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E177: Inside Rural Healthcare Leadership with Hospital CEO Aidan Hettler · The Advancing Healthcare Innovation Show

0:10
Hello and welcome back to the Advancing
0:12
Healthcare Innovation Show. I am your
0:14
host, Michael Stamatinos, and if you're
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new to us, welcome. It's great to have
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new episodes come directly to you. So
1:22
today's guest is Aiden Hetler, the CEO
1:26
of Seduk County Health Center. So Seduk
1:30
County, I can't say that 10 times in a
1:32
row, but Sedick County Health Center is
1:34
a critical access county-owned hospital,
1:38
>> which means that the hospital isn't just
1:41
part of the community. It is the
1:44
community. So it's it's one of the
1:46
largest employers. It's the safety net.
1:48
and and in many cases honestly it's the
1:51
reason why families you know can stay
1:54
where they live. So uh Aiden runs a
1:56
hospital where you know nothing is
1:59
really abstract. Um if staffing is short
2:03
uh or if nurses call out sick I mean you
2:06
feel it the same day. If volumes drop uh
2:09
it shows up quickly. I if trust is lost
2:13
you know everybody knows. So, uh, Aiden
2:16
is really casted now where he's got to
2:19
lead with a high degree of precision,
2:21
uh, discipline and judgment, you know.
2:23
So, when people think about rural
2:24
healthcare, it it's it's not a smaller
2:27
version of, you know, sort of big system
2:31
healthcare. Uh, the rules are different.
2:34
The trade-offs are real, and honestly,
2:36
there's just really no place to hide
2:39
when decisions go sideways. And uh this
2:42
conversation is really going to be
2:44
about, you know, leadership, what it
2:45
really actually looks like when
2:47
resources are are limited. Um and
2:50
accountability is is very public and uh
2:53
the stakes are are are absolutely
2:56
personal. So uh no buzzwords, you know,
2:59
no theory, like real life stuff. This is
3:02
just how it works. So Aiden, it's great
3:04
to see you. Welcome to the show.
3:07
>> Yeah, thank you so much for having me,
3:09
Michael. I really appreciate the
3:10
opportunity to come on.
3:12
>> All right. So, before we talk about
3:13
like, you know, how you got into it,
3:15
walk me through like a normal, you know,
3:17
Tuesday morning for you. Uh, what's like
3:20
the first problem you're dealing with uh
3:23
before 9:00 a.m.?
3:26
>> Oh, that's a great question because I
3:28
don't think there is any normal. Every
3:31
single day is something dramatically
3:34
different. I mean, I've had everything
3:36
from the phone calls that the night
3:39
shift nurse in the nursing home didn't
3:41
come in and the or the the dayshift
3:44
nurse didn't come in and the night shift
3:45
nurse is still here and there's nobody
3:47
else to call. So, you need to figure out
3:49
who to call and it's me sitting at the
3:52
nurse's station desk reaching out and
3:54
doing every single thing I possibly can
3:56
to find connections and find people to
3:58
come in and relieve the nurse who's now
4:00
passed her hours. Um, so a morning like
4:04
that, we could have a morning where a
4:06
washing machine breaks in laundry or
4:08
there's a piping issue in dietary or I
4:13
mean, you name it. It's any anything you
4:16
could conceive of. I don't think
4:17
anything is off the table. This role has
4:20
um taught me and shown me a lot in the
4:23
last three and a half years. And um
4:26
there's no normal. That's a good thing.
4:28
Keeps you on your toes. Definitely try.
4:31
But um yeah, it's it's been great.
4:36
>> Awesome. I mean, listen, when when
4:37
people think, you know, here, you know,
4:40
hospital CEO, um my hunch is that they
4:43
they imagine authority
4:46
>> in your world. Um what does like
4:49
authority look like, you know,
4:51
dayto-day?
4:53
>> Yeah. So, that's a really awesome
4:56
question, especially for someone my age,
5:00
because it's not so much about
5:03
authority. And I think people think of
5:05
all healthcare CEOs just in this blanket
5:08
light of, oh, they're in the ivory tower
5:10
and they make all this money and, you
5:13
know, they make decisions that they
5:15
don't care how it affects people and
5:16
this that and the other. And um in rural
5:20
healthcare like so many of the points
5:21
that you made before eyes are on you
5:24
always every move that you make every
5:26
decision that you make there's you know
5:28
opinions and it has real impact and you
5:30
feel that impact because you're so much
5:32
closer to you know the patients to the
5:35
staff it's just dramatically different
5:38
and in terms of like
5:40
authority
5:42
um I became a CEO at 22 and you know,
5:47
people don't take the authority approach
5:50
super well, as you can imagine, from uh
5:54
someone that age. And fortunately,
5:56
that's not really
5:57
>> What was that like? I mean, I mean,
5:59
somebody looks at you, they see they see
6:00
a young buck coming in and maybe this
6:03
will be an opportunity for us to kind of
6:05
talk about the the unconventional path
6:08
>> that you kind of took to get I'll call
6:10
it to get into the seat, you know,
6:11
because people work their entire careers
6:15
to try to get into that seat, right?
6:16
maybe they have aspirations of that and
6:18
and you were placed into that seat um
6:22
earlier than most I'll say.
6:23
>> Talk about the unconventionalness of uh
6:26
the unconventional path of you getting
6:28
into that seat.
6:29
>> Yeah. So I originally left uh college
6:35
you know my undergrad experience I came
6:36
out with a degree in supply chain
6:38
management and just general kind of
6:40
business management stuff. I started at
6:42
Loheed Martin. I had an amazing, you
6:45
know, role there. Was really enjoying
6:47
everything. And uh my role was remote
6:50
and at the time I had found myself
6:52
living and working in Julesburg, which
6:55
is where our our health system is based.
