Latest / The Advancing Healthcare Innovation Show / E181| What 23 Years as a Hospital CEO Actually Teaches You with Tom McDougall, Jr., DSc., LFACHE

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E181| What 23 Years as a Hospital CEO Actually Teaches You with Tom McDougall, Jr., DSc., LFACHE · The Advancing Healthcare Innovation Show

0:11
Hello and welcome back to the Advancing
0:13
Healthcare Innovation Show. I am your
0:15
host, Michael Stamatinos, and if you're
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new to us, welcome. Glad you're here.
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We're super excited to have you because
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we're just bringing some really exciting
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conversations with healthcare leaders
0:26
that are painstakingly uh reshaping the
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future of healthcare and we're
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passionate about a few different areas.
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We're passionate about leadership, about
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innovation, about access to care. We're
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passionate about innovation adoption.
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So, if it's your first time tuning in,
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let me just uh take a quick step back
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and go a little bit deeper into, you
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know, what are we really trying to get
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done here? And our focus is on bringing
0:50
real stories of leadership and
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innovation within healthcare to life.
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Not stuff that you're reading from a
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real things uh real people that are
1:01
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interviews come directly to you. So,
1:31
most people, they talk about healthcare
1:34
from a from from the outside, from a
1:36
different vantage point. Um, today's
1:39
guest has lived in it. Tom McDougall has
1:42
spent his life inside of it. He became
1:46
CEO of a hospital at 27 years old. Uh
1:50
just let that sit for a second. So while
1:53
most people are still trying to figure
1:55
out their first real job, Tom was
1:58
leading an entire hospital. And he
2:01
didn't just do it once. He went on to
2:04
lead multiple hospitals and health
2:06
systems across for-profit, nonprofit,
2:09
government, and academic settings. So,
2:12
30 yearsish in healthcare, you know,
2:15
more than two decades as a CEO. So, he's
2:18
at hospitals, physician groups,
2:20
ambulatory centers, imaging, home
2:22
health, you name it. Um, he's seen this
2:25
system from pretty much almost every
2:28
angle that actually matters. So he is um
2:33
a fellow executive, a fellow at the
2:34
American College of Healthcare
2:36
Executives. He also teaches healthcare
2:38
finance and economics. Um which means he
2:41
doesn't just lead, he's really
2:43
understands sort of the math behind it.
2:45
And fun fact, I just uh learned that he
2:48
actually is a uh land real estate agent.
2:50
We might be able to sort of weave that
2:52
into today's conversation. But, you
2:54
know, I think what makes him interesting
2:56
to me is his leadership, his approach to
3:00
leadership, um, how he writes about it,
3:03
how he kind of takes decision- making
3:06
under pressure. And that is something
3:09
that isn't necessarily coming from a
3:11
place of theory. It's lived experience.
3:13
And that's really, really compelling to
3:16
me. And I think we're going to really do
3:17
our best to unpack that. You know,
3:19
healthcare's got a lot of ideas. doesn't
3:21
have a shortage of big ideas, but it's
3:24
really complex. It's got egos that are
3:26
in it, incentives, uh, and honestly some
3:29
hesitation and some fear, rightfully so.
3:31
Tom's navigated all of it. So, we're
3:34
going to talk about a lot of this stuff
3:35
today, and I'm super excited about it.
3:37
So, uh, it's great to see you. Welcome
3:40
to the show.
3:42
>> Thank you, Michael. I'm so honored that
3:43
you asked me to join you today.
3:46
>> Yeah. So, um, after our first
3:48
conversation, I just knew that this one
3:50
was going to be a fun one. I mean, you
3:51
became a hospital CEO at 27. Kind of
3:54
kind of take us back to that moment,
3:57
like where where were you when you found
4:00
out what was happening, you know, what
4:02
did like what did your parents say? What
4:04
did the staff say? And like I mean, just
4:07
privately like were were you ready?
4:10
>> Not no easy answer. No, I was not ready.
4:14
Um, I had never supervised more than
4:18
four people in my entire career. I had
4:21
never operated a department of a
4:23
hospital. Um, I had joined I came out of
4:26
graduate school.
4:28
>> I did my administrative residency with
4:30
an organization in South Carolina. It
4:32
was the Baptist Healthcare System at the
4:34
time. And uh one of the things they
4:38
asked me to do was to build
4:40
relationships with the hospitals that
4:43
were surrounding uh kind of our uh our
4:46
our center of our health care system
4:49
which was the large hospital in town. So
4:51
I start, yeah, 26 at the time. I start
4:55
going out and just knocking on doors of
4:58
hospitals, meeting with the CEOs that
5:00
were there, talking to medical staff
5:02
members, talking to anybody that would
5:04
talk to me. And my it and it was it was
5:06
kind of ironic, Michael, because my job,
5:10
if you really want to bear it down to
5:12
what my job was, my job was to keep the
5:15
for-profit hospitals or for-profit
5:18
hospital systems out of our market. That
5:21
was my job. Um, now the irony is is I
5:24
worked for for-profit health care
5:26
systems for the better part of my
5:28
career, but at the time I was working in
5:30
a in a religious-based nonfor-profit
5:33
system. So, I'm out talking to all these
5:35
different hospitals. We get one deal
5:36
done. Um, my boss who was the CEO of the
5:40
system, he placed an administrator there
5:42
and I move to the next county over and
5:44
start working with that hospital and I
5:47
work through all the details uh and uh
5:51
he gives me a list of things that he
5:53
would like to see in the contract. So,
5:55
I'm back and forth, back and forth, back
5:56
and forth. I get the contract finished.
5:59
I walk into his office. We have a
6:01
meeting schedule. I walk into his office
6:03
and he was a he's a great guy. He's a
6:04
guy named Chuck Beaman. Um just
6:06
brilliant, funny, um just he's he's the
6:09
perfect leader. And and Chuck uh
6:12
welcomes me in and he says he says,
6:15
"What do we get?" And he was talking
6:18
about the terms that he wanted in the
6:20
contract.
6:21
>> Well, I didn't know that any of them
6:24
were negotiable. So, I had gone back and
6:26
forth to this hospital over and over
6:28
again, and I got all of them. I didn't
6:30
quit until I got every single term
6:32
exactly the way he had requested it.
6:34
Well, when I tell him that, he starts
6:35
laughing and he says, "Well, where's the
6:38
contract?" And I slide it across table
6:40
to him. He blips to the back page,
6:43
doesn't look at it, signs it, slides it
6:45
back across the table, and looks at me
6:46
and says, "Great. When do you start?"
6:49
And I didn't know what he was talking
6:51
about, but he that's how I got hired in
6:53
my first hospital CEO job. Um, so I show
6:57
up at this facility And Michael, man, it
7:00
was it was crazy. I never saw in my
7:04
entire rest of my career, I never saw
7:07
another hospital like this one. It was a
7:09
county run organization. There were five
7:12
county council members. Um they each
7:15
could appoint one member to the hospital
7:17
board
7:18
>> and every one of the appointees was
7:21
political.
7:22
>> Um it was the it was the mole for their
7:25
respective county commissioner. Um, so
7:28
I've got these five people and I had
7:30
everything. I had I'm I'm not
7:33
exaggerating. I had a tenure school
7:35
teacher. Um, I had a janitor at one of
7:38
the other schools. I had somebody from
7:40
the security department at a u one of
7:44
the national organizations that was in
7:46
the area. I had this just wide ranging
7:49
group of people. They were all super. I
7:51
liked them all. They all had really
7:53
diverse backgrounds. But add on top of
7:55
it that there was sunshine laws in the
7:58
state. And so the local radio station
8:01
would show up at our board meetings and
8:04
put one of those old rectangular tape
8:06
recorders in the middle of the table and
8:09
press record and record the entire board
8:13
meeting that was public publicly
8:15
available. So we would go into private
8:16
if it was a contract discussion or a
8:18
personnel issue, but other than that
8:20
it's all public. So then they would play
8:23
it back over the radio during the lunch
8:26
hour for like two or three days.
