28
  - from the office of what whatever that's exactly
• 9:31
  - called,
• 9:32
  - are they empathetic at all? Is it politicians
• 9:35
  - that's setting these numbers and then people in
• 9:36
  - the offices are a little bit empathetic? Or
• 9:38
  - how do you how do you look at
• 9:39
  - that, or does it really matter
• 9:41
  - if it's been legislated one way or the
• 9:42
  - other?
• 9:43
  - Well,
• 9:44
  - I think they I think they understood what
• 9:46
  - we were trying to explain to them.
• 9:48
  - I'm not so sure I'd say empathetic,
• 9:51
  - because I'm not sure they understand how what
• 9:54
  - the cost drivers are really for the hospitals,
• 9:56
  - and they have a legislative mandate.
• 9:58
  - Now people we are who we are starting
• 10:01
  - to see that are more empathetic are the
• 10:03
  - legislators themselves. We've we've gone to our local
• 10:05
  - legislators who put OCA, the Office of Health
• 10:07
  - Care Affordability,
• 10:09
  - into place. And I think they did that
• 10:11
  - with good intentions,
• 10:14
  - but didn't understand the unintended
• 10:16
  - consequences
• 10:17
  - of that. And we're trying to educate them
• 10:20
  - to get
• 10:21
  - the the the, at least the percentages, more
• 10:24
  - realistic
• 10:25
  - so that we can work together with the
• 10:27
  - state to actually make things more affordable.
• 10:30
  - But it it just can't be, let's go
• 10:32
  - after the hospitals, hold them to an unrealistic
• 10:35
  - percentage, and then penalize them. And the penalties
• 10:38
  - are are extraordinarily
• 10:40
  - high.
• 10:41
  - They could literally
• 10:42
  - bankrupt
• 10:43
  - or close hospitals. And I don't think that's
• 10:45
  - exactly what,
• 10:47
  - access and affordability means,
• 10:49
  - is shutting down hospitals. So something's gotta
• 10:52
  - get changed in in this process, and our
• 10:54
  - job is to is to do the education.
• 10:57
  - And we told them, I said, we're we're
• 10:58
  - deeply concerned about affordability, but it has to
• 11:00
  - be realistic affordability as well.
• 11:03
  - Thank you. And and and take a moment,
• 11:06
  - Chris,
• 11:07
  - on on a different subject. I mean, Scripps
• 11:09
  - Health doing great things, notwithstanding
• 11:12
  - all these challenges, continuing to provide incredible patient
• 11:15
  - care.
• 11:16
  - Let me
• 11:18
  - talk about that for a second.
• 11:20
  - Could you give us one or two or
• 11:22
  - three areas
• 11:23
  - that you're particularly proud of the work that
• 11:25
  - Scripps is doing before we move on to
• 11:27
  - discussing leadership? Just a few things that, like,
• 11:29
  - stand out to you Nick, god, we are
• 11:31
  - so thrilled about this or that.
• 11:33
  - Oh,
• 11:35
  - I have a laundry list of those. I
• 11:36
  - mean, our culture is is unbelievable. As you
• 11:39
  - know, I took over I came in into
• 11:42
  - this organization as chief operating officer for six
• 11:44
  - months before I became the CEO after votes
• 11:46
  - of no confidence from our physician leadership.
• 11:50
  - I put together a a group we call
• 11:52
  - the position leadership cabinet. It consists of the
• 11:53
  - chiefs of staff and vice chiefs of staff
• 11:55
  - and my hospital administrators
• 11:57
  - with this hypothesis that if we could find
• 11:59
  - a way of filling the gap of information,
• 12:01
  - which we do every month,
• 12:03
  - we would reach the same conclusion. And fast
• 12:05
  - forward twenty six years, we've accepted 100% of
• 12:08
  - the recommendations coming out of the physician leadership
• 12:10
  - cabinet. Only one vote's been less than unanimous
• 12:13
  - and that by one vote, you know, proving
• 12:15
  - that hypothesis.
• 12:16
  - We have wonderful physician relationships in this organization.
• 12:20
  - Our quality is top notch. This last year,
• 12:22
  - premier,
• 12:23
  - picked us as one of the top health
• 12:24
  - care
• 12:25
  - systems in the country for quality using only
• 12:27
  - objective data. We're now falling from the because
• 12:31
  - of all the, you know, mergers and acquisitions,
• 12:33
  - we've fallen into the middle size category,
• 12:36
  - but we are number two in that. So
• 12:37
  - we're number two of the five in the
• 12:38
  - middle category, Purely objective quality information.
• 12:41
  - We've been on Fortune magazine's best 100 employers
• 12:44
  - list now going on well, now for eighteen
• 12:47
  - years, going on nineteen years, and we're growing.