6:58
And um
7:01
like I've shared with you in the past,
7:02
small towns, you know, everybody knows
7:04
everyone and everything about him. So
7:07
they knew first off that I was Aiden,
7:09
the guy who's not from here, but he
7:11
works in business. He works at Loheed
7:13
Martin. He this, he that, the others,
7:15
all that. And um
7:18
eventually there was an inquiry one day
7:20
from the marketing director at the
7:23
hospital and she said, "Hey, you know,
7:24
we've heard of you. Uh we know you work
7:27
at Lockheed. That's really great. You
7:29
must, you know, you must be a smart guy.
7:31
You know, all the all the flattery and
7:33
and we have an opening coming up in our
7:35
CEO role. How would you, you know, how
7:38
would you like to take a crack at that?"
7:40
and
7:42
absolutely
7:44
without hesitation I said no thank you
7:47
flattered
7:49
um I really didn't think it was the
7:50
right role for me I had never ever
7:52
considered going into healthcare um
7:56
>> it it just it hadn't been my pathway you
7:58
know I was in supply chain management I
8:00
did contracts administration at Lucky
8:02
Martin and really enjoyed that work
8:04
never really thought
8:07
>> take any leaps especially not uh that
8:10
soon after just starting there. Um, but
8:14
through a lot of really good
8:16
conversation, I found that being a
8:19
healthc care leader aligned pretty
8:20
deeply with my personal values. You
8:22
know, doing the work to take care of
8:24
people, impacting my community,
8:26
>> and just a lot of things that really
8:28
resonated. And what I did know in my
8:30
career is that I absolutely wanted to be
8:34
a leader. you know, I really um gain so
8:39
much from
8:40
filling others cups and you know, making
8:43
sure that they have what they need to do
8:45
their best work and by doing their best
8:47
work they're going to do best by the
8:49
patients.
8:50
>> Yeah.
8:51
>> So,
8:52
>> did you know I mean did did people see
8:53
early on they were like Aiden's
8:55
different like he is he really is a
8:57
leader. Were you always seen as a leader
8:59
even growing up earlier?
9:00
>> Yes.
9:01
>> Yes. I was always that guy, you know, in
9:04
school that would raise his hand. Yeah,
9:06
I'll be the project leader. Yeah, I'll
9:08
do this. And I really liked it, you
9:10
know, and it wasn't just for the sake of
9:12
going back to this authority
9:13
conversation. It wasn't for the sake of
9:15
like I got to be the guy to do that. Um,
9:20
I never really even wanted that. I would
9:22
have been more than happy to just be the
9:23
worker. Um,
9:25
>> yeah. But when this opportunity came and
9:29
the ask came for me to do it through you
9:32
know a lot of reflection and again
9:34
discussion like I mentioned I came to
9:37
realize that obviously this is an
9:39
awesome opportunity very unconventional
9:41
very fortunate for someone my age to be
9:43
extended such a invitation to even apply
9:46
let alone sit in the seat permanently.
9:49
Um,
9:51
but I realized it would be really great
9:52
and it it was a lot of what I had hoped
9:55
to do, you know, impact people um,
9:57
whether indirectly through our care or
9:59
directly through my team and and it was
10:03
great and eventually, you know, I went
10:06
through the interview. It was, you know,
10:08
kind of unconventional. It was a big
10:11
panel interview, 17 people in there, our
10:13
whole board, all the department managers
10:15
and so I mean everything was unique from
10:19
the start and that's really what's so
10:22
great about it. You know, it was great
10:24
that the interview was that way and I
10:25
got to interface and and have the
10:28
dialogue with all of the leaders of the
10:30
organization so that they could see me
10:33
for who I was and what I could bring to
10:35
the table because what I could bring
10:39
wasn't, you know, a deep healthc care
10:41
bench of skills and knowing revenue
10:43
cycle and knowing, you know, rules and
10:46
regulations and laws and I didn't know
10:48
any of that. But what I did know, um, at
10:51
least I felt that I knew really well,
10:54
was that I could connect with people and
10:56
hear them and listen to them. And above
10:58
all else, that was what the organization
11:02
really needed at the time. I was the
11:04
fifth CEO hired in a 5-year period, so
11:08
that's obviously a good amount of
11:10
turnover. And um,
11:13
>> rural healthcare is not easy on anyone.
11:15
um especially being in the hot seat of
11:18
of the CEO, but I felt like I could be
11:21
someone who could at least hear, you
11:24
know, everyone and understand them and
11:26
work work with them to make meaningful
11:28
progress. And
11:32
getting back to that authority piece,
11:33
you know, I said, I I lead
11:36
diplomatically, you know, in a
11:38
democratic style. you know, we're going
11:40
to crowdsource opinions and input
11:42
because even if you think you're making
11:44
a decision for one department, it's
11:46
really going to affect so much more. You
11:47
know, it's all interconnected and
11:50
intertwined. So, I never wanted to be
11:54
the sole authority who was like, "Yes,
11:56
we're doing this unilaterally and no
11:58
discussion about it because it it's not
12:00
in my ethos. It's not who I am." But I
12:03
also believe it's a better way to lead
12:05
because then
12:07
>> if you move forward with something and
12:09
it doesn't go well, you can fail forward
12:11
as a group and you knew that as a group
12:14
or at least a majority we decided to do
12:16
this together and we're going to own
12:18
whatever the outcome is and that's okay.
12:22
>> So then what what what really kind of um
12:25
you get into the seat, right? you
12:28
>> do you have like a um a board of
12:31
adviserss that you get to go to
12:32
confidants that can support you and help
12:34
you on the day-to-day because if you
12:36
haven't
12:38
done the job right but they feel like
12:39
all right this guy can connect how did
12:41
you how do you leverage that in terms
12:44
>> yeah so my board was pretty insightful
12:47
and helped you know give some some
12:50
structure my board of trustees that is
12:52
since we're a county-owned um health
12:55
system and They said, you know, we want
12:57
you to find a mentor. And I found that
13:00
and an amazing guy named Kevin
13:02
Stansbury. Um, very highly regarded and
13:05
respected in rural healthcare, I I would
13:07
say, across the country. Just an amazing
13:10
person, heart of gold. Um, and was
13:13
willing to take me under his wing and
13:14
and be that confidant for, you know, the
13:17
5 a.m. phone call of, "Oh my god, I
13:19
can't believe this is happening. I think
13:21
this is what I should do. Is that
13:23
totally crazy? Help me." he was that
13:25
person. Um, and then honestly the the
13:30
leaders that were in the organization
13:33
prior to me also, you know, welcomed me
13:37
and helped me get up to speed in terms
13:40
of education and the things that I
13:42
needed to know to operate effectively in
13:44
this role and help them solve the
13:47
problems that they faced that now that
13:49
at that time we were facing together.