8:29
>> Wow.
8:29
>> And that's how that was my first CEO
8:32
job. And there probably a lot of people
8:34
sitting out there going, "Wow, that's
8:36
crazy. It was nuts." I get a phone call
8:39
I get a phone call from the vice
8:41
chairman of the board uh two days after
8:44
one of the board meetings.
8:46
>> Um and he says he says he said, "Tom, we
8:48
got to talk about something you said in
8:50
the board meeting." And I said, "Okay."
8:52
I said, "That's fine. What which topic
8:54
are we talking about?" Because the board
8:56
meetings would go on for like two and a
8:57
half hours. Yeah.
8:58
>> I said, "Which topic are we talking
8:59
about?" He said,
9:00
>> He said, 'Well, I want to talk about
9:01
this. And I said, "Okay." He said, "I
9:04
just heard it on the radio and I don't
9:07
like your answer."
9:09
And I said the only thing I knew to say,
9:11
I said, "Well, you were there when I
9:14
actually said it, and you didn't seem to
9:16
have a problem with it when I said it."
9:19
and he said, "Well, it sounds different
9:21
on the radio
9:22
>> that that's an actual conversation."
9:25
Um, and so, uh, I did the only thing I
9:28
knew to do. I started all of my
9:30
comments, um, everything that I could
9:32
prepare in advance, I scripted it. I
9:35
wrote it out and I would hand this guy a
9:37
copy of my transcript at the end of
9:39
every board meeting. I didn't know what
9:41
else to do. U, but it it was crazy. But
9:44
yeah, I have people that tell me, they
9:45
say, you know, that's amazing that you
9:47
were a hospital CEO at 27. And I always
9:50
have the same response. Nope. What was
9:53
amazing is I didn't get fired. That was
9:55
the amazing part because every just
9:58
about, you know, probably 98% of the
10:00
people in the organization were older
10:02
than me.
10:03
>> Yeah. But what did what did the staff
10:04
say, you know?
10:06
>> They were they were fantastic. Um, I I
10:10
never had any issues with the staff and
10:14
it was almost as if all of these
10:16
seasoned department director type
10:19
people, um, it was almost like they
10:22
treated me like their kid. And so, you
10:25
know, they would, you know, they it it
10:27
was it was wild because they would like
10:29
come in my office and say, "Hey, I just
10:32
want to kind of give you a heads up.
10:33
this is the way things work in a
10:35
radiology department and this is this is
10:38
you know the way we need to handle it um
10:40
and you know these are the dynamics they
10:44
were they educated me for two years
10:46
solid that's how I figured out how a
10:48
hospital operates is because these
10:50
department directors were so gracious
10:52
and embracing me
10:54
>> um I I think they almost saw me as their
10:56
project
10:57
>> but it was fun
10:59
>> that's fun so it's like when you walked
11:01
into the hospital that first week. I
11:03
mean,
11:05
what did you like first misunderstand
11:07
about leadership?
11:09
>> You know, I blew it. Um, I actually made
11:11
a terrible mistake because I had I had
11:15
done so much assessment on this
11:17
organization. Um, I knew it's I I knew
11:20
the warts, I knew the positives, I knew
11:22
everything before we ever signed a
11:24
contract to manage the facility. Uh, and
11:27
so I step in and the second week on the
11:30
job I announce that we're going to start
11:32
doing strategic planning. What a dumb
11:35
thing to say, Michael. I I did I didn't
11:38
know how the hospital operated. What a
11:40
what an ignorant statement. But in
11:42
hindsight, I recognized that I was
11:45
reverting to where I was comfortable
11:47
because I could write a strategic plan
11:49
in my sleep at that point in my career.
11:51
Um, and so I I know in hindsight I was
11:54
reverting comfort level. Um, but that
11:57
was one of the dumbest things I did. One
11:59
of the uh other really stupid things I
12:01
did, this was in the next hospital, but
12:04
I was like four years into my hospital
12:06
CEO career. Somebody walks into my
12:08
office and they said something that, you
12:12
know, Michael, it was stupid. It it was
12:14
a stupid comment, stupid suggestion. I
12:18
look at them, I laugh and say, "Are you
12:21
serious?"
12:23
They were serious.
12:25
And you know, what a horrible management
12:29
mistake. Um it was, you know, but I I
12:33
had just enormous I everything I learned
12:37
was on the job training. Um I had a lot
12:40
of very good mentors that took good care
12:42
of me. Um but they would give me advice.
12:45
They were very good about pointing me in
12:48
the right direction and making sure I
12:49
didn't screw it up, but short of that,
12:51
they'd let me figure it out. That's how
12:53
I learned. Um, and you know, I I wrote a
12:57
book um called Karma Doesn't Need My
12:59
Help: 11 Weekly Leadership Lessons for
13:02
Success and Peace.
13:04
That that book is about the lessons I
13:06
wish I had learned earlier in my career.
13:08
Yeah,
13:08
>> that's why the book was written. Um
13:10
because I learned so many lessons the
13:14
hard way and I don't want other people
13:16
to learn them the hard way.
13:18
>> Yeah. I mean, you know, at 27, I mean,
13:22
who you who were you really trying to
13:24
impress?
13:25
>> Oh, I was trying to impress everybody. I
13:27
mean, make no mistake, Michael. I the
13:30
amount of pressure I put on myself
13:34
because I didn't want to let my boss
13:36
down because he thought I could do the
13:38
job or he wouldn't have hired me to do
13:40
the job. So, I was terrified of letting
13:42
him down. I was also terrified people
13:45
would figure out I didn't know what I
13:47
was doing.
13:48
>> It was it was absolutely constantly
13:51
terrifying to me. So, I I developed bad
13:54
habits. You know, one of the bad habits
13:57
I developed was if somebody would come
14:00
tell me something, um, I wouldn't lie,
14:02
but if I pretty much knew what they were
14:05
talking about, kind of in the ballpark,
14:07
I would say, you know, thanks for
14:08
telling me that. I already knew it.
14:11
>> What a dumb thing to say as a leader.
14:14
Okay, because you're you're smiling. You
14:16
know exactly what I did. I mean, I shut
14:19
off my communication flow. People quit
14:21
telling me stuff because they thought I
14:23
knew everything,
14:24
>> right? you're balancing out basically
14:26
you're saying, "Hey, look, um, I want to
14:28
posture as if I know this." So, you kind
14:31
of overcorrect and then you
14:33
>> kind of state that, but really in
14:35
reality is like you still want to keep
14:37
the
14:38
>> the channels open. people give you
14:41
information, but because you're at an
14:43
age in your life where, you know,
14:45
obviously wisdom and experience come
14:47
when you make lots of mistakes and um
14:52
>> you make a bunch of
14:54
>> I finally learned I finally learned that
14:56
lesson. So later in my career, I was
14:59
almost the complete opposite of saying,
15:02
you know, I already knew that. I was the
15:05
complete opposite where I just took on
15:07
this philosophy of until I heard details
15:11
about something three times, I didn't
15:14
think I even understood exactly what I
15:17
needed to understand. And so I went to
15:19
the further extreme
15:22
>> and was and I people would come tell me
15:25
things and I would just sit and listen
15:26
like I had no idea. And I had already
15:28
been told by two other people the same
15:30
information, but I would just sit and
15:32
listen. And uh funny story uh my last
15:35
hospital CEO job before I retired, one
15:38
of the people that I worked with uh she
15:40
was brilliant, very intelligent. Um we
15:42
had a very good working relationship and
15:45
she came and told me something one day.