• 12:49
  - I'm I'm in the process of of starting
• 12:51
  - to,
• 12:52
  - build new medical office buildings, a new hospital
• 12:55
  - in San Marcos.
• 12:56
  - So
• 12:57
  - as I say, things internally
• 12:59
  - are good and strong, and and as I
• 13:02
  - go, we I talk about the three p's.
• 13:05
  - Patients first always,
• 13:06
  - our people second,
• 13:08
  - because it's the people who take care of
• 13:10
  - the patients, and then performance, because it's performance
• 13:12
  - that takes care of the people who take
• 13:14
  - care of the patients. If we can focus
• 13:16
  - on the three p's, which we do,
• 13:19
  - then we don't have anything to worry about.
• 13:21
  - And right now, as an organization, we're strong.
• 13:24
  - Thank you so much. No. Just incredible what
• 13:26
  - you've been doing what you've been doing for
• 13:27
  - a long time there at Scripps Health.
• 13:30
  - Chris, years ago, I read your book, The
• 13:32
  - Frontline Leader. I've admired your leadership for a
• 13:35
  - long time. You have this amazing history of
• 13:37
  - being actually
• 13:38
  - a a police officer before
• 13:40
  - becoming
• 13:41
  - a hospital leader and then CEO.
• 13:45
  - What advice to emerging leaders? When you think
• 13:47
  - about the advice you give to emerging leaders,
• 13:49
  - what advice you give,
• 13:51
  - any starting thoughts there?
• 13:53
  - Yeah. These days, number one,
• 13:55
  - health care is so incredibly important. It's not
• 13:58
  - going away. No matter what the challenges you
• 14:00
  - read and hear about, and I know there's
• 14:02
  - a lot of retirements these days and people
• 14:04
  - saying, well, maybe I shouldn't get into health
• 14:06
  - care. Maybe because of AI, I should not
• 14:08
  - go into health care. Well,
• 14:10
  - AI is gonna make things better in the
• 14:11
  - long run for us. It's scary right now
• 14:13
  - because we don't know how it's going to
• 14:14
  - impact people. But, again, we're also still focused
• 14:17
  - very much on our people. So health care
• 14:19
  - right now, and I think pretty much forever
• 14:22
  - is going to be a hands on business,
• 14:24
  - and I think health care is a great
• 14:26
  - industry to get into.
• 14:28
  - Be focused.
• 14:29
  - There's a lot of things going on out
• 14:31
  - in the world that can get you create
• 14:33
  - a distraction or what I call a firefly
• 14:35
  - effect.
• 14:37
  - And,
• 14:38
  - I I keep telling my people that we
• 14:39
  - have some core core goals,
• 14:42
  - high quality care, high service health delivery,
• 14:46
  - take care of of our physicians,
• 14:48
  - you know, we have to hit our financial
• 14:50
  - targets.
• 14:51
  - All you know, just about five or six
• 14:53
  - things we have to do, all of them,
• 14:54
  - by the way, are hard.
• 14:56
  - But everybody knows that we're that they're hard,
• 14:58
  - but we're they're measurable, and we're gonna hold
• 15:00
  - people accountable to those. And as a result,
• 15:03
  - people stay focused on the core goals instead
• 15:06
  - of getting distracted, and we hit the goals.
• 15:08
  - So, you know, be be focused. Be strategic.
• 15:11
  - We have to be aware of what's going
• 15:13
  - on in the marketplace
• 15:14
  - and and make the adjustments to our strategy
• 15:16
  - and our operations to be more affordable,
• 15:19
  - or to, you know, improve our access points
• 15:22
  - or whatever it happens to be.
• 15:25
  - And my fundamental
• 15:26
  - thing is take care of your people. You
• 15:28
  - take care of your people, your people are
• 15:30
  - going to take care of you. Anybody in
• 15:32
  - leadership should understand that, and these are scary
• 15:34
  - times for for people, so we need to
• 15:36
  - keep them informed.
• 15:37
  - And as I often say, it's not what
• 15:40
  - it people organizations are good at saying what
• 15:42
  - they're doing. What they have to be doing
• 15:44
  - is explaining why they're doing what they're doing.
• 15:46
  - When people understand the why,
• 15:49
  - they most likely would make the same decisions
• 15:51
  - we're making and they can support it.
• 15:54
  - And and how important is that to take
• 15:55
  - that effort? Because it takes extra effort
• 15:58
  - to explain to people, here's why we're doing
• 16:00
  - this. And and not everybody wants to hear
• 16:02
  - it,
• 16:03
  - but it's so important to give some feel
• 16:06
  - and coverage and emotionality to it so people
• 16:09
  - don't think you're just sitting in an office
• 16:10
  - making decisions without a reason or thought process.