13:53
>> Yeah.
13:53
>> Because put in there. So,
13:55
>> I mean, was there a moment early on
13:57
where you're like, okay, and you
13:58
thought, all right, uh, this is this
14:01
role is not what people think it is.
14:04
>> Um,
14:06
you know, I don't know that I was so
14:08
insightful then, not my first year, but
14:11
I looked back after my first year and I
14:13
thought, wow, I can't believe anybody
14:15
even gave me keys, you know, in a bad
14:18
>> Your first year, you probably aged like
14:20
10 years.
14:22
>> Oh, yeah. Yeah. And it, you know, it was
14:25
all just it was figuring things out as
14:29
we went, but that almost makes it sound
14:32
haphazard, you know, but everything was
14:34
very deliberate and intentional in terms
14:37
of, you know, working our way through
14:40
problems and issues because when I was
14:42
hired, you know, the board of trustees
14:45
kind of had a list of things that they
14:47
were like, "Okay, you need to figure out
14:50
these five
14:52
initiatives. and and they weren't small.
14:54
I mean, they were gigantic things
14:56
ranging from financial to cultural to
14:58
you know, we had a ton of jobs open and
15:00
had a retention problem and had this and
15:02
that. And um you know, we just started
15:06
chipping away kind of a piece at a time
15:08
at those needs and those needs blossomed
15:10
into new things that we found out we
15:13
needed to do. And it's kind of
15:14
progressed and snowballed naturally ever
15:17
since then. And we've never stopped
15:19
tackling the issues as you can imagine
15:21
in rural healthcare and and in
15:23
healthcare in general.
15:24
>> There are plenty of problems to address
15:27
and tackle.
15:30
>> There's a lot of things running through
15:31
my mind right now, but I just want to
15:32
kind of
15:34
>> gave you just a little bit there.
15:35
>> Yeah.
15:36
You know, the the inner kindergarten
15:38
person is like, "Oh, how did you do
15:40
this? How did you do this?" But I mean,
15:42
one thing is clear is you're running a
15:44
county owned hospital. Um that means
15:46
that there's um a lot of public
15:48
accountability and you mentioned around
15:49
decisions and and how those decisions
15:51
impact others. So open visibility,
15:55
politics,
15:56
um whether you want them or not.
15:59
Thinking about this like when you make
16:01
decisions, did you even ever think about
16:03
like, hey, am I going to be able to like
16:06
go out to the local restaurant or the
16:08
place and get food and are they going to
16:10
be pissed at me? Like like talk me
16:13
through that thinking. Oh, absolutely.
16:15
Yeah. I mean, the the impacts
16:20
can be felt everywhere, you know, in the
16:23
community and um yeah, that's something
16:26
that you have to live with. I mean, I've
16:28
been stopped in the local cafe and the
16:32
grocery store and it's people who, you
16:35
know, they know me,
16:36
>> but I don't know them. they have kind of
16:40
awkward interaction where suddenly you
16:42
know they've got me cornered and they're
16:44
like I can't believe that you did X Y
16:46
and Z and what were you thinking and
16:49
>> and it's really hard because as you can
16:51
imagine in a
16:52
>> what's like what's an example of a
16:54
decision that you had to make you know
16:57
knowing that everyone's going to have an
16:59
opinion like give me an example
17:01
>> ones are personnel ones in a small town
17:04
because you know if you make the
17:06
decision to cut ties with an individual
17:09
who's, you know, been in the community
17:11
forever. People want to know why. And,
17:14
you know, I don't fault them for that.
17:16
That's human nature to want to know the
17:18
why behind things and how could you have
17:20
done this?
17:21
>> And those are always the trickiest
17:23
because
17:24
>> I can't talk about the why, you know,
17:28
for a million different reasons. Of
17:29
course, you know, private, you know, all
17:32
the all the things you can run through
17:33
the list. Um, and that's really hard for
17:36
people to understand because they'll
17:38
hammer you for answers and they want,
17:40
you know, accountability for the person
17:41
that they know. They want to hold you,
17:43
you know, being me in this case,
17:45
accountable for that action. And there's
17:49
really no good resolution there because
17:53
I'm bound by, you know, the privacy
17:56
standards and rules and and that's that.
17:59
So those are always kind of the most
18:01
difficult because people really want to
18:03
know and they just can't. And in small
18:06
towns that goes against the grain
18:09
culturally of just how things work.
18:11
>> Yeah. It's like high school all over
18:13
again,
18:14
>> right? And the hard thing is when people
18:17
can't know certain information, then
18:20
they create information to fill the gaps
18:23
on what they think they know happened.
18:25
It's especially brutal whenever they're
18:27
upset at you and then they start, you
18:31
know, well, I I bet he did XY and it
18:35
it's hard because then you hear about
18:36
that later. You know, everything spreads
18:38
in a community and you're like, well,
18:42
that's what the word is, but in my
18:44
heart, I know, you know, this wasn't
18:47
what it is or, you know, people
18:48
internal. So, those are those are always
18:52
>> hard.
18:54
um just because of the restrictions, but
18:57
they're ones that, you know, you're duty
18:59
bound to keep and that's okay.
19:02
>> You know, I'm just thinking about sort
19:03
of the you know, I mentioned earlier on
19:05
sort of the contrast between, you know,
19:07
urban big big systems versus rural and
19:10
in big systems they they can they can
19:13
pause, they can, you know, take time
19:16
debate.
19:17
>> It it seems like you you don't you don't
19:19
have that luxury.