15:46
We had had a bad quality outcome. It it
15:49
was a bad one.
15:50
>> But she's updating me and giving me
15:52
details on it. And so I listened to her
15:54
for like 10 or 12 minutes
15:56
>> and uh finally get to a point where I
15:58
can ask a couple questions. Well, I ask
15:59
a couple of questions. And she sits back
16:01
in her chair and looks at me and she
16:03
says, "Damn it, McDougall, you already
16:06
knew this, didn't you?"
16:08
>> And I did.
16:09
>> Two other people had already told me
16:11
about it. But I just let her go and go
16:13
and go. And she said, she said, "Why'd
16:15
you let me explain it all if you've
16:17
already heard it all?" And I said,
16:18
"Well, I had heard all of it. You you
16:20
told me this and this. I hadn't heard
16:22
that yet." But I went to the far extreme
16:25
of I just I became you know a lot of
16:28
people are sponges early in their
16:30
career. I became a sponge later in my
16:33
career where I I just wanted so bad for
16:38
people to share information with me so
16:40
that I had information to make decisions
16:42
that I became just a sponge for people's
16:45
opinions. Um and uh you know that that's
16:49
an example of one of those lessons I
16:50
wish I had learned earlier. Yeah. Well,
16:52
do you feel like sometimes you get to a
16:54
certain point, you get to the big
16:55
office, people don't tell you the truth?
16:59
>> There is some of that. Yeah. Uh and and
17:02
I used to refer to it as EF Hutton
17:04
effect. Okay. So, people who are
17:07
listening to this podcast, uh not
17:09
everybody's going to know who EF Hutton
17:11
was, but you you smiled. You know who it
17:13
was. There was an investment group that
17:15
was called EF Hutton. I think they've
17:17
been out I think they got merged
17:19
probably two decades ago, but the
17:21
commercials were when EF EF Hutton talks
17:24
people listen.
17:25
>> So I'm a big believer that you have EF
17:29
Hutton's in every group. So if you're in
17:32
a board meeting, um it may be the board
17:35
chair or it may be somebody else, but
17:37
somebody is the voice, somebody is in
17:41
charge. And when that person speaks,
17:44
then
17:46
everybody else either backs off of their
17:48
opinions or they don't share their
17:50
opinions.
17:51
>> And so I learned and trained myself u to
17:55
be quiet in meetings.
17:58
>> Um because I knew that when I voiced my
18:02
opinion of something, I was going to
18:04
shut people down from sharing their
18:06
opinion if it was a different opinion.
18:08
um and they may never express it and
18:11
they may have been the one that would
18:12
that were right
18:14
>> and so I needed that information. Um and
18:17
so you know I I like I said I call it
18:19
the EF Hutton effect. So you need to
18:22
recognize in every group every
18:24
stakeholder group who are your EF Hutton
18:26
and how are they impacting the
18:29
communication flow within those groups
18:31
because they can absolutely shut it
18:33
down. Um, now now that's a useful thing
18:37
too because I uh I had a uh I had a
18:40
situation one of my early hospitals.
18:43
>> We had a topic come up in a medical
18:45
staff meeting and this this topic I mean
18:49
it it became a roller coaster out of
18:51
control um you know and and this
18:54
discussion is going on for far too long.
18:56
But at the heart of the discussion
18:58
wasn't me. So there was no way that they
19:03
were aggravated with me or frustrated
19:04
with me. And a lot of times as a
19:07
hospital CEO, you're the target because
19:10
you've made a decision somebody doesn't
19:12
like. Well, in this particular
19:13
circumstance,
19:15
I wasn't the center of the discussion.
19:17
So weirdly, I was entertained. I was
19:20
kind of enjoying everybody chasing this
19:22
rabbit because I wasn't the rabbit. And
19:25
so it it goes on for this meeting starts
19:28
just really dragging on. we reached a
19:29
point where we need to make a decision
19:31
and I would always sit next to the EF
19:33
Hutton in the meetings and in this case
19:36
it was the chief of our medical staff
19:38
and I leaned over to him and I said the
19:41
phrase that I used all through my
19:43
career. It's time and he knew like other
19:47
people exactly what I meant. What I
19:50
meant was it's time for you to shut this
19:52
down and we need to make a decision. So
19:54
when I said it's time, he leaned
19:56
forward, looked over his reading
19:57
glasses, and said, "Okay, folks, I
19:59
appreciate all your input. This is what
20:01
we're going to do." And the meeting was
20:03
over 60 seconds later,
20:06
>> but he was smart enough to stay and
20:08
listen to everybody's opinion, but we
20:10
both knew he had to shut it down. We had
20:12
to get on with things.
20:14
>> Yeah.
20:15
if you because you've led in for-profit,
20:19
you know, nonprofit and a lot of other
20:22
settings, you know, different owners,
20:23
same patients, right? What what changes
20:28
um when the ownership model changes and
20:31
like what never changes?
20:34
>> You know, it's that's an excellent
20:35
question. I get asked that question
20:37
pretty frequently. the the answer is the
20:41
only thing that's different is who holds
20:44
the power.
20:46
>> So let me explain that. So hospitals
20:49
whether you're a you know and forprofit
20:51
and not for profofit is a tax status.
20:54
>> All hospitals should be in the business
20:56
of making money because if there's no
20:59
money there's no mission. Okay. So you
21:01
you have to stay focused on that. you
21:03
have to be fiscally responsible or you
21:06
can't do all the other things that are
21:08
part of your mission. So, all hospitals
21:10
are in the business of making money
21:12
regardless of their tax status. Um, what
21:15
changes though when you change from
21:17
nonprofit to an academic facility or an
21:21
investorowned facility is who holds the
21:24
ultimate power. So in nonprofit, it
21:28
tends to be people who are either
21:29
community members or people who are at
21:32
the board level or people who are at
21:35
administration.
21:36
>> If you move to an academic center, it's
21:39
going to be the physician faculty of the
21:42
organization that hold the power.
21:44
>> When you move to the investorowned
21:46
setting, your corporate office tends to
21:48
hold the power. And so the only, you
21:52
know, I say the only difference, that's
21:54
a substantial difference, but from the
21:56
CEO chair, you're still the CEO of the
21:59
organization. So you have to recognize
22:02
and acknowledge where that power exists
22:05
and then make sure that you are gaining
22:08
support from those power sources when
22:10
you need to get something done. But
22:12
that's that's really the difference. Um,
22:15
you know, the the bigger difference is
22:17
the size of the organization. Yeah. Um
22:20
because a a small hospital, the CEO is a
22:25
pretty much a jack of all trades. Um
22:27
they can do just about everything. Um
22:30
because they have to be able to do that.
22:31
So they've got to be
22:33
>> You got to be Swiss Army knife. You have
22:35
to be Swiss Army knife.
22:36
>> Absolutely. So running a small hospital
22:39
is so much harder than running a big
22:42
hospital. When I was operating a
22:44
hospital that was like 20 million a year
22:46
in cash collections, that was hard. That
22:50
is a hard job. The largest hospital I I
22:54
operated was about 440 million in cash
22:57
collections. That was the easiest job I
22:59
had. And the difference is the resources
23:02
that are available to you. So in a small
23:05
hospital, you tend to have your
23:08
leadership that you depend on. In the
23:10
small hospital, they tend not to be they
23:13
they tend tend to be a different level
23:16
of experience. They may have been with
23:18
that organization for 20 years and may
23:20
have been a department director for 12
23:22
of it.