• 16:14
  - How important is that explanation
• 16:16
  - of what you're doing and why you're doing
• 16:17
  - it?
• 16:18
  - It's critically important because if people don't understand
• 16:21
  - the why,
• 16:22
  - they're not gonna be as supportive. And then
• 16:24
  - leaders spend all of their time trying to
• 16:26
  - gain the support that they should already have
• 16:29
  - in place to make the changes that are
• 16:30
  - necessary.
• 16:32
  - As you know, I have a number of
• 16:33
  - leadership academies,
• 16:34
  - you know, the the the Scripps Leadership Academy
• 16:36
  - for managers and above, the Frontline Leader Academy
• 16:39
  - for supervisors. We have our employee 100 for
• 16:41
  - frontline employees.
• 16:43
  - I go to every single one of those
• 16:45
  - sessions. I stay the entire day,
• 16:48
  - with them, and they all start with a
• 16:50
  - wide open q and a.
• 16:52
  - So I get the chance to explain why.
• 16:55
  - And as I often tell people, there's only
• 16:57
  - three things I'm not gonna answer questions about.
• 16:59
  - I'm not gonna violate HIPAA. Not gonna talk
• 17:01
  - about personnel issues that's to relate to individuals.
• 17:04
  - And, if we have a nondisclosure agreement in
• 17:07
  - place, we do business transactions, as you know.
• 17:09
  - I can't talk about that. Those are the
• 17:11
  - only three things that are off limits. And
• 17:13
  - things happen in these academies. Number one, people
• 17:16
  - get their questions answered, but they build trust.
• 17:19
  - I get to know leaders that I might
• 17:20
  - otherwise not get to spend time with or
• 17:22
  - know. They get to spend time with the
• 17:24
  - senior leadership team that they might not get
• 17:26
  - to know very well, and we build that
• 17:28
  - trust together. And then, tomorrow morning, for example,
• 17:31
  - I have the Scripps Leadership Academy alumni
• 17:33
  - call. I I have a call with them
• 17:35
  - monthly, and it just starts with, you know,
• 17:37
  - several 100 people, probably 400 people, on the
• 17:41
  - line, and I say, what's on your mind?
• 17:42
  - And we do a q and a.
• 17:44
  - So all we do is to keep people
• 17:46
  - up to date with all of these things.
• 17:48
  - That's the kind of time leaders have to
• 17:50
  - spend their time doing,
• 17:52
  - or they're gonna be reacting and spending time
• 17:54
  - doing reactionary things.
• 17:57
  - Fantastic.
• 17:58
  - Chris,
• 18:00
  - any challenges throughout your career that you particularly
• 18:03
  - have learned from? I I know you've been
• 18:05
  - running this. The the Scripps Health System for
• 18:07
  - twenty six years now. It seems like a
• 18:09
  - lifetime. Simply remarkable.
• 18:12
  - Would you
• 18:13
  - give us a couple challenges
• 18:15
  - you faced or
• 18:16
  - or things that have been, you know, really
• 18:19
  - interesting in sort of molding you as a
• 18:20
  - leader and how you think about things?
• 18:22
  - Well, that's an interesting question. Well, probably
• 18:25
  - the first thing I mean, it and it
• 18:26
  - goes way, way back then when I was
• 18:28
  - a young vice president at a hospital in
• 18:30
  - Orange County.
• 18:31
  - And there was so much angst and anger,
• 18:35
  - between the medical staff, administration,
• 18:37
  - and the board.
• 18:38
  - And in fact, the the the doctors boycotted
• 18:40
  - the hospital until they got the CEO fired.
• 18:43
  - That's when I was actually hired.
• 18:46
  - And and and they're still very angry. So
• 18:49
  - they they continued boycotting until they could get
• 18:51
  - maximum,
• 18:52
  - representation on the board.
• 18:54
  - Back then that was 49%. That wouldn't be
• 18:56
  - legal today. Back then you could get up
• 18:58
  - to 49%.
• 18:59
  - And they basically elected the most negative angry
• 19:02
  - doctors
• 19:02
  - to be on the board.
• 19:04
  - And when they were on the board, they
• 19:06
  - agreed with the board 100% of the time.
• 19:09
  - Go figure. Right? What was the difference?
• 19:11
  - The difference was now they had information they
• 19:14
  - didn't have before. They could they got the
• 19:17
  - why. And that's when I learned how important
• 19:19
  - the why was. By the way, their their
• 19:20
  - medical staffs would be angry at the doctor
• 19:23
  - board members because they weren't challenging the administration.
• 19:26
  - And the doc said, well, because they're right.