19:21
>> No. What what types of decisions um do
19:25
you do you have to like make fast that
19:28
others would
19:29
>> you know maybe study for for months?
19:33
>> Yeah. I mean, fast decisions come
19:37
in, you know, several forms, whether
19:39
it's, you know, getting involved to the
19:43
degree that I can as a nonclinical
19:45
person in a clinical decision, you know,
19:47
with my team and they need someone to
19:49
make a call and make it quickly. Um,
19:52
those are hard. We're, as you can
19:55
imagine, operating with old facilities,
19:58
you know, that are aged. They've had
19:59
updates along the ways, but the the
20:01
core, you know, the core hospitals from
20:04
1950. Our nursing home is built in 1962,
20:07
not majorly renovated really since. Even
20:10
our our newest building, our assisted
20:12
living was built in 1998.
20:15
And you know, that comes with mechanical
20:19
issues and things that happen out of the
20:22
blue. And you got to think quickly and
20:25
you have no resource. I mean the
20:27
resources are really restricted not just
20:29
in a financial sense but to frame this a
20:34
different way in my first
20:37
couple months on the job it was December
20:39
of 2022 we'd had a blizzard we'd had
20:42
crazy cold like I mean it was just the
20:44
wildest kind of start to
20:47
>> the winter that we'd seen in some time
20:49
and we had you know boiler failures in
20:54
our nursing home and it all. These
20:56
things always happen in the middle of
20:58
the night. Always in the middle of the
20:59
night. And it was it was right before
21:01
Christmas, so I wasn't even in town. I
21:04
was on the other side of the country
21:06
visiting family, doing all this stuff.
21:07
So then you have this moment in your
21:08
head where you're like, "Oh my gosh, you
21:10
know, what are we going to do if we
21:12
can't get these boilers back online
21:14
because we can't get a a technician to
21:17
come out because there really aren't
21:19
any." You know, there are some, but some
21:22
the expertise can be limited within the
21:25
range of our area and then so things
21:28
just snowball and they cascade quickly
21:29
and then you're faced with, you know, do
21:31
we need to evacuate residents?
21:33
>> Yeah, I was going to say, do you got to
21:34
do you got to move people? You know,
21:36
that's obviously can be very dangerous.
21:38
>> And thankfully, we had avoided that in
21:40
in this um situation that I'm I'm using
21:44
as an example, but like we went hour by
21:46
hour and we're like, okay, what's the
21:48
status? What are the temperatures?
21:49
What's safe? How are people doing? And
21:52
you know, it gets it can be a real
21:55
nailbiter as you can imagine because
21:57
those happen quick and once you make
22:01
them there's no looking back because you
22:03
got to you got to do what you got to do
22:04
to keep people safe and protected. So
22:07
>> yeah, I was to me there's you know
22:09
there's obviously trade-offs. How do you
22:12
sort of explain tradeoffs when like you
22:16
know to a community especially when you
22:18
know doing everything like it's not it's
22:22
not possible you know
22:24
>> you know what I mean I mean how do you
22:26
explain those trade-offs you have to you
22:28
know to the to the to the frontline
22:29
leaders.
22:30
>> Yeah.
22:30
>> Um do you explain why you do take
22:32
certain decisions like tell me about
22:35
like you know how you communicate that
22:37
you know out to the team. Yeah, it's
22:39
it's
22:41
difficult because every decision that I
22:44
make whether people agree with it or
22:46
not, they have a nuanced opinion about
22:49
it which they're entitled to. So you
22:52
it's a delicate balance and dance
22:55
especially in these small organizations
22:57
and small communities because we have
23:01
people who
23:05
demand answers and information and they
23:08
want their input. And there's a certain
23:10
level of
23:12
comfort that you have to have in a
23:13
leader or as a leader saying, "No, you
23:17
know, we did this because this
23:19
happened." Like you, it's kind of like
23:21
you always have to have your guard up in
23:23
your defenses because you never know
23:25
where the conflicting opinion is going
23:27
to come and what people are going to say
23:28
and you almost have to be ready to run
23:30
it back step by step and say, "Well,
23:32
this was the information I had, so we
23:34
did this and this changed this input, so
23:36
we did this."
23:38
So
23:40
>> it's very much just kind of being at the
23:42
ready and when you make a decision you
23:44
really got to defend it but also you
23:47
know for longer range projects and
23:49
things a big thing that I tried to
23:52
express continually was people also have
23:55
to be comfortable with us pivoting. you
23:58
know, just because we said we're heading
24:01
in this direction or this is the goal,
24:04
sometimes that does change because you
24:06
find out more information along the way.
24:08
So, I've had it kind of
24:10
>> the counter thing where people have
24:12
said, "Well, no, you said we were
24:14
>> holding you to it forever." You're like,
24:16
"This is now we're not. Why?" And I've
24:20
had to say, well, you know, we hadn't
24:22
realized this happened, you know, kind
24:24
of often during our EMR um transition,
24:28
which went really well, but there were
24:30
so many things that we learned along the
24:32
way that we would have to change. You
24:35
know, if we promised nursing that
24:38
something was going to be connected a
24:40
certain way and then found out that it
24:41
really wasn't possible or it wasn't
24:43
financially feasible, then we have to
24:45
backpedal and say, "Well, we can't do
24:47
this, but now we can do this because
24:48
these are the resources that we have at
24:50
our disposal and so on." And and you get
24:52
the picture. So, it's funny how it goes
24:54
both ways, how that questioning and and
24:58
defense after the fact can change to,
25:02
you know, offensive posturing
25:04
when decisions are being made or they
25:06
need to be changed. So,
25:09
>> I mean, you talked about, you know,
25:10
sitting on old infrastructure, you know,
25:12
buildings, but also technology. think
25:15
thinking about that coming from a place
25:17
like Lockheed, you've got this core list
25:20
of five tenants that you know the list
25:22
of five big rocks that you need to kind
25:24
of start tackling.
