Thoughts and Prospectives from Health Care Employers

Thoughts and Prospectives from Health Care Employers


So without further adieu, please help me
welcome Mr. Ament to the stage. So I’m gonna talk about a couple of things
tonight but I’m going to really zero in on number three maximizing the student
experience, the importance of networking and career expectations versus reality
and I’m going to build in a couple personal examples under each of these.
And we’re also going to spend some time at the end answering questions any
questions you have I’m an open book. First I want to talk a little bit about
perspective however so you understand my blessed journey. Let’s talk a little bit
of what why the VA. We actually have an expression “Why VA” and it’s a
marketing campaign that we have. But it’s not just marketing for the veterans
joining the organization for their benefits it’s also for our recruitment
slogans. And then of course there’s a call to action at the end. I originally
pursued healthcare leadership because I wanted to utilize my passion for
business where I could serve. You may have briefly heard the word Special
Agent in my bio, I was a federal agent for four years where I did narcotics
investigations, counter espionage investigations and I did a sting
operation at a hospital in Dayton Ohio where we brought in buses for 47 people.
So when I dropped the gauntlet they did not lose a bit of business. They just
brought in 47 people we arrested the people that I was investigating they
didn’t miss a beat. Three years later when I was going to matriculate as an
MSC officer in the Air Force, I needed a reference and the reference one of the
references was the hospital commander and he said are you kidding me you kept
me out of trouble you kept my hospital running you got rid of 47 bad eggs what
can I do. So that’s kind of and there’s there’s a theme here that you’ll see as
we move forward. Thirty years of experience yes, hospital administration and consulting. I still am doing
some consulting on the side. Thirty organizations, that doesn’t mean I’ve had
30 different jobs it means in some of my roles I touched a lot of hospitals at
one time. But I’ve served the not-for-profit sector in the
investor-owned sector and the governmental sector, and there’s a lot of
differences between those organizations but there’s a lot of similarities
especially the good ones. I’ve led two organizations to be national
best-in-class for patient satisfaction. When you get
into the sector and you’re working you may be working for an organization that
measures our patient satisfaction with an instrument called Press Ganey
associates. Two different times we were the top one percent of the country and
Press Ganey, one time we were the number one Hospital in the country in that in
that measurement. But my entire career my business focus has always been in value
creation. Now this were a business group they would understand exactly what I’m
talking about but imagine a Venn diagram that’s got service, quality, and cost or
price. The center is is the value proposition. The way I look at value for
from a leadership perspective is trying to grow that top-line, operational
efficiency or expense reductions, and of course customer service. I have been
involved in 30 organizations and my reputation is a turnaround guy and
I’ve never had a layoff. So that’s one of my claims to fame.
So imagine after 30 years having your employer, who you just started working
for, you went there for you thought a particular purpose, and they call you and
say got some good news for you, your hospital has just sold as part of a nine
hospital swap. Thank you very much because when we recruited you we needed
you to do your thing because this deal has been on the table for two years and
we couldn’t pull it off because we didn’t have a sizable margin. The average
healthcare margin the average profit margin in healthcare is less than 4%, and
you really need 4% to replace yourself, pay raises for employees capital
improvements. We had a 23% ebit margin, and what I got from my efforts
was we sold our Hospital. Now the employer said don’t worry we’ll take you
someplace else, and I’m thinking what have you done. What have you become, I’m
usually the guy that drives a strategy and I just found myself to be a pawn in
somebody else’s strategy. So the irony was the tools that had always made me
successful were the same tools that just had me start doing some real
soul-searching. The epiphany when I looked back was “why did I get into
health care in the first place?” I’m a business guy, why did I go healthcare.
When I started thinking about why I went healthcare, I said you know what I’ve
lost my way. I was so enamored with turning hospitals around I forgot
why I got into health care. So for about a four month period of time, when my
employer was trying to figure out where to send me next. I’m looking at getting
out of health care operations entirely. As a matter of fact I was a finalist to
be a president of a foundation, I was going to raise funds for an overseas
Children’s Hospital and I said okay I’m going to give back but I’m gonna get out
of the the rat race of leadership. Then I got a call because of my
networking from a colleague of mine and said Rick you got to think about the VA.
I can’t spell VA, I’ve never considered VA, why? Well they’re making a
big push they’re bringing in outside blood, they’re looking for people with
passion, who drive service who are business operators and are not afraid to
fight the bureaucracy. Okay, let me check this out. Next thing you know I chose VA.
And if we go back my passion and my leadership is to serve. So let’s talk a
little bit about the VA if you don’t know what the VA is. Who we are,
what are our foundational services, what are our priorities,
and let’s debunk a couple myths. Nationally there’s 170 hospitals that
belong to the VA, we’re one of the largest healthcare systems in the world. We have
over a thousand clinics, we employ 380,000 employees, we’re the second
largest government bureaucracy in the world, that’s nothing to be proud of. My
particular system includes the Robert J Dole VA Medical Center here in town as
well as six clinics throughout rural Kansas. We serve over 29,000 veteran
covered lives, now again, I’m fully prepared to answer questions at the end
and you’re gonna be wondering what’s a covered life, I’d love to talk about that.
We have 1200 employees and we’re growing. 32% of whom are veterans themselves but
there isn’t a myth out there that I didn’t really count as a myth that you
must be a veteran to work for the VA. I happen to be a veteran, a long time ago
again Reagan remember that, but that is not a prerequisite to working for the VA.
