Gary R. Ulicny, Ph.D. Interview Transcript

The following is a transcript of my interview with Gary R. Ulicny, PhD. To find links to the audio files and more information about the interview, please click here.

These transcripts are made possible by a gift from the NNEAHE.




Mark:
Welcome to the Forge, Gary.

Gary:
Oh, thanks for having me. I'm looking forward to talking to you today.

Mark:
You went to the University of North Carolina, and you received a Bachelor's in Special Education. What drew you to UNC and specifically why the interest in special education?

Gary:
Well, I'll start with the special education part. When I was in high school, it's a unique story, how I got involved. Most people have defining moments in their life where they look at how it shapes their future. I was in high school, and I'd be walking through the school, either at my locker, doing something, and one of the young men from the special education class would come up and poke me in the back and say, "Bleep bleep," and run off. That's a true story. A lot of people would be turned off by that, but I was extremely curious.


I went to the special education teacher and I said, "Is there something I need to know? Is there something I need to be doing in this situation?" I think she saw some of my interest, and so for my last two years in high school, I became the student resource or student assistant in her class for the special education class. That's what got me interested in special education.

Mark:
Wow, that's neat. A lot of young high school age men would not have had that response.

Gary:
Yeah, and so the way I got to UNC was I went on a football scholarship.

Mark:
Oh, okay.

Gary:
The reason I chose UNC is at that time, it was interesting, this would've been in the late '60s, early '70s, there weren't near as many restrictions on the number of recruiting visits you could make. Now I think you can visit five schools. I think I missed 62 days of high school, visiting different colleges because I had never really been out of my hometown. I knew I wanted to go to a school that was academically a high integrity school, because I, at 205 pounds, I didn't have a whole lot of future in football.


I had taken some trips and in February, the week before I went to UNC, I went to Northwestern in Chicago, outside of Chicago in Evanston, and so I got off the plane and it was 13 below zero. The snow was blowing sideways, and I said, "Boy, this is a great school, but I don't think I want to put up with it." The next weekend I flew to Chapel Hill and got off the plane. It was 70 degrees and it was just beautiful, and in February, the flowers were coming out, and I just made a connection with that school and ended up down there.

Mark:
Wow, so tell us a little bit about your early career. Your first jobs out of college included being an education specialist during the school year and working with people with developmental disabilities in the summer. Was this what your degree prepared you to do, and what was that work like?

Gary:
Yeah, and that shapes the rest of my career, too, is that I had always been very, very interested in work. I knew I didn't want to work in public schools, and at that time, the kids with the most severe disabilities were in state institutions. What I really prepared to do was, at that time they, to work with those people who were severely and profoundly intellectually disabled, and the place to do that was in the state institutions.


My first job was really as a teacher in the local state institution, working with the kids with these pretty severe disabilities. It wasn't really teaching ABCs or science or math, it was really focusing on some of the basic skills, like toileting, eating, dressing, activities of daily living and those things. I knew I really wanted to do that, so that's where I ended up.

Mark:
You did that for a few years, and then you went to Appalachian State University, where you earned your Master's.

Gary:
Well, there was a lull in between, and I think it's important to talk about that because it also shaped my leadership skills and where I ended up, is at the end of a couple years working in the institution, I realized that I wasn't going to change much about that. It became a very frustrating experience for me because I had always wanted to do this so that I could improve the quality of life for these folks, and it was clear, given the bureaucracy of that, which is probably why we don't have many state institutions anymore, it was almost impossible to make those changes. I dropped out of that and stopped doing it, and basically, for about a year and a half, traveled around the United States.

Mark:
Really?

Gary:
Just taking odd jobs. Went to, moved to Jackson Hole, Wyoming, and went through California, New Mexico, different places, so about a year and a half I spent on the road. A couple friends joined me for a certain period of time, and you had a opportunity to really reflect on what I wanted to do. I moved back to Chapel Hill, and pretty much knew I didn't want to live there anymore. I had been there, and I took a map of North Carolina, and I looked at the farthest place west, which is Murphy, North Carolina, and the farthest place east, which is a little island called Okracoke, North Carolina, and I flipped a coin and ended up at Okracoke.