25:25
>> You're in the job and you know a year
25:27
into it. When do you start to really
25:30
shake things up? Do you initially start
25:32
shaking things up or do you wait till
25:33
you start to have some solid
25:35
relationships in place until you start
25:37
making little pivots or how do you think
25:39
about it? You think about it from, you
25:41
know, asymmetrical riskreward, you know,
25:43
small small risk but like really
25:46
outsized reward. T take me through your
25:48
thinking.
25:49
>> Yeah.
25:49
>> What you
25:51
definitely
25:53
earth shaking moves are something that I
25:57
do not recommend you know in small
25:59
communities and things like that and and
26:02
and the process flow for making big
26:05
changes
26:06
>> are really different from what people
26:10
you know I I came from you mentioned me
26:11
being in the locked environment. Well,
26:14
anytime you make big changes at a
26:16
company like Lockheed, it's, you know,
26:19
it's like turning an aircraft carrier.
26:20
You you can't do it going a million
26:23
miles an hour. You got to do it slowly.
26:24
And, you know, there's a process for
26:26
this. And you follow chain of command
26:27
and you do, you know, everything's the
26:30
logical kind of flow that they teach you
26:32
in business school,
26:33
>> right?
26:34
>> Process driven. And that's great. um
26:38
in this environment
26:40
that is not really the case. You know,
26:43
for a lot of things you need to develop
26:45
what the process is going to look like
26:46
for the case that's in front of you. And
26:49
then in terms of big shakeups,
26:53
I you you just really
26:57
can't and need to do everything that you
26:59
can to avoid those. And this isn't
27:02
avoidance of necessary change. This is
27:06
of abrupt culture shocking things that
27:10
are come that will come back and bite
27:12
you because you know you also have to
27:15
deal with kind of the lack of having the
27:18
bully pulpit that people have when
27:20
they're from the community and you know
27:22
have been with the organization for a
27:24
long time as the new guy on the street.
27:27
You don't have that. So you need to be
27:29
really wise about
27:30
>> right
27:31
>> what capital you do have and the
27:33
relationships that you've built. And one
27:35
surefire way to expend all of that
27:38
capital at once is a rapidfire off-the
27:40
cuff decision that people don't like.
27:43
So,
27:44
>> or you know, not necessarily don't like,
27:46
but they don't agree with or again can't
27:48
know the information behind. So, you
27:50
have to be really delicate with just
27:53
about any decision. Um, and kind of
27:57
brace your brace yourself. sounds, you
27:59
know, like it's so like an attacking
28:02
environment and it's not, but you just
28:03
need to be ready
28:06
to to state your why and state your case
28:08
and stick to it and not deviate. So,
28:11
>> and you mentioned also sort of off
28:13
camerara about, you know, some of the
28:15
folks that you've been able to kind of
28:16
pull in externally and and get them to
28:20
look at the broader bigger mission and
28:22
vision. Do you do you use that as um as
28:26
a mechanism to recruit? And have you
28:28
found that to be really sticky? Do
28:31
people enjoy the fact that it is a small
28:33
town? People get to know one another.
28:35
It's kind of got a family feel to it.
28:37
Talk me about
28:39
>> enticing and luring in talent that
28:41
wouldn't normally be uh I think it was
28:43
your CIO that you had brought in, your
28:44
CTO.
28:45
>> Yeah. Yeah. our CIO and we have an
28:47
amazing CMO and we we have a ton of
28:50
really great leaders that we're very
28:52
fortunate, you know, to have and I could
28:54
go down the list, but yeah, that that
28:56
mission factor is huge because I don't
28:59
have the ability to
29:03
entice talent with, you know, big
29:06
paychecks, amazing benefits, living in,
29:09
you know, a town that is, you know, ripe
29:13
with resources and activities and things
29:15
you can go to do, you know, like the
29:16
closest Targets to over two hours away
29:20
and we don't have a coffee shop. We will
29:23
though actually very soon, which is
29:25
exciting. Um, so you really are are on
29:30
it there with yet. It does take the
29:32
stickiness of the mission and getting
29:34
people to believe it to come and work
29:38
for us, you know, for people to
29:40
recognize that
29:43
in the sea of, you know, options that
29:45
they may have for for work and careers,
29:48
we are different, you know, and we are
29:49
headed in a different direction. And we
29:52
embrace growing because if you're not
29:55
growing, especially in rural, you're
29:57
dying. And a lot of people really liked
30:01
that energy, you know, and I was talking
30:04
to them about joining our team and and
30:06
why they should. And
30:10
it it really worked, you know, when I I
30:13
mentioned
30:14
>> that when I started there, we we had a
30:17
ton of open roles, you know, we had a
30:18
lot of travel staff on our nursing
30:20
roster and, you know, everything that
30:22
you could imagine.
30:24
Um, so it was kind of piece by piece,
30:27
person by person. Like I can't point to
30:29
any defining moment of like, yeah, we
30:32
nailed it right there with culture and
30:34
now everybody's flooding in. But it was,
30:36
you know, bringing one person in at a
30:38
time, you know?
30:40
>> When did you when did you know that
30:42
you're like, hey, there's something
30:43
really good going on here? Like when did
30:45
you know? Because it was
30:46
>> how much time was that? Like was it year
30:49
end of year one, end of year two?
30:53
That's an interesting question. I would
30:55
say
30:57
at the end of year one, we got an
31:01
opportunity
31:03
that
31:04
came about really interestingly. I guess
31:07
that's a a theme uh with how I was
31:10
placed and so on. But we got a call from
31:14
a local clinician that their clinic
31:17
practice was being closed by their
31:20
larger organization. And this clinician
31:25
asked me, she goes, "Well, do you think
31:27
there's any chance after they close it,
31:28
you guys at Cedric County Health Center
31:30
would reopen it?"
31:33
And
31:35
I and I'm really glad you asked this
31:37
question because I don't think I've ever
31:38
reflected on it this way, but I would
31:40
say that I think that was a very pivotal
31:44
moment where we
31:45
>> as an organization started to think, you
31:48
know, yeah, we really can push for more.