And our operating expense budget exceeds two hundred and twelve million dollars.
For those of you that want to know how that compares, first of all, if we’re not
in the government you have to have a margin so put a margin on top of that.
And usually your cost your gross to net charges are somewhere in the 40 to 50
percent gross versus net revenue. So just double that number,
we’re about a half a billion dollar organization in terms of gross revenues.
Okay, what are our foundation, what are foundational services? So the VA has been
grappling with what it is for many many many years. Our most recent Secretary of
the VA who I have tremendous respect for no longer with us, he came out about the
same time I did. He identified that there were three
things that we would do, whether you were in Poplar Bluff Missouri, or whether you
were in our largest facility in Houston, all VA’s would do the same thing. That
way we could have some perspective and veterans could have some expectations.
You ever been to a McDonald’s and you knew what that french fry was gonna
taste like. When you go to a VA I don’t care how big or small you need to know
that these three things are guaranteed to be they’re going to be their best
services the first is comprehensive primary care and I know there’s some PA
students and some of those practitioners in here so we can talk about what that
really means. The second is military-related
behavioral health and the third is military related rehabilitation and pain
management. We put a lot of emphasis in these three areas as a matter of fact, if
I have to make strategic decisions on where to spend dollars, these three will
always get the dollars first. If you’re a future employee in one of those areas
keep that in mind. Now beyond our foundational services were not Poplar
Bluff, we’re also not Houston, we have a lot of other services. We have 10
surgical subspecialties we do interventional radiology, oncology, we
have a dialysis program, a strong dental program, a strong ophthalmology program,
infectious disease, so we had the full continuum of services. Debunking some
myths, I’d love to talk about when we get done talk about some myths that you may
have I’d like to debunk them here this evening. But first miss myth underpaid
employees we can’t compete with the private sector. I’ve been there just
it’ll be two years in December, we’ve given significant number and significant
amounts of pay raises. Right now our RN turnover rate is less
than 3%, I would challenge any of my competitors in this state to show
me an RN turnover rate better than 3%. We have some aid significant pay
adjustments and it’s never strategically smart to be the highest-paid in the
market, but you want to be that provider of choice that people say I want to go
work there and their pay is not a deterrent. It just
so happens we are the highest payer in a number of areas. It’s just not something
I like to publicly brag about but it works for us because we have a low
turnover. There are five to forty applicants for every open position, and
the only reason I put five on the low end there is because there are some very
specialized and/or administrative positions I may only get five people do
apply. But if it’s clinical it’s usually upwards of 30 to 40 people per position.
Another myth we’re inefficient in costly Coming from the private sector working
in an environment of turnarounds we are less efficient than I’d like to be. But
to say we’re inefficient and costly it depends on which hat you’re wearing and
how you wear your hat. We do not have shareholders. I do not have to worry
about shareholder equity. I do not have to worry about turning profits back to
anybody. Any penny I save at the VA we keep in the VA. So think about that as a
motivational tool when I’m meeting with staff and saying I need your help
let’s become more efficient. We never had those discussions, now when I talked to
the nurses and I say I need your help let’s become more efficient. Why
would I do that? Because for every hundred thousand dollars I can find
that’s a nurse plus benefits. I don’t have to push that money up upstream I
keep that money local. So if you want to have a stronger team you want to have
more hands at the bedside, I’ll tell you where we need to go you tell me how to
get there. It’s amazing how smart our staff are when they’re on the floor and
how many efficiencies are finding. Our first goal was five million, our second
goal is 10 million. 10 million, do you have any idea how many staff that is?
Tremendous number of new employees we’re bringing on board. Incidentally all
savings stay in-house. Next myth, old buildings, old technology. So we have the
juxtaposition of having these really beautiful really old buildings on campus
I can’t touch them. The Historical Society will not allow me to touch the front,
behind we can do anything we want. So our capital budget is usually in the
three to five million dollar capital improvement per year. We right now have
37 million dollars worth of capital improvement on campus as we speak, either
completing or starting. A substance abuse rehabilitation, retention treatment facility. A nine million dollar expansion to our
emergency department, a seven million dollar primary care building that just
opened, a nine million dollar surgery expansion, 11 million dollar patient room
upgrades. Our patient rooms would be the best patient rooms in town when we’re
done and we’re about to start those this fall. And our gamma camera is about to
start this fall and our PET CT just went in last fall. So yes it’s a beautiful old
building and we have state-of-the-art technology. Next myth, access to services is poor and slow. Don’t remember or don’t believe
everything you see on television whether it’s fox or CNN. Doesn’t really
make any difference because with a hundred and seventy facilities, were like
any other large system, we’re gonna have excellent providers and we’re gonna have
folks that could do a better job and all the concerns you heard four years ago in
Phoenix about getting access to care and all the problems that they had with
access.I don’t know the facts on that, those may have been true concerns
in Phoenix those are not the concerns in our market. So right now in primary care
the wait is 4 to 16 days. Four days if you’re an existing patient, 16 days if
you’re a brand new patient. I’m new to town, I could not find a provider in less
than 16 days when I moved to town. So our access is better. Specialty care 8
to 13 days, and behavioral health is 5 to 12 days. So if you’re a brand new patient
seeking behavioral health services, you can be with one of our providers in 12
days if it’s emergency it can be right now. A myth, lack of innovation leads to
poor care lack of innovation. Okay. I came to work one Monday and I had a gentleman
knocking on my door and said we need about five minutes of your time. We made
a proposal last week when you were gone a decision couldn’t be made. Okay, what’s
the proposal? He brought in three colleagues, now this person is an AP RN.
