Latest / Becker’s Healthcare Podcast / Leading Through Rural Healthcare Turnarounds and Tough Decisions with Dallas Killian

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Leading Through Rural Healthcare Turnarounds and Tough Decisions with Dallas Killian · Becker’s Healthcare Podcast

• 0:02
  - Every health system executive right now is being
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  - Becker's eleventh annual IT and Revenue Cycle Conference,
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  - The Future of AI and Digital Health, exists
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  - for exactly this challenge.
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  - Here, you'll find more than 2,500 executive level
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  - 600 plus speakers, and four days of sessions
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  - built around the questions leaders are actually wrestling
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  - with.
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  - that hold up over time.
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  - You can register on our events page at
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  - beckershospitalreview.com
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  - by clicking on the events tab in the
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  - upper right.
• 1:00
  - Hi, everyone. This is Scott King, the first
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  - ever rural healthcare leadership summit
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  - with Becker's. I'm joined by very special guest,
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  - Dallas Killian, chief operating officer over at East
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  - Adams Rural Healthcare. Dallas, how are you doing?
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  - Thanks so much for joining us. I'm doing
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  - great. Thank you for having me. Of course.
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  - And I appreciate you being here and and
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  - also speaking with us at the conference. Just
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  - just curious if we get before we dive
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  - into the, topics here, if you can just
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  - please tell us a little bit about your
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  - background, your organization. Yeah. You bet. Yeah. My
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  - name is Dallas. I
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  - I work at Eastside Regional Healthcare. We are
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  - located in Ritzville, Washington. It's a a very
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  - small community in Eastern Washington
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  - surrounded by wheat fields.
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  - It's a definitely a farm town.
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  - The population of the town itself is just
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  - over 1,900 people, so very, very small.
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  - The
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  - population we really service is just over 7,000.
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  - So
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  - a lot of small
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  - rural towns,
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  - which usually means one or two farm farms
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  - really is what it meant.
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  - But it's it's a great place. I grew
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  - up there. I I left for about
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  - fifteen years and then just recently moved back
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  - with my family,
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  - to take, actually, a marketing position with the
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  - hospital.
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  - The the hospital is looking to grow their
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  - services,
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  - increase their revenue, increase their their patient volume.
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  - And my job at the start was visiting
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  - other hospitals,
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  - anywhere from an hour to an hour and
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  - a half away from us
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  - to see if we could,
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  - garner up some support, some referrals from them,
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  - and kind of pitch what we have, our
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  - providers.
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  - We went through,
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  - a pretty tough financial
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  - stint,
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  - of our history. And
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  - with that, a new administrative team was presented
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  - and kind of put into the mix, and
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  - I was part of that,
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  - team. I I applied for the chief operating
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  - officer position and
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  - took that over in October of last year.
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  - So it's it's been a roller coaster, but
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  - it's
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  - it's a pillar of that community, that hospital.
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  - It's the biggest employer by far in Ritzville.
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  - If
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  - if the hospital were to ever close or
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  - services were to close,
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  - I think Ritzville itself would be a a
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  - ghost town
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  - in the immediate future. And
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  - it's it's a great it's been a great
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  - experience, so a great learning experience for us,
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  - But that's that's kinda in the background. Yeah.
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  - No. Thank you. Really, really interesting career journey.
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  - It's interesting how things unfold and how people
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  - get Right. Leadership positions. And Yeah. You know,
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  - you kinda just remind me of of something
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  - we keep hearing about in these podcasts is
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  - that kind of
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  - familiarity with the rural community. And Right. As
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  - you said, population 1,900.
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  - Yeah. Your system's the biggest employer of of
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  - the community. So
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  - most rural systems kind of hear immediate feedback
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  - anyways with a small population. But being the
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  - biggest employer, kind of all the decisions you
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  - make, you kind of expect to get, like,
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  - immediate feedback from people just from word-of-mouth spreading?
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  - Yeah. Definitely. Yeah. If that's why transparency
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  - means the most in a rural health care
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  - setting. Yeah. Because if if you're silent or
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  - don't have open or honest feedback,
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  - rumors and
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  - misinformation
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  - quickly fill fill that void. Right. People, especially
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  - with when you're talking about health care in
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  - a small community where
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  - if that were to close, like I said,
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  - it'd be an hour or so
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  - traveling for just primary care, let alone emergency
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  - care.
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  - That's that's a big deal. People want to
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  - know what's going on. And when they're left
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  - in the dark,
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  - that's when their minds start to wander. Rumors
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  - start to spread.
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  - And that when we and I'll get into
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  - the restructuring a little bit.