23:23
>> But how they started is is they were
23:26
they were a really talented CT tech that
23:31
happened to one day find themselves as a
23:33
director of the radiology department. No
23:36
shame in that. Good for them. That's
23:38
that's that's impressive.
23:39
>> Bet side, right? They're sort of bedside
23:41
group.
23:42
>> They may not have ever worked in another
23:43
hospital. So, their point of view is
23:45
very myopic to that organization and
23:48
that particular department in the
23:50
organization. Whereas, you go to a big
23:52
hospital and your radiology director may
23:54
have been a radiology director for 22
23:57
years in different size hospitals and
23:59
they, you know, have special training in
24:02
negotiation. They have special training
24:03
in leadership. they have special
24:05
training in how to manage staff.
24:07
>> Um it's completely different. Um and
24:10
then the other side of it is the
24:11
seauite.
24:13
>> So you know you were operating a small
24:15
hospital, your CFO may be very talented,
24:17
but they're young
24:19
>> and this is their first or second CFO
24:21
job. Whereas you get into the big
24:24
hospital, you've got a very talented CFO
24:26
with a lot of experience. Um and they've
24:29
done a lot of different things during
24:30
their career. So the, you know, it's
24:33
it's not I'm not being critical of
24:35
anyone. I admire everyone that's in
24:38
those jobs in those different settings,
24:41
>> but from the CEO chair, you have so much
24:44
more talent around you in the big
24:45
hospitals than you do in the small
24:47
hospitals.
24:49
>> So take me to like a smaller hospital.
24:52
Are there decisions that you kind of
24:53
replay in your mind? Do you still replay
24:55
scenarios and situations you go back
24:57
there? Are there decisions that you
24:59
think about that you took that you still
25:00
think about, you know, even years later?
25:03
>> Oh, yeah. Oh, I have a long long list of
25:06
things I blew.
25:09
I mean, things that, you know, you look
25:11
back, but Okay, so I'm an economics
25:15
nerd. So, rational choice theory. I
25:18
mean, I'm hang with me for just a
25:19
second, Michael. Rational choice theory
25:21
says that people are going to act all
25:24
the time based on information that that
25:27
is available to them for their highest
25:30
personal utility. Okay. So,
25:32
>> I'm going to act on information I have
25:34
available to buy the best car for me.
25:37
>> Right. Right.
25:38
>> Based off of price, features, whatever,
25:41
longevity, pick whatever category you
25:43
want. I'm going to make the best
25:44
decision on that. But rational choice
25:47
theory really doesn't work because
25:49
there's something called bounded
25:50
rationality, which bounded rationality
25:52
is a limitation of information
25:54
available. So while I may be making the
25:57
best decision I can under rational
25:59
choice theory, I don't have all the
26:00
information. That is the world of a
26:03
hospital CEO. You rarely have all of the
26:08
information you need to make a perfect
26:10
decision.
26:11
>> And so you know,
26:12
>> so when do you know it's enough? When do
26:14
you know it's enough information?
26:17
>> You you almost are balancing it. Is it
26:20
instincts? And what is it?
26:21
>> You're balancing your gut and you're
26:23
balancing the data that's available to
26:25
you in addition to the opinions of
26:27
others. So I used to refer to it as slow
26:30
decisions.
26:31
>> Gut data opinions. GDO gut data
26:34
opinions.
26:34
>> Yes. Yep. So I would balance it. I would
26:37
not make a decision if I could. I mean
26:40
sometimes you have to make a decision
26:41
with just what you know. We could talk
26:42
about co I mean you just made a
26:44
decision. I mean you just hope for the
26:46
best. Uh but you know the
26:50
I'm I'm balancing the information I have
26:52
available to me in the moment and when I
26:55
my gut tells me I I know enough maybe 80
26:58
85% of what I need to know. Let's make a
27:01
decision and get on with it. But the
27:03
balance of those three sources of
27:05
information to make a decision is the
27:07
key to how fast you make a decision.
27:10
>> Okay. So let me explain that. So if my
27:13
if the data is suggesting one thing but
27:16
my gut is telling me something else, if
27:18
I have the luxury of not making a
27:21
decision right now, I won't make one
27:23
>> because I've got a conflict or maybe you
27:26
know other people don't agree with what
27:29
I think. So if if you if you don't have
27:32
those three things aligned, then you
27:35
should make decisions slowly in hopes
27:38
that they will become aligned
27:40
>> because that increases the likelihood of
27:42
a good outcome from your decision. But
27:44
if everything's lined up, make a
27:45
decision fast, get on with it. If my
27:47
team agreed with me on something and the
27:50
data supported what my gut was telling
27:51
me, let's make a decision. Let's move on
27:53
to the next thing. Um, so that's really
27:56
the key is whether or not you have
27:58
balance in what information is available
28:00
to you. But if if you're out of balance,
28:02
don't make a decision. Put it off if you
28:04
can.
28:06
>> It's fascinating. And what are what are
28:08
some of the I'll call it the sleep well
28:10
at night numbers that you look at? Are
28:12
there things that you look at prior that
28:14
you would say, "All right, these are in
28:16
line
28:18
pretty good." What are those things?
28:21
>> Uh, well certainly it's budget. I mean,
28:23
if you're if you're making your your
28:26
budget and your margin, then you you you
28:29
do better because otherwise you're
28:30
consumed with how do I how do I
28:32
accomplish that? But the the interesting
28:35
thing to me is the if I look back on 23
28:40
years as a hospital CEO, the times that
28:45
I lost sleep were because one of my
28:48
relationships had been damaged.
28:51
uh somebody that I had a good
28:54
relationship with or I wanted to have a
28:56
good relationship with and they were
28:59
frustrated or disappointed about
29:01
something I had done or I had not done
29:05
when they were frustrated with me then
29:08
that's when I lost sleep. You know, I
29:11
can think of times that I was
29:12
negotiating deals with physicians and if
29:15
those, you know, physicians that I
29:18
admired and liked as individuals were
29:21
aggravated with me, that's when I lost
29:23
sleep. It was always the relationship
29:26
side. Um, but I'm very big on
29:28
relationships first and transactions
29:30
follow. Uh, you work on your
29:32
relationships and then then you have the
29:35
opportunity for successful transactions
29:37
or deals or whatever you want to call
29:39
it. M I mean what are some of the
29:41
patterns that you're seeing now? I mean
29:43
there's a lot of uh clamor around AI and
29:46
you as sort of an operator fundamentals
29:48
there.
29:50
What patterns do you see emerging? What
29:52
are some of the risks that people that
29:54
are in the seat now need to be aware of
29:55
that they're not necessarily paying
29:57
attention to?
29:59
I don't know that you know healthcare
30:00
executives I would argue that if you
30:02
chose any industry in the United States
30:06
so let's you know let's just take the
30:08
top 12 industries whatever those may be
30:11
I would argue that healthc care
30:13
executives if they're not number one in
30:15
terms of talent and ability they're
30:17
number two
30:18
>> you have to you have to be really
30:21
talented to survive in a market where
30:24
you do not price set
30:26
>> I mean you are paid and a lot of times
30:28
you're fighting to get paid for the
30:31
services that you provided in the middle
30:33
of balancing satisfaction and quality.