He brought in a social worker, he brought in a, I want to say a behavioral health
nurse, and a telemedicine nurse. They said here’s our proposal, we want to provide a
tablet to every discharging patient in the market that’s discharging it from
anywhere in our market whether they’re on our benefit program or not if they’re
a veteran, if they’re a high-risk discharge from another hospital,
and we want to work with that veteran and talk to them everyday via telehealth
and we want to track, because there is a 20 veterans commit suicide every day in
this country. But of the 20 veterans that commit suicide only six of them are
receiving care in the VA, that means if you’re not being followed by the VA your
chance of committing suicide are tremendously greater. Mr. Aiman we don’t
care if these folks are following with the VA we want to follow them so we can
drop the suicide rate in Kansas. We’re trying that we’re the only ones in the
country to do that. That’s pretty innovative, when I got a guy that knocks
on my door on a Monday morning and said let’s try this.
Moving primary care out of a hospitals, now this is innovative for the VA. It is
not innovative in the private sector. We just spent seven million dollars
building a brand new primary care building and just moved into it. We’re
gonna be moving out. We’re moving all of our primary care to where our
patients are which is what we should have done and what the private sector
has been doing, so we’re going to be moving primary care clinics
out to western and southern Wichita and we’re gonna occupy the new building with
services that we have we just don’t have enough buildings for. So we’re gonna use
the building, we’re just going to make sure our services are where the patient
is and not make the patient come to us. And then telehealth hubs. We spent a
lot I spent a lot of time out in rural Kansas talking to rural hospitals.
I have rural hospitals that have a lot of veterans in their market, I don’t want
the veterans to have to come to me and in some of these markets they don’t have
strong behavioral health programs. Well behavioral health is one of our
foundational services, so we’re working with those hospitals to set up
telehealth hubs in their hospitals. I don’t need to get your patients, look at
me as a funding source. Help me enroll these veterans and we’ll
track them, we can do behavior telehealth visits right there,
and we do that a lot so there’s a big push for a behavioral telehealth out in
rural Kansas. Stagnant, reactive, lethargy, kind of this big bureaucratic,
slow-moving organization. Quick story, so when I was interviewing for the job, I
was offered a position up in Minnesota, and my boss gives me a call one day and
says, Rick I’d like to talk to you about a job in Wichita. Said Wichita okay, said
I’ve already been offered a job in Minnesota. I know that, I know that, so
it’s not an integrity problem, he goes nope. I want to talk to you. Okay, so I fly into Kansas City which is where my boss is located, and
we’re chatting for about an hour is all it’s a fantastic discussion. The boss
says you have any questions, the future boss, you have any questions? I said, I
do have a question. I have a real hard time with bureaucracy, I realize there’s
rules every place I’ve ever worked there’s rules. I said, but I don’t like
anybody holding me back, and I’m concerned about the government
bureaucracy. He’s a physician, he looks me in the eye and he says Rick, I don’t want
you to break any rules I don’t want you to break any laws, but bend every damn
law and rule you need to to make Wichita home. So you know what I can work for
this guy, the rest is history. So we are not, we don’t have to be lethargic and
slow. My boss isn’t. So Business Development. We brought on a business
development function. A little bit of a dilemma here because it took me six
months to get the job description created because in the VA, the words
business and development should never be in the same sentence, so they didn’t know
what we were talking about. That’s okay I didn’t need to have a job description, we
started doing the job and our growth is to grow our top-line by 20%. That is a
huge, huge initiative, and they’re very aggressive and they’re doing a fantastic
job. That’s not the kind of thing you normally hear from a government entity.
Strategic partnerships, I’m going to talk in a minute about when we just we just
did a ribbon-cutting in Liberal Kansas on Friday. But we have three strategic
partnerships that are being targeted right here in Wichita, things that we
want to do in this market with other providers, that used to look at us as
competitors. No no we want to be your partner we want to work with you to do a
better job of taking care of my vets. Let’s talk a little bit about Liberal. So
when I move to the Kansas market, we have six of these clinics and one of them is
in Liberal, Kansas. Show a hands who’s familiar with Liberal, Kansas. Okay. So our
clinic has 238 enrolled veterans. I have a hard time paying the light bill with
238 patients in a clinic. So that’s been the debate for years,
close the clinic, don’t close the clinic, close the clinic, don’t close the clinic.
Have a hard time recruiting providers, and even if even if you do recruit a
provider, it’s a it’s a huge loss leader. So the whole debate is should we keep it or should we close it. Well the technical
issue is if you close it, it’s literally an act of Congress to get another one,
and right now Congress is not approving new facilities. So we thought, do we
really want to close it? So I said let me do some investigating, so I go out to
Liberal I meet the staff. I go meet the CEO or the local hospital, we sit down I
say, what would you think about being a veteran friendly Hospital? He says, I’d
love it! What does that mean? I said, I don’t know let’s figure it out. So in
about 30 minutes we sat down and said, what if I move my clinic into your
hospital. What if I buy my physician care from you. What if you get my lab business,
what if you get my radiology business, and instead of– Oh by the way I didn’t
mention that, every Wednesday a bus came from Amarillo, Texas to the Walmart
parking lot to take veterans down to Amarillo to have surgical procedures
done, and have been patient care done. Wichita was too far to come, Amarillo was
only three hours. I said, we’re gonna stop the bus, you want all that patient
business? Absolutely! Okay, here’s what I need from you. Remember I say we have 238
enrolled veterans. There’s actually 1,400 eligible in that market. You help
me recruit veterans and you don’t look at me as a provider of healthcare, you
look at me as an insurance product. I’m a conduit of federal dollars into your
facility, work with me let’s grow our product. So we’ve done that, but the
problem is with the government contracting takes two years to 28 months.