31:52
So we we ended up um hiring on that
31:55
clinician. We weren't hiring at the
31:57
time. It was it was
31:59
>> really kind of a huge risk, you know,
32:01
taking and and we're talking, you know,
32:03
our clinician team was six. This was
32:04
hiring a seventh
32:06
>> in our world, you know, where every
32:08
dollar matters. That's a really big
32:09
deal. So, you're like, okay, we're going
32:11
to do this and yeah, I think we are
32:13
going to reopen that clinic location.
32:15
And that marked the first time our, you
32:18
know, small system had physically
32:20
expanded in 26 years. So,
32:24
that was a really big deal. And I think
32:27
that
32:29
was probably a unique moment that
32:31
started changing the tide because it was
32:32
like, okay, we can make big moves
32:35
because it was a big deal, you know, in
32:36
our region that
32:38
>> Well, not only that, but like it it also
32:40
reinforces the vision like, hey, like
32:42
we're going to grow.
32:43
>> Yeah.
32:44
>> Well, it's it's one thing to talk it,
32:45
but it's another thing to walk it and
32:47
then to back it up. Now they're like,
32:49
oh,
32:50
>> yeah.
32:50
>> He really doesn't mean what he says.
32:54
Yeah. And like here's here's proof of
32:56
it.
32:56
>> Yeah. So it was cool and you know it
32:58
really put the wind in our sales and and
33:00
mind you this was this was such a crazy
33:03
crazy stupid thing to do. Like any
33:05
expert in the industry would tell you
33:07
that it was the worst timing for us to
33:10
take on, you know, another clinician,
33:13
another clinic because we were in the
33:15
middle of our EMR transition. We were
33:18
planning another service line expansion.
33:20
We were I mean my team
33:23
they are a bunch of a team hitters
33:27
that's for sure because in 2023 and in
33:30
2024 we all we did was you know hit
33:34
homer after homer after homer because we
33:37
had to like there were just so many
33:39
pieces in motion that it couldn't fail.
33:42
>> Give me an example of a home run.
33:45
>> Oh man. Um
33:48
definitely, you know, being extended the
33:51
opportunity to open that clinic. I know
33:53
I keep going back to it, but it was
33:54
really cool that of all the cuz there's
33:56
there's other small rural health systems
33:58
in our region, right? Like we're not on
34:00
an island, you know, 200 miles away from
34:02
anybody else within 50 miles there's
34:04
five others. But it was cool that this
34:08
person reached out to us because they
34:12
had heard, you know, through through
34:15
communities and things about what we
34:17
were doing, you know, how we were
34:18
starting to look different and act
34:22
different and, you know, do things
34:24
right. So, we were their choice
34:27
>> to take over this location and care for
34:30
this new community that we hadn't
34:32
previously been in. Um, so acquiring
34:36
that clinic, having that clinician join
34:38
us was totally a home run because it
34:42
opened doors to things that we had never
34:44
even imagined before.
34:46
>> Yeah.
34:46
>> And you, another home run, frankly, was
34:50
just doing an EMR implementation. like
34:52
we did this crazy project and I know
34:56
that you know systems do EMR
34:58
implementations all the time but it is
35:01
such a fundamentally
35:05
impactful project like we and we we
35:09
approached it as take everything that
35:11
you know about your current workflows
35:13
you're going to need to put them in a
35:14
box over here because we we are
35:16
recreating the wheel over here like this
35:20
was our opportunity
35:22
to rightsize and adjust processes to
35:26
make them the way that we wanted to to
35:28
meet our our patients where they were
35:30
and and everybody else. So, going live
35:34
in the fall of 2024, it was September
35:38
30th. It was like the last day of
35:40
September. It was so goofy. The finance
35:42
people hated that because it wasn't day
35:44
of the month. And I I do feel for them
35:46
there. But it marked a huge achievement
35:50
because along the way we changed all
35:52
those processes. We also aligned the
35:54
right way with a lot of our partners.
35:57
You know, we found new partners for
35:59
radiology who are amazing and have
36:02
completely changed the way that our um
36:06
system is able to practice now and our
36:08
clinicians are able to get information.
36:10
We changed our tele pharmacy service. So
36:13
now we have much better access for our
36:16
clinicians and our nurses to call
36:18
pharmacy and ask questions and you know
36:20
and it was just every single little
36:21
piece along the way that culminated to
36:25
Yeah, that was a home run moment because
36:28
>> we
36:30
did all the work, you know, for for a
36:33
year and a half straight. The team just
36:35
was grinding through every process flow
36:38
in the system and and there's always
36:40
hiccups. And I I bring this up anytime I
36:43
am given the opportunity to chat on a
36:44
podcast because I think some people
36:46
listen out there and think everything
36:49
goes right all the time, you know, for
36:51
these people that are being
36:52
>> they're living in hot land.
36:54
>> Exactly. I think it's important to say
36:56
like, yeah, you know, today we're on the
36:59
EMR. It worked, still works, and we're
37:02
still making fixes, and that's okay. So,
37:05
I I just like throwing in that plug
37:07
because I don't think we ever talk
37:09
enough about Yeah. Well, yeah,
37:11
>> we tripped and stumbled and fell forward
37:13
here and and that's okay. You know, it
37:15
happens.
37:16
>> So, it's all the mark of progress.
37:19
>> But yeah, those are some examples of of
37:22
home runs and and when the tide really
37:24
started to change, I feel like for our
37:26
culture because it was energizing to do
37:29
these these massive massive things all
37:32
at the same time, but we we achieved
37:35
them and it didn't break us either,
37:37
which was really cool. If anything, do
37:39
you feel like it galvanized the team
37:40
even more now?
37:42
>> Yes. My CFO and I have actually recently
37:45
talked about this a few different times
37:47
of how that period of time I think
37:51
everybody rallied
37:53
so well. I mean, and it it was like kind
37:57
of in perfect harmony. I don't know that
37:59
there was anything that's ever united
38:01
them. And I know this is coming right
38:02
out of the pandemic, but this was like a
38:04
positive unification point of like,
38:07
yeah, we are doing this together. It
38:11
impacts everyone and it's going to be
38:14
great.