30:36
Um, so you know, and then the complexity
30:39
of relationships. You've got, you know,
30:41
hospital CEO cannot generate their own
30:43
revenue. There's nothing I can do. You
30:46
know, I can't like walk out to the
30:47
factory floor and start producing
30:49
widgets.
30:50
>> Uh, I can't do it. I'm relying on the
30:53
people.
30:54
>> The people are the well, I have to have
30:56
physicians that trust the organization
30:58
to refer patients there. And then I've
31:00
got this team that has to make sure that
31:02
the care is provided. Um, and somehow
31:06
someway we figure out a way to have good
31:08
outcomes from a quality and satisfaction
31:10
perspective and make our budget. Um, you
31:12
know, it was being a hospital CEO was so
31:17
humbling to me. I never took pride um,
31:21
well, that's not true. I took pride in
31:23
having that badge because everybody in
31:25
healthcare wears a badge that has your
31:27
name and it has your title under it. And
31:29
I thought it was so cool that underneath
31:32
my name it said CEO. I thought that was
31:35
cool for about six weeks out of 23
31:39
years. I thought it was cool for six
31:40
weeks and it was the first six weeks I
31:42
was the hospital CEO. And then I
31:45
thought, wow, this is the most humbling
31:48
job I've ever had. Um, and and where
31:52
that came from is my third week of my
31:56
first hospital CEO job, I get called for
32:00
jury duty. And I' I've been called for
32:03
jury duty twice in my life. And the
32:06
first one happened the third week of my
32:08
first hospital CEO job. And you know,
32:10
Michael, I I I had a little bit of a big
32:14
head at the moment. So, I I I was having
32:17
thoughts like, "Oh my gosh, how's the
32:19
hospital going to operate without me?"
32:21
You know, I'm they're telling me I've
32:23
got to leave my cell phone in my truck.
32:25
I mean, I I was a nervous wreck about
32:28
this jury duty. So, I end up in jury
32:31
duty for 4 days. Um, and do you know
32:34
what happened at the hospital?
32:37
Everything ran perfect. There wasn't a
32:40
single issue. There wasn't a problem.
32:43
nothing major occurred in my absence.
32:46
Um, and when I got back from jury duty
32:49
and I was kind of catching up with
32:50
people, so I'm rounding in the hospital,
32:52
making sure everybody has what they need
32:54
and doing all those different things.
32:56
>> I realized 90% of the people in the
32:58
hospital didn't even know I was gone for
33:00
4 days.
33:01
>> So, I developed this this opinion that
33:06
and and this is not insulting to the
33:08
CEOs out there because I admire them.
33:10
I've done the job. I know how hard it
33:12
is.
33:13
>> Yeah.
33:13
>> But if but my opinion is that the least
33:17
important person to the care that a
33:20
patient is going to receive at any
33:22
moment of any day is the CEO of the
33:25
hospital. And the reason is they're not
33:27
providing any of the care. They're not
33:30
interacting with the patient. They're
33:32
not doing the MRI. They're not in the
33:35
surgery suite at the time the patient's
33:37
having surgery. they're not in the room
33:39
when the patient is, you know, having
33:42
that IV drip um that starts beeping
33:45
because it needs to be replaced. The CEO
33:47
is not taking care of the patients. And
33:50
the entire reason the healthcare
33:52
organization exists is the patients. So
33:55
my opinion is is in terms of patient
33:57
care at any given moment, the CEO is the
34:00
least important person. Um, and that was
34:02
extremely humbling to me because I
34:06
realized that if I was going to be
34:08
successful as a hospital CEO, I was
34:12
1,000% rellyant on every single person
34:15
in the organization to do their job and
34:17
do well.
34:19
>> Yeah. So, this this reminds me of a of a
34:22
story. There's a guy named Horst Schultz
34:24
who started this uh group. It's called
34:26
the Ritz Carlton Group. If you ever
34:28
stayed in Ritz Carlton, it's quite
34:30
something.
34:31
>> And he talks about
34:34
when they on board
34:36
people that are coming to work and he
34:39
would go in and he would orientate them
34:41
into the values that they're doing. And
34:43
he would, you know, onboard these like
34:46
dishwashers, people that, you know, room
34:48
clean, room service and and things like
34:50
that. and he'd say,
34:53
"If you don't come to work, it's a
34:55
disaster.
34:57
Can't turn the room over." Like, there's
34:59
there's a lot of things that are going
35:00
to happen. But actually, he started out
35:02
and he's like, "Hey, I'm Or Schultz and
35:04
I'm the CEO and I'm important." And he's
35:07
a German guy, so he has this accent. But
35:09
he's like, "But if you don't come to
35:10
work,
35:12
all this stuff breaks. It's a problem.
35:14
We need you here." And he's like, "If I
35:16
don't come to work," he's like, "Nobody
35:18
will know. Nobody will know. Like you
35:21
said, you go to jury duty, four days out
35:23
of pocket, nobody knows you're not
35:26
there. But you've got to make a lot of
35:28
decisions that impact, you know, care
35:30
delivery. How did you train that muscle
35:32
around decision- making, judgment? Did
35:35
that sharpen over time? Did you have a
35:37
matrix that you used, you mentioned
35:39
around talking to people, getting input,
35:42
and then just making decisions? Is that
35:44
is that something you learned early on
35:46
in your career and you just kept using
35:47
it or did you end up refining it?
35:49
>> You kind of develop it over time. Um,
35:52
and you have to you have to develop a
35:54
couple of habits and then you evolve
35:57
with those habits. And let me explain
35:58
what I mean by that. So yes, I came up
36:00
with my own personal method of of data,
36:04
opinions, and gut. So that was my method
36:06
is I would I would check and balance all
36:09
three of those things to make sure. And
36:11
that was something I kind of I'm trying
36:13
to remember if somebody advised me on
36:14
that or if I kind of figured it out.
36:16
Somebody probably suggested it and I
36:18
refined it because that's what we all
36:20
do.
36:20
>> Um but I learned I learned kind of that
36:24
ability to do that. But that's when you
36:28
know during a time when I was
36:30
inexperienced when you become
36:32
experienced
36:34
we all develop two biases that are so
36:37
dangerous to us and we don't think about
36:40
these biases like we should. Um and the
36:44
two biases the first one is a hindsight
36:46
bias. So I have experienced something
36:49
previously therefore I have an idea how
36:52
it's going to turn out in the future.
36:55
So, in the past, I've dealt with, you
36:57
know, three different physician
36:58
negotiations. Now, I have my fourth
37:01
negotiation. Well, I have a bias because
37:03
of my actual experience on the previous
37:06
three. And that bias can get you in
37:09
trouble because it causes you to make
37:12
assumptions about people or terms or
37:15
situations or motivations that may not
37:19
be correct, but you have this bias that
37:21
I'll figure it out. The second one is is
37:24
referred to as a huristic bias. So
37:27
unlike a hindsight bias, a huristic bias
37:30
is I haven't experienced it but I think
37:32
I know.
37:34
>> And so these two biases are the most
37:37
dangerous thing for experienced
37:40
individuals. So and that's where you've
37:43
got to be super careful with it. And I
37:47
learned and I learned the hard way. I
37:49
can tell you stories, but I learned to
37:52
ask why. Okay? So, that's where you can
37:57
keep from having these biases affect
38:00
your decisions from a negative
38:02
perspective. So, if if I have one of
38:05
these biases creep up in my mind, so for
38:07
example, the physician negotiation, if I
38:10
if I have an expectation of how this
38:13
contract's going to turn out, you've got
38:15
to stop and think, why do I think that?