We found a little bit of a loophole. I don’t like following rules, I’ve told
you that my boss is really pleased with that, but we didn’t break any we just
found one that we were unfamiliar with, and in five months we had an approval
and we just did a ribbon-cutting last Friday.
And now our clinic is sitting in the hospital in Liberal Kansas, and their job
as my partner is to help me recruit vets. Systems redesign. So with my background
you can imagine I’m thinking about trying to improve, trying to become more
efficient. This University happens to have an industrial engineering program.
With all the aircraft companies here in town, they’re producing a whole
lot of folks with an industrial engineering background. I need me some of
them they’re folks. So we’ve had an industrial engineer, we’ve got one, and we
sat down and we said we really need to expand, how we how am I going to
ten million dollars of expense. How am I going to make sure that I’m one of the
best from a quality perspective hospitals in the VA, and how am I going
to make sure I push that service excellence envelope. So we’ve added three
additional industrial engineers from this location. One is for business
principles one, is for clinical quality outcomes, and one is for customer service.
And then of course we have an analytics person to work with that team. So we’ve
gone from one to six people working on Industrial Engineering and process
improvement. Now we’re not getting paid for that, I get paid a little bit
differently, but if I can pull 10 million dollars out of the organization I’ll pay
for my industrial redesign and that’s what we’re trying to do. Employee
engagement. Anytime you have a organization that’s trying to be
cutting-edge and you’re trying to recruit more staff and you’re trying to
recruit more providers, you’re trying to provide more services to your veterans,
trying to come up with partnerships. You need to have employees bring ideas to
you. I set a direction, but I’m not the smartest guy in the room. My job is to
find the smartest folks in the room. So we have a lot of programs to get
employee engagement up. Our original goal is to get it to 30% was our first push.
We blew that out of the water with 47% participation. I have 47%, that was this
was last year, 47% of our employees are involved in some form of process
improvement, clinical improvement, customer service. We produce an employee
newsletter completely produced by employees. My only input is I’d like to
make sure we focus on these themes and then from there they completely do it, we
have embedded reporters in departments. 70% of my employees it got bachelor’s
degrees, tell me I don’t have folks out there that can write. I don’t have to
just have a marketing department, I got all kinds of folks that got all kinds of
ideas. We just want a national award for the best employee newsletter in the
country, and this is all done by my staff. I’m not directing any of it. Very
exciting! So Why VA, for me, it’s obvious I’m working in an organization, if you
remember my first slide, that allows me to provide leadership, utilizing my
passion in a way that I can serve. I found home. So some perspectives as an employer. Perhaps your future employer. First of all let’s
talk about how do we maximize the student experience. This is just my
perspective as an employer, as a previous student and as a father. So the question
is what do you want to be when you grow up? So I’ve got three children in
doctoral programs. None of them followed a normal course,
you can probably imagine that listen to me for 15 minutes that my kids are a
little bit different than cut from the cloth. Every one of them changed the
group degrees multiple times to include my youngest son in his PhD program has
been to two different, this is his third school and focusing exactly what he
wants to do. And each time they come to me and they’d say, dad we’re thinking
about making a change, what do you think? And my answer to them every time is do
what you need to do because I still don’t know what I want to be when I grow
up. And if you have that attitude in life, you’re fresh, you’re excited, you’re
energetic and you can still be old as dirt, and still be looking for exciting
things down the road. Second seek your education with an open
mind. I was just talking to some young ladies this evening, have an open mind!
You don’t exactly know where this is going to take you, 18 year old kids
coming out of high school should not know what they’re gonna be doing when
they’re 60 years old. So you need to come into this thing with an open mind.
Academic preparation gives you the tools you’re going to get those tools right
here. But purpose comes from the heart. Now you may have some academic
professors, you may have some mentors that can help steer that, that can help
mentor that and it can help massage that. But it comes from the heart, you’re not
going to get that from a textbook. So do what you need to do from your heart with
the tools that you get here. And of course follow your passion. So what do I
look for in future partners, we don’t we try not to call them employees we try to
call them partners. I do something called a likeness of fit interview. Just a
quick show of hands have you ever heard of a likeness of fit interview? I’m
impressed because my management team had not. So I don’t like, I will not
micromanage I have 80 managers and supervisors
and I don’t want to make the decisions on who they hire. I clearly don’t want to
make the decision on who their leadership needs to be when they bring
in new leaders. But what I do want to do is before that final offer is made I
want to make sure I have a chemistry match, so we implemented about a year and
a half ago. Managers are going to and leaders are going to make the decision
based upon the technical skills and the experience of these leaders, and then
advance them to my senior team because we interview every supervisor from
grassroots supervisor up for what’s called likeness of fit. Now when I talk
to somebody about likeness of fit, I don’t talk about textbook, I don’t talk
about experience, here’s what I talk about. I talk about passion, I talk about
the Three A’s. I talk about intellectual curiosity, I talk about willingness to
fail. Three A’s, alignment, accountability, and anticipation. If you’re going to be a
manager with a clinical background I want to make sure that we’re just not
taking somebody who’s clinical and throwing them into a management job.