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  - It's
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  - there was a lot of rumors that were
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  - spread, so combating that with open dialogue
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  - is huge
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  - because people grasp onto that. There any changes
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  - in a small community, people are
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  - very keen on that. Yeah. So you just
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  - kinda gotta put some transparency forward and and,
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  - obviously, action as well.
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  - What's currently commanding most of your attention as
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  - a leader right now?
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  - Right now, we're still kind of wrap wrapping
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  - up some some restructuring.
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  - That's been the biggest thing for me is
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  - figuring out where our gaps are in efficiency.
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  - As an operating officer, it's a little bit
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  - different than clinical.
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  - I know on the clinical side,
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  - our our director of nursing or nursing managers,
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  - they they see it at a different lens
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  - than I do.
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  - I see how can we
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  - enter our pennies, so to speak. How can
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  - we
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  - pay attention to those pennies and dimes so
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  - the dollars can just figure themselves out? That's
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  - what I've been trying to tackle is see
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  - where those gaps are, how we can be
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  - more efficient, how we can,
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  - save on our purchasing.
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  - Because for a small hospital, that's absolutely crucial.
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  - We can't just be throwing money away, and
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  - we're very, very small,
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  - especially compared to some
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  - that are here at this conference. Like Yeah.
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  - We're very, very small, very, very rural.
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  - So that's been my main focus is kind
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  - of putting those teams in place,
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  - seeing how we can consolidate on positions and
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  - have people multitask a little bit more.
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  - We've we've lost some people due to attrition,
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  - and that's just that happens with restructuring.
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  - So figuring out who has the bandwidth to
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  - take on
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  - more responsibility,
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  - including myself. What can I take on to
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  - save on some money, make things more efficient,
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  - skip the middle man,
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  - because that's what the community deserves?
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  - Absolutely. Yeah.
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  - In a year marked by so much rapid
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  - change in health care, what recent decision or
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  - or pivot required
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  - the most leadership conviction from you personally, particularly
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  - when it comes to aligning people,
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  - resources like you were you were mentioning with
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  - some budget things and or capabilities?
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  - Yeah. So earlier this year,
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  - we
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  - and not even fifty days ago, we were
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  - still in a pretty tough spot financial spot.
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  - We were trying to figure out which service
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  - lines
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  - made money, which ones were underutilized,
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  - which ones could be cut from the program,
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  - and the community wouldn't feel too much of
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  - an effect to that.
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  - And we
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  - looked at the profit and loss margins of
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  - our rural health clinic, and it was
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  - essentially hemorrhaging a
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  - lot of money every month. And
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  - like I said, fifty fifty days ago, we
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  - were
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  - we were wondering if we were gonna make
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  - it still.
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  - So we had to we had to make
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  - a change quickly, and
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  - we were looking at,
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  - closing our rural health clinic.
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  - We we ended up keeping it open, finding
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  - a path forward,
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  - but that's been taken up a lot of
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  - time.
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  - That has that took a lot of leadership
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  - during that time because when you're talking about
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  - closing lines of service, that means
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  - in a small town, your neighbors are without
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  - jobs.
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  - Their positions are cut.
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  - My kids won't have primary care
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  - there at in town. So
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  - it was a big deal. It took a
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  - lot of leadership
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  - making tough decisions for the betterment of the
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  - organization.
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  - And, essentially, that led to us finding a
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  - path
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  - because
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  - that allowed us I think the biggest quality
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  - of a leader is listening to your people,
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  - and the people essentially came up with a
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  - plan forward.
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  - A lot of people,
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  - offered to take pay cuts to to keep
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  - it open,
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  - which was amazing to me. It
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  - showed their leadership as well. Yeah. But that
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  - was that was a tough time, and we
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  - got through it. We we saw a path
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  - forward, but
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  - that required a lot of leadership on my
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  - part, I think.
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  - How did that tough time challenge your assumptions,
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  - and
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  - what did it change about how you approach
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  - decision making now?
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  - I think
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  - and I'll I'll, I'll reference Jocko Willink. I
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  - don't know if you know who that is.
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  - He's actually a Navy SEAL. He wrote he's
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  - written a bunch of books, and one of
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  - the my favorite books he's written is Extreme
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  - Ownership.
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  - He talks about
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  - the best
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  - way to get buy in from your people
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  - is if they come up with a solution,
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  - not you dictating what's gonna be done
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  - and kind of ruling with an iron fist
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  - and telling them you have to do this.
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  - The best way to get buy in is
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  - for them to figure out the plan forward.
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  - And I think that's the biggest assumption that
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  - I've made is
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  - give give people more of a benefit of
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  - the doubt. You know? When times are tough,
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  - they will
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  - they will make up the difference.
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  - You know? Sometimes people don't.