38:18
What is it? What is it in the
38:20
conversations, the negotiations, or
38:23
anything else that causes me to believe
38:26
it's going to turn out that way? Why do
38:29
I believe that? And if you can't come up
38:31
with it, then your bias is probably
38:33
influencing why you believe that. Um,
38:36
I've always encouraged my kids, you
38:38
know, if you if you believe something to
38:42
the point where it will come out of your
38:43
mouth, whatever it is, I don't care what
38:45
it is. It can be something big. It can
38:47
be something small. But if you if you're
38:49
going to verbalize that you believe
38:51
something, you better be able to back it
38:53
up and explain why you believe it.
38:56
Because until you can explain the why,
38:58
you don't really believe it. You're just
39:00
repeating somebody else's opinion. And I
39:04
think later in my career, I developed
39:06
that that almost uh check and balance in
39:11
my own head
39:12
>> if I couldn't explain it to someone
39:14
else.
39:16
uh then you know that then I needed to
39:18
stop because something was influencing
39:20
my decision that was not correct.
39:23
And you know
39:25
>> and a lot of your listeners they lived
39:27
through co okay you can throw all this
39:29
stuff out during that first six months
39:32
of co throw every bit of it out because
39:35
nobody knew what we were dealing with
39:38
and uh it was a very very interesting
39:41
time as a healthc care executive. uh we
39:44
we've seen this evolution of healthc
39:46
care leadership particularly from the
39:49
CEO chair and some of the seauite
39:52
members where we have seen four
39:55
different evolutions in a six-year
39:57
period now which is really challenging
40:00
because if you go to precoid
40:03
that was a time period where it was
40:05
almost this uh servant leadership
40:08
approach where you were strong but you
40:10
were a consensus builder. That was your
40:13
approach.
40:14
>> You get into COVID and nobody wanted you
40:18
to be a consensus builder. They wanted
40:19
you to tell them exactly what they
40:21
needed to do and you didn't know.
40:23
>> Yeah.
40:23
>> But that they needed
40:26
>> they needed we don't have time. We just
40:27
need to decide. We need to decide.
40:29
>> They needed somebody to make a decision
40:31
and just get on with it. And we may be
40:33
right. We may be wrong. It doesn't
40:34
matter. We got to make a decision. We
40:36
got to know what we're going to do for
40:37
this next patient or do for this next
40:39
situation. So you became it you almost
40:43
were forced into this all powerful
40:46
Wizard of Oz where you just took to the
40:50
best of your ability you just made a
40:51
decision. I always remember I had an
40:53
assistant administrator at the facility
40:55
where I was during CO and he um he
40:58
walked my office one day and he said I
41:00
got to ask you a question. I said sure.
41:02
He said he said remember when you made
41:04
the decision that we were going to do X
41:07
two days ago? I said yep. He said, "How
41:10
did you know that was the right thing to
41:12
do?" And I said, "I didn't. I had no
41:16
idea." I said, "I just made a decision
41:19
because we didn't have the luxury of of
41:22
waiting another few days." So, I made a
41:24
decision, hope for the best. Um, so you
41:26
had that period of time, which was
41:28
really difficult. Well, then we had the
41:31
staffing crisis where hospitals,
41:33
physician practices, it didn't matter.
41:35
Everybody's turnover was ridiculous. And
41:38
you're losing staff left and right. At
41:41
one point I had close to 25% of the
41:44
nurses in my hospital were agency
41:47
nurses. They were travel nurs
41:50
>> 25%.
41:52
You have no culture when you have that.
41:54
You don't because you know as great as
41:58
agency nurses are, they're not bought
42:00
into your culture. They're not. They're
42:02
there for 13 weeks. And so you you have
42:05
this challenge. So we became you almost
42:08
had to become grandfatherly. So we go
42:10
from the all powerful Wizard of Oz
42:12
during CO to now I've got to be this
42:14
grandfatherly person that you know
42:17
everybody likes me and I like them and I
42:21
spent tons of time rounding and just
42:23
going and sitting in departments and you
42:26
spend all this time doing that because
42:29
you're scared to death people are going
42:30
to leave. So I've got to give them a
42:32
reason to stay that isn't money. I've
42:34
got to give them a reason to stay
42:35
because they don't want to leave this.
42:37
They like it here.
42:39
>> Yeah.
42:39
>> So, you know, we're serving ice cream
42:41
every Friday. I mean, we're having, you
42:44
know, annual cornhole tournament events.
42:47
I mean, we're doing anything and
42:49
everything for people to go, I just I
42:51
like it here. I don't want to leave.
42:52
>> Yeah. Yeah.
42:53
>> And so, you go through that phase. Well,
42:55
then inflation hits. So, uh you have two
42:59
things happen pretty much the same time.
43:01
Inflation hits. So, our average annual
43:03
wage at our organization increased by
43:06
38% in 18 months. My margins weren't
43:10
38%.
43:11
>> What are your margins?
43:12
>> Yeah. No, it not even close. Okay. So,
43:16
>> 38% increase in our average hourly wage
43:18
in 18 months. And then the COVID money
43:22
that was coming from the federal
43:23
government, that went away at the same
43:25
time.
43:26
>> So now I can't be grandfather anymore.
43:28
I've got to be accountability driven.
43:31
I've got to set the tone. I've got to
43:33
set the expectation. I've got to set the
43:36
goals. I've got to make sure everybody's
43:38
rowing in the same direction because we
43:40
have to get our financial situation
43:42
under control.
43:44
>> But the interesting thing was we went we
43:47
came through survival mode during CO
43:49
when we just we're just we're just going
43:51
to survive. Okay, that's our goal.
43:53
>> And then we go through the
43:54
grandfatherly, oh, we have to be
43:56
lovable. Nobody can leave. Well, now
43:58
I've I've had to revert into this
44:00
accountability leader role. And I have a
44:03
whole bunch of people around me that
44:05
have forgotten how to be accountability
44:07
leaders because I have told them for
44:10
three plus years, don't don't irritate
44:13
people to the point where they're going
44:14
to leave. They can't leave. And now I'm
44:17
like, I don't want them to leave, but if
44:20
they have to, they have to. I mean, it
44:22
it just was this bizarre six-year
44:25
period. And so I feel for for everyone
44:28
who kind of had had to go through that
44:29
process, just the constant evolution of
44:32
leadership.
44:34
>> I'd say you you left with a lot with
44:36
more time on the clock. Um
44:39
what when did you know it was time and I
44:42
guess what was the what was the straw
44:44
that you were like, "All right, time for
44:46
someone else to come in the seat."
44:48
>> Uh when I retired.
44:49
>> Yeah.
44:50
>> Is that what you're referring to?
44:51
>> Yeah.
44:52
>> Yeah. You know, it's I'm a big believer
44:54
that people will be successful when four
44:57
things align. It's the right person in
45:00
the right job in the right organization
45:02
at the right time.
45:04
>> And when one of those is out of
45:06
alignment, then someone's not going to
45:08
be successful. Um, and I I felt like I
45:12
was I was very successful to the end.
45:15
But I reached a point where
45:18
me personally and this this is not not
45:22
critical of the industry because I
45:24
understand but I operated hospitals from
45:27
the late 1990s well 96 when I took my
45:31
first hospital CEO job until 2024 so
45:34
it's pushing 30 years I was you know in
45:38
that type role and we had the evolution
45:41
of corporate offices when I first
45:44
started working in healthcare the a lot
45:47
of authority autonomy was at the CEO
45:50
level. So you had you may have had a
45:53
corporate office or you had a corporate
45:55
structure and and make no mistake this
45:57
is not investorown versus nonprofit
46:00
because some of the most powerful
46:01
corporate offices now are in nonprofit
46:04
organizations. I've seen them.