That’s the greatest predictor of failure, when we take successful clinical people
and stick them in management with no training. Now I can work with them if
they’ve got alignment, if they understand where we’re going. If they’ve got
accountability, not just for themselves but they’ve got the guts to look their
colleagues in the eye and hold each other accountable. And anticipation, skate
to where the puck is gonna be. How many managers do we have, how many folks have
you worked with that they’re constantly chasing around the curve and they can’t
quite catch it. Well if you know where it’s going, skate right to it. Don’t even
follow the puck go right to where you need to go. We don’t do that often enough.
So in our interviews when we talk about lightness of fit we ask provocative
questions. One of the provocative questions is how do you handle failure?
Now when the CEO is looking you in the eye and you’re asking for a job, the last
thing you want to hear is how do you handle failure. Because the honest answer
is well I look at failure straight in the eye and if I fail that just means
I’m gonna keep trying, because if I try 99 times and I only succeed once. That
means I had 98 learning opportunities, that’s a perfect answer. Now I am gonna
ask a little bit about are they incompetent, but I won’t stay on that
too long. I’m really excited about they’re willing
this and their willingness to fail. A willingness to fail is not the same
thing as a desire to fail. A willingness to fail is that intellectual curiosity
and that’s what I’m looking for in leaders. Importance of networking, I
cannot emphasize the networking enough. Now earlier in my career I didn’t
understand the importance of networking. Thank God I learned that over time or
through happenstance it benefited me but I need to tell you right now networking
is important. And I’m not talking about superficial schmoozing, I’m talking about
networking. So what do we mean. Let’s look at your professional affiliations,
there’s all kinds of different disciplines in the room, figure out what,
you’ve got multiple professional affiliations that you can
have, I understand that but pick one that allows you to grow that allows you to
develop that allows you to build colleagues and collegial relationships. I
happen to be a fellow in the American College of Healthcare Executives. That
means I’m board-certified in hospital administration.
I’ve been board-certified for 20 years. When I first became a fellow, I didn’t
really understand why I was doing it, but the last 20 years my affiliation with
the American College has paid off over and over and over again. Organizations,
find that organization that you feel good about. I’ve belonged to every place
i’ve lived I belong to the State Hospital Association. Two different times
I’ve been on the board of directors, why is that? Because it’s important to give
back. State Hospital associations are basically very focused lobbying
organizations, and they affect, or they can affect the way health care is
delivered in this country. So I want to make sure I have input to that. So find
the one that works for you. I’ll give you an example for an organization my oldest
son went to University of Michigan. Go blue, and his freshman year he had a
roommate who was from India, and all of his friends were from Southwest Asia. So
for some strange reason one Sunday or one Saturday he went to a Gandhi
Festival. He was a freshman, he’s now 36 years old those are the guys
that just went to his wedding. He still has relationships with these
guys and his entire outlook in life was kind of created by a Gandhi party that
he went to as a freshman, and that kind of helped his passion when he was going
through school. Personal relationships, peers and mentors.
These are networkers, find those peers and mentors that not just can help you
you can help them, because you’ll be scratching each other’s back and I’ll
give you a couple examples in a moment. And then of course passion. Networking is
only good if there’s a passion. Nobody wants a superficial schmoozer
walking up to them and shaking their hand. Everybody wants this bright-eyed,
bushy-tailed, high-energy person that’s got this intellectual curiosity that’s
always willing to learn. If that’s you that friend today and mentor today will
be a colleague 20 years from now. Because that’s where you’re gonna be in 20 years.
So just give back somewhere, somehow. Okay. Importance of networking, here’s some
examples from my past. So old as dirt but networking is paid off tremendously.
My first CEO job I was 34, it’s called by a colleague, I never saw the job, I never
saw the posting, I knew nothing about it. I was called by a colleague and said
Rick, you may want to look at this. I’m not sure that I’ve got enough
experience. I think this will work for you. Sure enough, my first CEO job. Four
years later we were on the cover of Hospital magazine. I would not have been
a good CEO and every CEO job that was available but that particular one was a
good fit for me and my colleague, my friend knew this. When I transitioned
from a CEO to consulting, I’ve done this numerous times, but two
different board chairs contacted me and said, board chairs that had been my board
chairs contacted me and said, Rick we’ve heard you were thinking
about starting a consulting company and they both had different kinds of
concerns. Would you be interested in coming to work for us as a consultant?