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  - But a lot of the time,
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  - people will
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  - they'll give a little bit. Like, if they
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  - see,
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  - for example, with that the clinic potentially closing,
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  - like I said, a lot of people stood
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  - up, and,
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  - a lot of people came with solutions that
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  - ended up
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  - being the the solution,
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  - so the ultimate solution.
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  - So
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  - the the biggest assumption is give people the
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  - benefit benefit of the doubt,
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  - work in collaboration with the people around you.
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  - It's not always just about the administrative team
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  - making a big decision.
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  - It takes input from all
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  - all managers, all directives.
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  - I think that's been the biggest thing. Yeah.
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  - I know. Great example. Appreciate you sharing.
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  - When you think about the forces reshaping health
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  - care right now, where do you believe leaders
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  - need to be more decisive?
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  - I think
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  - that last thing, having having the right teams
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  - in place,
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  - that's huge.
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  - I think I I went to a conference
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  - one time, and they talked about the difference
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  - between a, b, and c players.
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  - A players are the most bought in. They
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  - sacrifice the most. B players are kind of
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  - in the middle, and c players are just
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  - there for a paycheck. Right? Yeah.
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  - The biggest contributor to a players leaving your
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  - organization
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  - is the b and the c
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  - players.
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  - And I think that's absolutely true. When they're
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  - kind of getting taken advantage advantage of or
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  - they feel like they are
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  - as a players that actually have bought into
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  - the organization or to the mission,
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  - they're gonna leave. So I think having the
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  - right teams in place
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  - from the top down
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  - is the biggest thing,
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  - and also just
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  - finding ways
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  - to consolidate positions.
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  - Give people the benefit benefit of the doubt,
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  - and people can take on more of a
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  - load than you think usually, and they're more
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  - willing to do it. You just have to
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  - ask.
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  - Sometimes they say no, and that's that's
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  - just what it is, right,
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  - with leading people. Sometimes people don't have the
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  - bandwidth to do it, but most of the
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  - time, people are willing to help you out
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  - if you ask them for help. And I
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  - saw that time and time again over the
• 11:55
  - last five to six months
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  - at our hospital. So
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  - just having the right people there
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  - definitely helps, and people
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  - will move on just naturally due to attrition.
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  - They if if they're not a good fit,
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  - they also feel it. Right.
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  - So they'll they'll move on naturally.
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  - But making sure you get to know your
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  - team members so you know who to put
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  - in those places is key.
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  - Absolutely.
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  - And the last question I have for you,
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  - Dallas, as uncertainty has become kind of the
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  - new norm in health care, what leadership habit
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  - or mindset has been most critical in keeping
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  - your organization and your people moving forward?
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  - Yeah. I think
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  - there's an uncertainty everywhere in health care. And
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  - a lot of the time, as leaders, you're
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  - making
• 12:41
  - a decision between bad and worse.
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  - Right? Right. And I think the biggest
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  - leadership habit is you still have to make
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  - that decision.
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  - That that decision is not gonna go away.
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  - If anything, it's gonna get worse the longer
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  - you put it off.
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  - And
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  - during our restructuring
• 13:00
  - and our, you know, our financial crisis, there
• 13:03
  - was a lot of times where the the
• 13:05
  - right answer was not always clear.
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  - We had to do a lot of digging.
• 13:09
  - We had to do a lot of research
• 13:11
  - and put in a lot of hours to
• 13:13
  - figure out the best path forward.
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  - But at the end of that time, you
• 13:18
  - still have to make a decision.
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  - Whether it's good, bad, worse,
• 13:22
  - you have to make it, and your people
• 13:24
  - are depending on you.
• 13:26
  - Most of the time, people are more reasonable
• 13:28
  - than you'd think. If you have to make
• 13:30
  - a tough decision
• 13:31
  - and you give the reason behind it, whether
• 13:33
  - it's to your employees or to the community,
• 13:35
  - they'll understand
• 13:37
  - their people are reasonable. And
• 13:40
  - if you give the reasoning behind your decision,
• 13:43
  - more often than not, they'll understand. So
• 13:46
  - leadership is about making those tough decisions and
• 13:48
  - understanding
• 13:49
  - that if you don't make them,
• 13:52
  - it'll be even tougher Yeah. Than presenting
• 13:55
  - them with those plans. Yep. Yep. You need
• 13:57
  - to be decisive just like we were kinda
• 13:59
  - talking about earlier. Well, Dallas, thanks so much
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  - for being on the podcast and for speaking
• 14:03
  - at Becker's first ever rural health care leadership
• 14:05
  - summit. Yeah. Appreciate it. For having me. Appreciate
• 14:07
  - it.