46:06
>> And so we've seen over, you know, during
46:10
the time that I was operating hospitals,
46:12
we saw this growth in the talent, the
46:16
skill set, the size of these corporate
46:18
offices and more and more of the
46:22
authority and the autonomy in the CEO
46:27
chair at an organization. More and more
46:31
of that had moved to the corporate
46:32
office. Um whereas early in my career I
46:35
could make lots of decisions
46:38
uh and there were barriers I couldn't
46:40
make all decisions but I could make a
46:42
lot of them and then later in my career
46:45
a lot of that authority and autonomy had
46:47
been had been moved to the corporate
46:49
office um or to a regional office and I
46:53
understand why I get it okay that's it's
46:56
it's an evolution in healthcare I'm not
46:59
being critical of any of that but I
47:02
accepted
47:03
that because of my approach to be
47:06
relationship first and transaction
47:09
second.
47:09
>> Yeah.
47:10
>> That without the authority and without
47:13
the autonomy to do what I thought needed
47:15
to be done, my relationships were
47:17
starting to suffer.
47:19
>> Yeah.
47:19
>> And I just accepted I am no longer the
47:24
right person for those jobs.
47:26
>> And uh it was not again it is not
47:30
critical of any one organization. It's
47:32
certainly not critical of of uh
47:35
healthcare in general. When I when I
47:37
left my last hospital CEO job, uh if I
47:41
thought it had something to do with the
47:43
company, I would have just gone to a
47:44
different company,
47:45
>> right?
47:45
>> But it wasn't that. It was it was my
47:48
realization that that I just wasn't
47:51
right for those positions anymore. I I I
47:54
had a personal need that was being unmet
47:57
to have the authority and autonomy to
48:00
build and maintain my relationships. Um
48:02
and so I made a decision to walk away.
48:05
>> So let's just say you're mentoring a 30
48:08
something year old operator today, you
48:10
know, what what skills do you tell them
48:13
to master? What what advice do you give
48:15
to them?
48:16
>> Yeah, they they've got to be able to
48:18
master a handful of things. Um and and
48:20
all of them are transferable from every
48:22
job to the next. Okay. So the first
48:24
thing they've got to do is and people
48:28
talk about emotional intelligence. Um
48:30
and absolutely you have to have
48:32
emotional intelligence but what you
48:34
really have to do is you have to be able
48:35
to read other people.
48:37
>> So it's a subset of emotional
48:39
intelligence. You have to you have to be
48:42
able to read people from a verbal and
48:45
nonverbal and figure out what is it
48:48
that's important to them. Okay. So that
48:50
is a that is a skill set that
48:53
>> some people inherently are pretty good
48:54
at that. Most of us are not. Most of us
48:58
you know the old phrase um you would
49:00
worry a lot less about what people think
49:02
about you when you realize nobody really
49:04
does. Um, I think we spend so much time
49:07
worried about what we are saying that we
49:09
aren't paying attention to what other
49:11
people are saying.
49:12
>> Yeah.
49:12
>> And and so that's the first skill is
49:15
just have that ability to read and
49:18
understand other people, particularly
49:20
the non-verbal.
49:21
>> Pick up on the non-verbal. I uh I was
49:24
working on a deal last week for one of
49:26
my my uh consulting clients and I knew
49:29
we had a problem because of something
49:32
nonverbal in the room that somebody on
49:35
the other side of this negotiation did.
49:37
It was a physical action and and I look
49:40
and I went, "Oh crap."
49:43
And and it just I don't know this person
49:46
well. It was actually the first time I
49:48
had ever been in a meeting with them.
49:49
But when they did this, I thought we
49:51
have a problem.
49:53
>> Um, and so being able to read those
49:55
situations, that's first skill set. The
49:57
second skill set is you, some people are
50:01
inherently good at negotiation and some
50:03
people are not. You need to become a
50:06
student of negotiation. Student read
50:10
everything you can read. Um, identify
50:13
people that you think are really good at
50:15
negotiation and figure out why they're
50:17
good at it. adopt those skills,
50:20
practice. Um, there's a there's an old
50:23
book, I don't even remember when it was
50:24
published, but it was called Getting to
50:26
Yes. It was done by Harvard Negotiation
50:29
Project.
50:31
>> Great book. Yeah. Bat. I mean, it is a
50:34
great book, but it's a great book
50:36
because of the not only do they uncover
50:39
the strategies for negotiation, they
50:41
uncover the counter strategies,
50:43
>> you know. So for example, if somebody's
50:45
using higher authority on you, um then
50:48
you need to establish your own higher
50:49
authority. Um if uh if you are you have
50:53
the upper hand and leverage in
50:54
negotiation, you need to be moving fast.
50:57
If you don't have the upper hand, slow
50:58
everything down. So that book is
51:00
actually outstanding. If you're going to
51:02
become a student in negotiation, start
51:04
with that book. It's an excellent one.
51:06
>> Um so negotiation is really key. Now the
51:10
the third skill set that people have to
51:13
develop and unfortunately
51:16
I have had limited experience in
51:18
teaching people how to do this. Um
51:20
>> okay
51:20
>> I I think to some extent there's
51:24
this is an inherent skill set. Some
51:26
people are capable. Did you ever see the
51:30
uh Netflix show that was called the
51:32
Queen's Gambit?
51:34
>> I haven't. I haven't but okay now I'm
51:36
interested
51:36
>> there. Okay. It is. Queen's Gambit is
51:39
about this uh young girl that is a
51:42
savant at playing chess.
51:44
>> Okay.
51:45
>> And she she can school people who are 40
51:48
years more experienced than her. But the
51:51
reason she could do it is she could play
51:53
out an entire scenario in her head
51:57
before it happened
51:58
>> and then five five to five to 10 moves
52:01
ahead. I mean, which is grand master
52:03
thinking
52:04
>> 10 moves ahead. I think
52:06
>> that's it. Strategic chess is the
52:09
ability to not anticipate your move and
52:13
whoever's on the other side of this
52:15
negotiation or discussion or whatever it
52:18
is. Not only negotiating your move and
52:20
their and their response to that, you've
52:23
got to be able to see down the down the
52:25
strategy five steps in both directions.
52:28
>> And not everybody can do that. Um it
52:32
takes practice, it takes skill, it takes
52:34
time. And so, you know, if I'm
52:37
ultimately wanting to get from point A
52:40
to point G, I've got to have some idea
52:44
of what that path looks like, not only
52:46
from my own actions, but from the
52:48
actions of others and to anticipate
52:51
those things.
52:52
>> Um, and that is a skill set. I don't
52:55
know how to teach people to do it. Um
52:58
the only success I ever had was
53:02
I I had a couple of uh direct reports
53:05
that were in the sea suite and they
53:07
recognized that I could kind of see the
53:09
board. I could kind of play out this,
53:11
you know, five steps ahead on both
53:13
sides.
53:13
>> Do they ever have you verbalize it out
53:15
loud how you're processing midstream?
53:18
>> Some of them. Some of them would. Um I I
53:20
would had I had a few people that said,
53:22
you know, hey, would you include me in
53:24
this? you know, I know we're and it
53:27
would start with something random where,
53:30
you know, we would plan for a meeting
53:32
that would involve, you know, some type
53:34
of negotiation with the stakeholder
53:36
group and we would go in with the plan
53:40
and I would abandon the plan 3 minutes
53:42
into the meeting because I picked up on
53:44
something non-verbal or they said
53:46
something and I went,
53:48
>> "Yeah, this isn't going to work." So,
53:49
you're basically doing
53:50
>> this isn't going to work. So, I, you
53:52
know, I immediately would pivot. Well, I
53:55
had several times where somebody who saw
53:58
me do that pivot, they're like, I want
54:00
you to walk me through this as we do it.