One of them was a four-year engagement, one of them was about a year-and-a-half
engagement, but the one engagement. We built the small, my claim to fame on
this one was, we built the smallest hospital in America. The smallest
hospital America because what was happening is they were asking the wrong
question. They’re sponsored, their owner had closed them down, and that community
was not going to have a hospital This rural community was not going to have a
hospital. That chairman of the board knew me very very well and said, help us get
our Hospital back. So I met with her board we sat down, I said, folks you’re
asking the wrong question. I can’t do anything about getting your Hospital
back. I don’t own it, you don’t own it, but let’s ask this frame this question a
different way. Let’s sit down and figure out what the bare minimum definition of
a hospital is and let’s figure out if we can start from there and build up. So we
built a smallest hospital in America. It was a four bed 10,000 square-foot ED
attached to a community gymnasium, with a helicopter pad. It met the criteria, when
you meet the criteria you get all kinds of funding mechanisms, cost plus
reimbursement on construction. Cost Plus? That means every penny I spend the
government gives me that money. Oh yeah! So we found ourselves a tertiary partner
and today it’s one of the best critical access hospitals in the country, with a helicopter pad. They have a primary care clinic attached it’s the 25-bed
hospital, they got CT, they get MRI, it’s an exceptional organization. All because
the board said let’s get creative and we did. JR is a good friend of mine.
JR I actually this is the slides not correct.
I’ve hired JR three times and JR has hired me twice. So I hired JR as
my chief financial officer once, and six months after I hired him I left the job
and went someplace else. Recommended that he replaced me, he did.
About a year later I called up, hired him back, he left came to work for me. About a
year and a half later, I left, he replaced me. In his new capacity he hired me twice
to be a consultant for some of his hospitals. So it’s mentoring, it’s
networking, it’s relationships. When you find people that you have a passion a
similar passion in your job and you respect them, you’re going to keep
reaching out to them. Johns about ten years older than I am and John’s a
finance guy, I’m not a finance guy but he and I had something we hit it off and we
played off of each other for 20 years. My indie experience. I’m not sure if I was
in my bio, but I was called by a colleague of mine. This colleague
happened to work for me at one point in my career, called me up one day and said,
Rick. I’ve got a handful of investors that want to start a JV organization and
build a hospital company in India. You’re the best operator I’ve ever worked with,
would you be interested in being our operational consultant?
You bet! So I spent 10 days in India. I met some new friends, their project never
really got off the ground but the vision was incredible and I keep getting calls
from this guy. That was 15 years ago. I keep getting calls from this guy for
other projects. And then of course me and the VA. I would have never thought about
the VA, but I had colleagues that I’d worked with and said Rick you really
need to consider this because they’re changing the way they look at life, we
know how you look at life, you may want to consider it. So I did. Career expectations
versus reality. So when I came in I had my experience, I’m sorry I had my
expectations, but my experience didn’t play out exactly as I thought. I had a
plan, I was going to be licensed by a certain age, I was going to be a CEO of a
hospital by a certain age, I was going to be a multi facility executive by a
certain age, and I was going to run a system by a certain age. I blew every one
of those away the last one by about 20 years, because once that last one was
done I was gonna retire in golf. The problem was I focused on the plan. I over
planned, the reality is you need to over prepare because when life strikes you
with all kinds of things that are out of your control, as long as you’re prepared
it doesn’t make any difference. You can rebound, you can do whatever you got to
do. My reality is my skills were my building blocks, and even though I went
the most recent organization before the VA they recruited me to be a multi
facility guy, because of my multi facility experience. And I thought I was
going to run 13 of their facilities. They said but you got to learn how we do it
first we want you to go to this one. That was really disingenuous and that is
polite as I can be about that. Nine months after I was there we had a 23%
operating margin, they sold the facilities and they were gonna send me
someplace else. Like I said, so but my building blocks even though they kind of
got me into that situation they also got me out of it real real quickly. Personal
satisfaction. I call it the secret sauce. Now I think the secret sauce has
basically got three ingredients, but the amount of each ingredient is up to you
and your definition of your secret sauce. But to me the secret sauce is some
combination of passion, balance and integrity to self. Now when I say balance,
in case you’re thinking he’s talking work-life balance. He’s talking about go
home earlier, he’s talking about don’t work weekends. Oh no. I’m a workaholic, I
always have been, I always will be. That’s not going to change, but balances to me
is how do I spend my hours? Can I look in the mirror at the end of the day? Am I
just pushing paper or am I still excited, am I still engaged, can I still get other
people excited? That’s what I mean by the balance, it can’t just be the rote and
the mundane, it’s got to keep you excited. And then integrated itself. You’ve got to
be able to ask yourself at the beginning of your career, what does success look
like? Now if your answer to that question is a certain amount of money, or a
certain position or title, or a certain number of letters on the back of your
name on your name badge. That’s okay. That’s not me,
but that’s okay, just remember that that’s what’s your definition of success
is. Then when you get to be like me and your oldest dirt, you need to be able
to look in the mirror and say am I still living my definition of success. So
here’s a story and our end story. This particular RN was a neuro ICU nurse at
Mayo. I think she was 26 when she went there and if you if you’re not aware the
Mayo neuro ICU is has been the best neuro ICU in the world for 21 years
straight. And so her clinical skills were strong, but they became very strong after
five years working in that unit. Some of her mentors and leaders strongly
suggested that she go and get her master’s or her her PhD and they thought
that maybe she would make her you know a good nurse educator. So she started in a
DNP program. I’m sorry she started out in a nursing PhD program, then changed to a
DNP program because she says look I need to be a provider, but she didn’t exactly
know what she what kind of providing she was going to do. So during her studies
and she also works full-time, she studied in Tibet for four months. Tibet, for four
months, some gal from Rochester Minnesota. She became drawn to holistic medicine.