38:17
>> Yeah. I'm even just thinking about some
38:19
of the other things that you mentioned
38:21
around areas around revenue cycle and
38:23
look, no money, no mission. We've heard
38:25
about that numerous times before. you've
38:27
got you went in you changed you know the
38:29
infrastructure
38:32
you know you talk about how delicate
38:33
finances were
38:35
you know often times I see that the most
38:38
innovative organizations are the ones
38:39
that have you know really great
38:41
financial like restrictions but they
38:44
somehow find a way
38:46
>> was it more along the lines of hey we
38:49
can't afford not to do this you know was
38:52
that was that sort of the the the
38:55
business case and then how do you then
38:57
do that in terms of well what's next
39:00
what's the other big rock you know
39:01
because you said there were five things
39:02
so you clearly updated the
39:04
infrastructure what were some other
39:05
things that you're
39:06
>> yeah
39:08
I
39:08
>> I mean some of the the quintessential
39:10
issues were when I started um they the
39:15
they we the organization were in a state
39:19
of you know quite big financial strain
39:23
because there were a ton of losses at
39:26
the end of 2022. So, it was this really
39:29
big inflection point of we've really got
39:32
to get this right. We don't know how
39:34
exactly we're going to get this right,
39:35
but this is a cannot fail kind of
39:38
mission to produce really like a
39:41
financial turnaround. So it was just
39:45
chasing you know recovery and expense
39:49
reduction everywhere we could but not
39:51
expense reduction at the detriment of
39:55
our people. You know the people always
39:58
came first. So in in the first year
40:02
when we were focused on you know
40:06
reducing the deficit that we had from
40:08
the year before in the present fiscal
40:10
year
40:11
>> right
40:12
>> we simultaneously
40:14
increased wages you know reviewed
40:17
benefits to make them better. We we did
40:19
all of those things because
40:22
I firmly believe and you know pushed
40:25
this idea you know into the minds of my
40:28
team. is like if we take care of the
40:29
people the other factors will come
40:32
together you know so don't worry about
40:37
cutting corners at the expense of
40:39
people's wages livelihoods those that
40:42
will never get us there you know so it
40:44
goes against conventional wisdom to
40:46
invest whenever you're also trying to
40:49
reduce such a deficit and I know there's
40:52
we have great leaders out there who know
40:54
that and do the same thing But that was
40:58
a huge part of what we did. So we
41:00
chipped away at that that financial
41:03
aspect. Our nursing home was also kind
41:07
of in rough shape. Uh right before I had
41:09
arrived, we had had a a state
41:12
reertification survey did not go well.
41:15
We got some immediate jeopardy tags. And
41:16
if you're familiar with those, those are
41:18
very serious.
41:20
>> Yeah. Um, and we were being looked at,
41:22
you know, by our state organization as a
41:26
potential place that may not make it.
41:29
>> So, that was on the list too of like
41:33
>> you got to turn around the nursing home
41:35
and, you know, figure this out and and
41:37
we still have some struggles today like
41:39
with with volume. But the thing that we
41:42
did get right um in the last three years
41:44
was getting the right team and people in
41:46
place. Um, that took a lot. It took a
41:49
lot of trying out different leaders in
41:53
the space and not all those worked. I
41:55
ended up hiring six dos in three and a
41:58
half years. And
42:00
on its face, people are going to say,
42:02
"Whoa, that's crazy. What is your
42:03
problem?" You know, what are you doing
42:05
to these people? How are they not making
42:06
it? But it it took that level of
42:10
turnover to find the just right person
42:14
who now is like the biggest rock star
42:17
there and has helped us achieve all the
42:19
other pieces. Like we struggled with
42:21
staffing
42:22
the whole way until we got this DO and
42:24
last year we were able to mark for the
42:26
first time that there were no travel
42:28
staff in the building in over 5 years
42:30
which is great. So again, testament to
42:33
like the right people getting them
42:34
there. And you're not going to get it
42:36
right the first time every time. I
42:38
certainly didn't. It took me six times.
42:40
>> But that was a huge part of turning
42:43
around that service line from a safety
42:45
standpoint, a quality standpoint.
42:48
>> And candidly, we're still working on the
42:50
financial standpoint, but I do believe
42:53
that that is going to come. we, you
42:55
know, we've got plans that we're working
42:56
on and all the things, but there was no
42:59
way that we would ever be able to even
43:01
begin tackling the financial aspect of
43:03
that service line until we had the
43:04
people right and we're there now,
43:07
>> which is great.
43:08
>> I mean, you said it, look, when pressure
43:10
stacks up, I'm curious what what uh
43:13
habit or practice do you have that keeps
43:15
you grounded and do you share that with
43:18
the team because obviously everyone's
43:19
under a lot of pressure and a lot of
43:20
stress.
43:22
>> Yeah. Um,
43:24
I think the thing that has kept me
43:27
grounded are the people that surround
43:30
me. You know, they it it's hard being in
43:33
this role because you're expected to be
43:35
the person who's always positive, always
43:37
the cheerleader, always championing, all
43:40
and doing all these things. And I think
43:42
to the best of my ability, I've done
43:44
that. But I've also had plenty of the
43:46
moments where I've been vulnerable with
43:48
my team. I've cried in front of my team
43:50
and said like, you know, I can't like
43:52
this is this is too much for me right
43:55
now. And they've stepped in and been my
43:57
shoulder to lean on just in the same way
44:00
that I've been the shoulder for them to
44:02
lean on when they needed me. So
44:04
>> in terms of grounding,
44:07
it's it's the people. It all goes back
44:09
to that, you know, surrounding yourself
44:11
with the people who can catch you when
44:13
you fall or trip. And um I've needed
44:17
them along the way just as much as you
44:19
know they've needed me. I think it's
44:22
very symbiotic.
44:24
>> Very fascinating. Just what's uh you
44:29
know when I think about mistakes I think
44:30
about you know learnings. Um
44:33
what's the best mistake that you made in
44:35
this role
44:36
>> so far?
44:41
Um,
44:43
there's plenty of mistakes.