54:02
And they were able to they were able to
54:05
develop some of those skill sets. And
54:07
and there's nothing special about me. I
54:10
think I acknowledge and recognize the
54:13
strategic chess skill set just because I
54:16
personally paid attention to it. But I
54:19
know a lot of executives who are really
54:21
good at this. I could I could name off a
54:23
dozen right now that I'm like, "Yeah,
54:25
they're they're good at this." Um,
54:28
>> but they just have that ability. Um, and
54:31
not everybody has it, but I think that's
54:33
where you kind of have the cream rise to
54:35
the top.
54:36
>> Well, tell us where where folks can
54:39
learn from you, where they can follow
54:41
your work. Like, give us a little shout
54:43
out. We'll make sure we put it in the
54:45
description. It's been really fun
54:47
conversation.
54:49
>> Well, I appreciate that. I've had a good
54:51
time. I I just realized this has gone
54:53
longer than I thought it was going to go
54:54
and I've enjoyed every minute of it.
54:56
>> Um I think the you know I about 10 years
55:00
ago so go back to when I was still
55:03
running organizations. Um I I started
55:06
having this this feeling in my chest
55:09
that I learned so many lessons the hard
55:12
way and I screwed up so many things so
55:14
badly that I don't want other people to
55:17
do that. And so I came up with this idea
55:19
that one day I was going to write a
55:21
leadership book.
55:23
And the leadership book I I told myself
55:27
I want to include a lot of stories that
55:28
I really can't tell until I've retired.
55:31
So I made up my mind that I was going to
55:34
wait until retirement. And that and you
55:36
know quite frankly Michael gave me an
55:38
excuse because I didn't have to do it.
55:40
>> You know this this burning urge that I
55:42
had I I I can't do it because I'm still
55:45
working in hospitals. I can't do it. I
55:47
can't tell those stories. But when I
55:49
actually retired,
55:50
>> yeah, you know, when I actually retired,
55:52
I was probably
55:54
>> three or four months retired and it hit
55:57
me, dang, my excuse is gone. You know, I
56:01
promised myself I was going to write
56:03
this book. And so I grappled with that
56:06
for a couple of weeks or a couple of
56:08
months and uh just started writing. And
56:11
I was I came I wrote about I wrote the
56:14
book to about 80%. And uh was so honored
56:18
that Quent Stutter and Dan Collard who
56:21
I've got a relationship with I mentioned
56:23
to them that I had written this book and
56:26
they took off with it um and decided
56:29
that they wanted to help me publish it.
56:32
And so I've been so honored that you
56:34
know they've helped me with it. But the
56:36
the book's called the book the book is
56:38
based off of two concepts and I'm I
56:40
won't take up too much more of your time
56:41
but two concepts. One is that events
56:45
happen all around us all the time and we
56:47
have to accept we don't have control of
56:49
those things but what we do have control
56:51
of is our response to those events.
56:54
>> Um and the formula is event plus
56:57
response equals outcome. And so the
56:59
outcome is dependent on not only the
57:01
event but also your response to it. So
57:03
if I have no control over the event and
57:05
I have 100% control over the response,
57:08
I've got 100% accountability for the
57:10
outcome
57:12
>> and whoa. Okay, that puts a lot of
57:15
pressure on us on how we respond.
57:18
>> The second one is is that is that
57:20
healthc care is hard and anybody
57:23
listening to this that works in
57:24
healthcare, they have been disappointed.
57:26
They've been disappointed in other
57:27
people. They've been disappointed in
57:29
organizations. They may even felt
57:30
mistreated. Okay. My advice is not to
57:34
focus on wishing karma on those
57:37
individuals because they disappointed
57:39
you. Let it go. Just let it go. I mean,
57:43
don't worry about it. It It takes up so
57:46
many negative emotions and so much of
57:48
your energy and your happiness and your
57:50
time and your peace if you're worried
57:52
about all that stuff.
57:53
>> And so, those are the last two lessons
57:55
in the book that I wrote. And then the
57:57
previous nine lessons are all the things
58:00
you need to be able to do to embrace
58:02
those two things. Um, and so it I'm I'm
58:05
extremely passionate about it. Um, my I
58:09
get asked all the time, who's your
58:10
audience? Well, my audience are the
58:12
first group is seasoned healthcare
58:14
executives because I admit I lost my
58:17
peace as a healthcare executive. I
58:20
didn't lose success. I lost my peace. I
58:23
lost my happiness. I lost my, you know,
58:27
drive and passion for all of it. I just
58:30
I wasn't having fun anymore.
58:33
>> Um, and I don't want other people to
58:36
experience that. I did and I walked
58:38
away, but I don't want them to walk
58:39
away. I want them to find some
58:41
>> find some strategies to have peace while
58:44
you're being successful. And then the
58:46
second group is young careerist. So, you
58:49
know, uh I I worry about healthcare
58:52
leadership because I see a lot of young
58:55
career young early careerists that are
58:58
getting a little disenchanted. They've
59:01
gone to school. They've chosen healthare
59:04
>> and now they're looking up going, "Wow,
59:07
promotions are slow. I don't really have
59:10
a lot of mentors.
59:12
>> Um the difference I wanted to make,
59:14
maybe I'm not making it at the level
59:16
that I want to." So, they're they're
59:17
they're getting a little disenchanted. I
59:19
want to give them some tips and ideas
59:22
about how to get over that hump to not
59:25
not be disenchanted to realize that
59:28
healthc care is hard and it's a grind,
59:31
but you can find success and peace. And
59:36
that's what I hope this book does is,
59:39
you know, learn the lessons the easy way
59:41
that I learned the hard way. And that's
59:43
that's how I wrote it. But there's some
59:45
great stories in there. There's some
59:46
stories that even my wife was like, I
59:49
can't believe you told that story.
59:52
>> Well, I would just say that from this
59:54
conversation, number one, Tom, thank you
59:56
for just being rigorously honest and
59:58
sharing stories. I think uh people do
1:00:01
learn more from stories, you know, and
1:00:04
just just thank you for carrying the
1:00:06
responsibility. Obviously, it's a huge
1:00:08
weight when you have a community that's
1:00:10
sort of uh on your shoulders that you're
1:00:13
caring for. That's and and you're taking
1:00:15
decisions that most people will never
1:00:17
even take into consideration in our
1:00:19
lifetime. That's not easy. Um so, it's
1:00:23
been a really fun just kind of having
1:00:24
you today as a guest. And you know, for
1:00:26
those of you that have tuned in, if
1:00:27
there is something that you felt that
1:00:30
resonated with you, um you know, would
1:00:32
you mind sharing it? share this episode,
1:00:34
give it to a colleague. And if there is
1:00:35
a topic that you want us to explore or
1:00:37
even a leader that you um want to hear
1:00:40
from, drop me a note. We do leave a, you
1:00:42
know, we do read the comments. So, this
1:00:44
is a platform that um it's not just
1:00:47
about content. It's really about
1:00:49
community and uh being in an authentic
1:00:51
community. So, thank you for listening.
1:00:53
Uh keep building with purpose, stay
1:00:55
focused, hang in there, and uh we'll see
1:00:58
you next time on the Advancing
1:01:00
Healthcare Innovation Show.