She changed her DNP focus from critical care to hospice and holistic health, and
next week my daughter is going to Hong Kong to host a holistic medicine seminar
for a hundred and fifty Taiwanese women that are trying to figure out what his
holistic medicine look like. And she gets her DNP in May. She followed her
heart, she’s got the clinical skills, she worked in the best ICU in the country,
but she wants to give and her passion is holistic medicine and hospice care and
that’s where she’s gonna hang her shingle out, she’s gonna run her own
Hospice. So call to action. What do you want to take away from this
I have three thoughts. First of all, you’ve chosen a health care field which
means you wish to give your life and service to others. Get your tools right
here. When you’re out in the world asking yourself what do you want to be when you
grow up? I do it every day. I tell my kids every day, remember to
follow your passion. As long as you got the tools, does it really make any
difference? Go with your heart, there’s nothing worse than going to the grave
and saying I wish I would have. Oh no no no no that’s a waste of life. And then of
course choose VA. I’m sorry Dr. Bin. Questions? It wasn’t that good so you
either weren’t listening. Please somebody. Future employees ma’am
the scholarship recipient. So I have to be, the question was, how does our pay
compared to Wesleyan via Christie? I have to be careful how I answer that, because
remember I was talking about having partnerships in town where I work with
these other folks, so I don’t want to throw them under the bus, but I have a
waiting list for RN to come from both of those organizations to come work
for us. It’s dangerous to be the highest-paid in the market so we’re not
in every nursing modality but we are among the highest and in many areas we
are the highest. Don’t tell them I said that, I’m sorry they know that.
You never want to be at the beginning of a labor war that’s dangerous
but it’s important for our culture for us to recruit good people and then to
retain good people, and if I take advantage of them and I worked in the
death and I don’t pay them well enough I’m not going to hang on to them, so we
understand that. One more quick comment. So remember we don’t get paid by episode
of care, I get paid by covered life, so the more covered lives I have the more
money I get. That’s why I have a 20% growth initiative, so it’s important for
me to do that because we’ve added 250 employees to our payroll and there’s no
real magic formula for me to get more money. And if I put 12 million dollars
with a pay raises on top of those 250 employees, I’m spending a heck of a lot
more money this year than I had in prior years. I just got to make sure that my
results are good so that my bosses bosses continue to give us this money
and they do. So our results are good, they like the direction that we’re heading,
we’ve got where we’re getting more money because we have a plan and we’re
following our plan, but part of our plan is pay well and retain well. Other
Questions? Yes sir yes ma’am. I’m sorry oh That’s my experience, so a my only
experience with the VA is Wichita, but I’ll go a little bit broader than that. I
am not too proud to steal so every hospital has their own little secret
sauce and the things that they do really really really well. We’re doing some
pretty innovative things here but I’m pretty confident in saying that very
little of that is pure innovation here. There’s a lot of innovation occurring
across the country, now there’s still facilities that are having problems and
they can’t work their way out of a wet paper bag, that’s it that’s a true
statement. And we are very innovative here but we
also there’s a lot of innovation occurring across the country. So if
somebody is about to graduate and you’re thinking about moving to a different
geography, give me a call, we’ll talk about the quality of the VA. I’ll be
honest with you, we’ll talk about the quality of the VA in that market. Absolutely so we have a partnership with
this university and with KU. And theirs we have a lot of partnerships and
part of the reason for that is I want to recruit to the VA. There’s going to be a
point I don’t have any more positions at Wichita but that’s ok not all of you are
gonna stay in Wichita. There’s a shortage of psychiatrist for instance across the
country. We’re doing a lot of innovative things to grow the psychiatry residency
program here in town. Knowing that I’m almost not quite but almost full, that’s
okay. I want to be a conduit for psychiatrists for the entire VA, so yeah
if you’ve got a desire to work someplace else in the country, we have 170
locations give me a call. Yes sir in the back. Well it’s a good thing they didn’t,
that’s a great question everybody hear it, how much influence does the
government have on my day to day operation? It’s a good thing when they
read my bio, they didn’t show my picture because two years ago I had hair.
Actually, that’s not true, my job is to be the buffer between that part of the
organization and my staff, so those are my headaches, but I’ll give you a couple
examples. I’d be thinking you were a fool if I said, ahh there’s no pressure, that’s
that’s insanity. But any organization is going to have the same kinds of pressure.
Via Christie is going to have it because they’re part of ascension health care,
the largest healthcare system in the country, and of course HCA has it as well.
But it’s how it works with us is everything is about salesmanship and
about service. So in my particular case I’ve not run out of powder yet and I
continue to push upstream to my boss and my boss’s boss to say there’s a reason
I’m going to be over budget. I need to do this, I need to do this, and my common
phrases we’ve been resource starved for twenty years. You guys have forgotten
about Wichita and if we look at our metrics, we’re a four-star facility. The
VA measures themselves in quality metrics across the country with five stars. And it’s
on a bell curve and we used to be a three star facility hospital number 78, I
think it was. The top 25 hospitals are 5-star facilities and we are hospital
number 30, knocking at the door to be a 5-star facility. We’re a very high
four-star facility, so when I tell my boss I need more bodies but they’re
targeted in specific areas. I’m growing my access to my veterans by 20 percent.