44:46
Best one though, that's a tough
44:48
question.
44:52
I've I mean I I've
44:56
had
44:58
I've made the mistake of hiring
45:01
people who I thought were exactly the
45:05
right fit and then they weren't and then
45:07
I've had to go through the process of
45:09
coming to terms with that and not coming
45:12
to terms with it because I thought, "Oh
45:14
well, I hired them so of course they're
45:15
going to be great." It had nothing to do
45:16
with that. But I really
45:20
languished in the sentiment of the
45:22
humanity around the situation because I
45:25
had done all the the work along with my
45:28
team to recruit somebody there and now
45:29
it's not working. So how do we either
45:32
make it work or how do we facilitate an
45:35
exit that's you know dignified and
45:38
things like that. And I I can't say that
45:40
I've perfected that either. But anytime
45:42
we've faced a situation like that, it's
45:44
taught me a lot about what I would do to
45:48
make it better the next time.
45:50
>> Yeah. One thing's for sure is you've
45:52
gotten a a lot of reps at having really
45:55
difficult conversations.
45:57
>> Yeah.
45:57
>> So, if there's any training, you know,
45:59
it's like you can't learn that from
46:02
reading a book. That only happens in
46:04
like real life.
46:06
>> Yeah.
46:06
>> Where really high stakes moments. So
46:08
you've you've obviously have gone
46:10
through that and will continue to, you
46:11
know, hopefully go through that less uh
46:14
as you continue to gain wisdom and and
46:16
all that stuff, but how do people follow
46:19
you, follow the work that you and the
46:21
team are doing? Maybe kind of give
46:23
people a little bit of a shout out just
46:24
for those that are uh you know,
46:27
spreading some love on the rural folks.
46:29
Uh let them know how how they can kind
46:31
of connect with you and stay in touch
46:33
with you.
46:34
>> Yeah, definitely. I mean, we of course
46:36
are present on all the social media
46:38
platforms you can think of. Facebook is
46:41
definitely our most active one. Um,
46:43
seems to be the fan favorite for people
46:45
in our area. Um, we have a new website
46:48
in the works, which we're really excited
46:50
about. That'll also serve as kind of a
46:52
community resource hub. So, we're pumped
46:55
about that. I'm of course present on
46:57
LinkedIn and and try and share things
47:00
from our our company's page to keep
47:02
people updated. And honestly, um, having
47:06
opportunities like this to come on
47:08
podcasts and and things of this nature
47:12
have helped tremendously. Um, our
47:15
facility and our system has gotten way
47:18
more press um, since I started because
47:23
it kind of started as the spectacle of
47:24
like, oh, here's this 22-year-old CEO
47:26
and I think everybody was kind of
47:28
holding their breath like, oh, is he
47:29
going to fail and are they going to
47:30
close? Like, what's going to happen? I
47:32
think a lot of people initially
47:34
subscribed because they just wanted to
47:36
see what was going to happen with us.
47:39
You know, was this going to work? Is
47:41
this so crazy that it would never work
47:43
and things like that.
47:44
>> And then fortunately, invitations like
47:47
this one kept coming kind of after the
47:51
the cooling period of of everybody nails
47:54
and waiting to see what happens. And
47:57
this has given a great platform to us
47:59
too to talk about you know who we are as
48:02
an organization, what we do, why we do
48:04
it, how we do it, um and things like
48:08
that. So uh there there's quite a few
48:12
episodes out there now and I hope this
48:14
is one of many that people choose to
48:16
listen to to hear about us and who we
48:20
are and what we're doing. So
48:23
>> Aiden, it's been it's been great. I I
48:25
you know before you know we wrap I just
48:27
want to say this that um I appreciate
48:29
your rigorous honesty you know going
48:32
into a seat like that of that level of
48:34
importance you know and even just saying
48:37
hey I'm 22
48:39
um you kind of went in really humble and
48:42
I think sometimes when you uh get a
48:46
chance to sit in that seat and you got
48:48
people that are around you that are much
48:49
much older in fact you know a lot of
48:51
people you could have been their kid and
48:52
now all of a sudden you're the boss
48:55
there's a level of sensitivity that you
48:57
have to approach things with and the
48:59
fact that you approached it in the
49:00
diplomatic type way that you did shows a
49:03
lot about your leadership style. And um
49:06
you know for those that are listening
49:09
maybe that's you maybe you're running
49:10
into a situation where you are in a in a
49:12
seat and maybe some of the people that
49:14
report to you are a lot older. Um like
49:18
this is a great example of what it can
49:19
look like and how the turnout can be
49:22
really really positive.
49:24
So, and also just that, you know, you
49:27
weren't performative here. You kind of
49:29
shared some of the some of the wins and
49:32
uh also just being very transparent
49:33
about, hey, we haven't figured this
49:35
whole thing out yet. You know, we had to
49:37
hire six directors of nursing in this
49:39
time span. Like, you know, we're going
49:41
to be making mistakes, but you're I'll
49:44
just say you're tempering it. You're
49:46
you're managing expectations
49:47
appropriately. And I think as a leader
49:49
probably the best thing that you can do
49:51
is to manage expectations because
49:52
expectations sometimes inadvertently
49:56
move into and shift into entitlements.
49:58
And that's like that's not a great place
50:00
to be in. Um so interesting interesting
50:03
to hear about that. So for those if you
50:04
want to hear more please if you don't
50:06
mind um share this episode, like it,
50:09
comment, subscribe. Those are always
50:11
helpful things. And if there is a topic
50:13
that you want us to explore uh or even a
50:16
leader that you'd like uh to hear from,
50:18
you know, drop me a note, leave us a
50:20
comment. Again, this platform it's um
50:22
it's it's really about community. It's
50:24
not just content. It's an interactive
50:26
living, breathing ecosystem. So, thanks
50:28
for listening. Keep building with
50:30
purpose. Uh keep leading with purpose.
50:33
And uh we'll see you next time on the
50:35
Advancing Health Innovation Show.
50:36
Thanks, Aiden.
50:38
>> Thank you.