• 19:30
  - The things they're doing, they had to do
• 19:31
  - because of this or this or this. And
• 19:33
  - that was a huge lesson for me. And
• 19:35
  - that's why ever since that time, I've done
• 19:37
  - things like create the physician leadership cabinet or
• 19:40
  - our leadership academies or whatever because that is
• 19:43
  - time well spent.
• 19:44
  - But people don't realize, it's not just creating
• 19:47
  - it. You actually have to be engaged in
• 19:49
  - it and discuss it and and and and
• 19:52
  - make the effort. And not everybody on the
• 19:54
  - other side of that wants to hear it
• 19:56
  - all the time. But you it's it's not
• 19:58
  - just creating. It's a constant nurturing and discussing.
• 20:01
  - And I think that's almost the hardest part
• 20:03
  - of leadership, the amount of time it takes
• 20:05
  - to really,
• 20:06
  - really visit and talk with people and make
• 20:08
  - sure things are communicated.
• 20:09
  - And what we think of is a two
• 20:11
  - way way, not just one way, because just
• 20:13
  - throwing information to people doesn't work, it's actually
• 20:15
  - gotta be engaging. Right? Exactly. Well,
• 20:18
  - one of the first questions I ever always
• 20:20
  - get in these classes is, well, what about,
• 20:23
  - you know,
• 20:24
  - work life balance?
• 20:25
  - And I said, look. I'm the last person
• 20:27
  - in the world you ever wanna hear about
• 20:29
  - work life balance,
• 20:30
  - because I have no idea what it is.
• 20:32
  - And then we ultimately talk about work life
• 20:34
  - integration
• 20:35
  - because,
• 20:36
  - different jobs require different
• 20:39
  - balances, as it were, and they change as
• 20:41
  - time goes on, but you have to find
• 20:43
  - a way to integrate and take care of
• 20:45
  - your family. I'll tell everybody, I said, don't
• 20:47
  - ever
• 20:48
  - support Scripps
• 20:49
  - more than you take care of and support
• 20:51
  - your family.
• 20:52
  - I, you know, often talk about
• 20:54
  - creating the the safe environment,
• 20:57
  - for people and and and, taking taking the
• 21:00
  - way the no or the lack of loyalty.
• 21:03
  - And you do that, everyone, a lot of
• 21:04
  - people believe that their faith may be number
• 21:06
  - one, their family, number two, maybe their employer
• 21:09
  - is number three. Well, if we can find
• 21:11
  - a way to give them a secure job,
• 21:14
  - not fear being laid off or things like
• 21:15
  - that, we have a no layoff philosophy,
• 21:17
  - not policy,
• 21:19
  - but we have a no layoff philosophy. People
• 21:21
  - know here that we will the last thing
• 21:23
  - we will do is do a layoff, and
• 21:25
  - and that may be because of external things
• 21:27
  - or whatever. But,
• 21:29
  - so we take away with that kind of
• 21:31
  - thing, and you it's amazing how loyal people
• 21:34
  - can ultimately be. And the other thing, I
• 21:37
  - guess, you know, in terms of life changes
• 21:39
  - was when, you know,
• 21:41
  - a a lady tried to kill me in
• 21:42
  - a family dispute call when I was a
• 21:44
  - cop, and,
• 21:45
  - I end up
• 21:46
  - losing that career and finding myself a patient,
• 21:49
  - and how important those caregivers were to me.
• 21:53
  - It's, you know, so in many ways, I
• 21:55
  - started in this business,
• 21:57
  - as a patient.
• 21:59
  - And so it's pretty easy for me to
• 22:01
  - always remind myself and everybody else that that's
• 22:04
  - the most important thing we do every single
• 22:05
  - day. No matter all the rest of the
• 22:07
  - noise that goes on around us, it's taking
• 22:09
  - care of that patient, an individual patient, and
• 22:12
  - that family is the most important thing that
• 22:14
  - any of any of us should be considering
• 22:16
  - in in any day.
• 22:19
  - Love it. Chris, it's always a fantastic pleasure
• 22:22
  - to visit with you. You're one of the
• 22:23
  - leaders I most admire in the country. Thank
• 22:26
  - you so much for all you do and
• 22:27
  - for the leadership of yourself in the Scripps
• 22:29
  - Health System. Thank you so much for joining
• 22:30
  - us today as well. Well, Scott, thank you.
• 22:32
  - I mean, the the the the publications, the
• 22:34
  - podcast,
• 22:35
  - the education that you're putting out there these
• 22:37
  - days, you're helping explain the why.
• 22:41
  - And, you know, I don't think there's a
• 22:42
  - day goes by where I don't log in
• 22:44
  - and take a look at your material or
• 22:46
  - listen to your podcast. So thank you for
• 22:48
  - what you're doing to help.
• 22:50
  - Thank you very, very much.