I’m moving my clinics out to where the veterans are because I need better
patient satisfaction and veteran satisfaction. I’m having relationships
with KU because I want to recruit psychiatrists not just for my facility
but for the country. We have never been told no, and we’re spending significantly
more than we’re allocated at the beginning of the year. Now my CFO was
pulling her hair out, because she keeps saying you’re spending money you don’t
have, and I said no grasshopper think like a fiscal strategist, not a bean
counter. We’re trying to create value and to create value got we got to prime the
pump, and so far that’s been successful. I’ll get to a point that it won’t be but,
I don’t like the word no so I’m gonna keep pushing until I hear it. Yes, yes sir. Oh, fantastic question! What would I like to see for the VA and healthcare in
general? Let me talk about the VA first. There’s a lot of discussion about
privatization, so here’s my thoughts on privatization, and privatization is you
take the VA because I was a huge proponent for privatization until I
became an employee, and now I understand why I’m not a proponent for it.
Privatization you take those dollars, it’s a lot of them and you put it into
the private sector and you say take care of the veterans just like you take care
of Medicare, Medicaid, handicapped children. Here’s and I suspect I fully
believe and I support the fact that probably the next five years a third of
our hospitals will be closed, because we don’t need a hospital in every market
where we have a hospital. Now we need a clinic and we need a service that’s
providing our foundational services. That doesn’t mean
we need to have a duplicative Hospital because when you have duplication you
don’t necessarily have good quality or good service. So I’m not I’m not a
proponent that we continue to push as is and I think the strong will survive. We
will be one of the ones that survived and about a third of the country I
suspect will not. That’s different than privatization. Here’s my concern with
privatization, how many of you know what a safety net Hospital is? How many you’ve
heard the term safety net? Okay, safety net hospitals they take a bundle of
money and they give it to a large inner city hospital and say look we’re going
to give you a special reimbursement for the indigent. Now take care of the
indigent you’re gonna get a little bit more money than these other hospitals.
And the organization’s, many of the organizations take that money and they
do nothing with it. What it is they fill up their ER with indigent population and
as a result that becomes the primary care clinic, so you’re doing primary care
the same place you have the inner city knife and gun club, and your wait times
to see a provider, and they’re not primary care providers, they’re very
expensive ED providers, could be six seven eight
hours. Sound familiar? That’s a safety net Hospital. Had they
taken those dollars and put clinics out where the population is,
they could have managed the health of the population, they would have never
needed to access the ED and those dollars could have gone a lot further
and done a much better job. Imagine that with the veterans. Now a lot
of my veterans are amputees with PTSD and multi-system problems. You take a 32
year old OEF OIF vet that’s had four tours in Afghanistan, is missing a limb
is missing an eye, and has PTSD. You want to put them in an inner-city hospital
and wait for four hours? I don’t think so, and the staff that are gonna take care
of that have no idea what this person has been through, my staff do. So there is
a place for the VA, I’m just not going to be so foolish as to say it’s exactly the
same. It’s not, it’s a different population. But let’s also not be so
foolish as to say just take those dollars, because dollars are dollars and
veterans or veterans, that is absolutely not true and I didn’t understand that.
Great question. I saw a hand. Yes you again! You did raise a hand. I do recall.
Keep thinking do I see other hands back there. Yes ma’am. Well thank you. Her question was how
we brought back the residency program for PAs, but she’s given me credit for
something I didn’t do. Here’s what we did do. Thank you, here’s what we did do. We
committed to a partnership, a stronger partnership with the University, with Dr.
Bin and said what can we do better? Her vision was, let’s have a group of leaders
from both organizations let’s get together and let’s have a workshop, let’s
sit down and talk about what we could do better. It was an incredible experience. I
thought it was going to be a slide show we would all go back and think about it,
we’d have another meeting in 90 days, like you know meetings between two
governmental or government-funded entities often are. Instead there was
synergy right there on the spot and I think there were what 12 different
modalities that came over and probably 15 to 20 of my staff and we were too
they’re in this hour and a half long meeting some folks were sitting there
still for three hours and different things bubbled out of that. One of the
things that bubbled out of that was the people from the PA school and some
really impassioned PAs and my program said you know what we need to do more
here. With our expansion of primary care and comprehensive primary care being one
of our foundational services, our leadership historically has been primary
care means physician driven. And the private sector primary care does not
just me and physician driven. So we’re pushing the envelope to do more than
just physician and some of my staff heard that. They started putting their
heads together. It wasn’t six months and there was a
proposal on my desk for us to host a PA residency program. And initially it’s
starting with the ED, but we have folks lined up already that the next residency
are the next residents they’re looking at primary care and they’re looking at
behavioral health. So we anticipate in the next three years our PA residency
program, which didn’t exist a year ago, is not just going to be in the ED. it’s
also going to be in primary care and it’s going to be in behavioral health.
Incidentally touching our three foundational services. So it’s because of
us just throwing out there, this is our vision, other people talking about their
vision and then colleagues and partners networking is sitting down and saying
you know we have a passion what can we do together. It doesn’t have to be slow,
it was very quick. Thank you for that. Other questions. Yes ma’am At that meeting? Excellent excellent! Thank you for that and audiology is
aim is a specialty under physical medicine and Rehab, and physical medicine
and Rehab is one of our three foundational services. But it wasn’t
until we started articulating our foundational services and drawing kind
of a laser focus on that and it wasn’t until we said, being partners with our
community. When you start talking like that it’s amazing the synergy that can
be created. So thank you for that. Other questions. Okay, thank you very much. I’m very
flattered for this I appreciate it!

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