Went out there and my dad had had a home improvement business, so I was always able to pick up a job. Always had carpentry tools in my truck, and so I went down there and stayed at the campground and started doing some carpentry work and just fell in love with the place and stayed there. Lot of life decisions are made in either drunk or under stress, which I've found to be historically true, and so several of us were sitting around one night. We were lamenting that, on this beautiful island that had these great waters and very good fishing grounds off there, that the locals had really lost commercial fishing as a way of life. They all were working on the ferries and the dredges that were there, so three of us decided to open a fishing business.


For the next four years, I was a commercial fisherman and did that. How I ended up at Appalachian State was under, like I said, you make most decisions either drunk or under stress, so I got into it over a few beers, and got out of it, we were, part of our fishing was we had to cut these gum trees out of the swamps up in Currituck, North Carolina, and actually, you would actually sink those into the sound and use those to tie your nets off.


One day in August, it's hot, and I'm coming out of the swamp of Currituck, hauling a gum tree, and I got bit by a water moccasin. It was right by a tree. He bit me right on the side, on the side of my belly there, and so I had to go to the hospital, get the antivenom, and had a chance to reflect on whether that's what I wanted to do when I was 50 years old. That's when I decided to go back to Appalachian State.

Mark:
Wow. That's quite a journey, and a coin flip included in there. I love that.

Gary:
Yeah, well, when you think about it, if you look back at your life and you say, "God, if I just would've done," the decision I made to go, where to go college. I had 20 different offers of where to go. That really shaped the rest of my life. It's funny to, if you look back and say, "Well, what if I had decided to go to Ohio State or Bowling Green or one of these other universities, what would I be doing today?" Those are often decisions that do shape your life.

Mark:
Wow, so you had spent a couple years, it sounds like several years, really working with your hands, being out, working a very traditional, hands on job. How did you, and you said, "Maybe I don't want to be doing this forever." The body gets tired, get tired of getting bit by moccasins pretty quickly, I imagine. You did go back to Appalachian State, and you decided to return to special education at that point.

Gary:
Right. What I was really interested was rekindling that, maybe in a different way, and I chose Appalachian State because they had a program that was directly geared towards people with severe and profound disabilities. They also had a relationship with Western Carolina Center, which was the, at that time, one of the most progressive state institutions in the country, and they had a couple there, Jim and Judy Favell, who were really doing some cutting edge research as it related to how you would interact with that population. That's what drew me to Appalachian State, that along with the fact that certainly it was in state tuition, which was helpful for a guy that didn't have a whole lot of money from the commercial fishing business.

Mark:
Right. Did you get a chance to work with those folks that were-

Gary:
Yes. The way I did it, my first year I spent on campus, and I took courses at the university there. Then the second year, I spent my whole year down in Morgantown, North Carolina, at the state institution, doing research and working with the Favells, which eventually led me, then, to University of Kansas.

Mark:
Okay, and you did that. Did you go to University of Kansas immediately after you finished your Master's? It looked like that from your CV.

Gary:
Yes, I did. I did.

Mark:
Okay.

Gary:
Well, what happened was that, about that time, I'm getting around 32, 33 years old. That's a heck of a time to begin your PhD program, so there were two things. One is the Western Carolina Center had a relationship with the University of Kansas, which has the largest behavioral psychology program in the country. There was a gentleman out there named Todd Risley who was, and the way that Kansas program worked, at this point in my life I didn't want to spend eight years getting my PhD, so I wanted to pick some place that was going to give me the degree to put me in position to get jobs that I wanted, but at the same time to not pigeon hole me into, a lot of classes that we did were unnecessary and really wouldn't contribute to my future.


The great thing about the Kansas program is you had three required courses, and then what you did is you sat down with your advisor and you build a curriculum. You had the whole university at your, in front of you, and you could choose different areas. What I chose was I did quite a few courses in human development or behavioral psychology. I picked some courses from regular psychology, and then I also did some from the business school. My emphasis really out there became more organizational behavior management.


That ties back to, almost every job I've had, I ended up being in charge of something, but for my first job actually out of college, I walk into this state institution in North Carolina, and I'm the new teacher, and I have six people reporting to me, all in their 40s and 50s who've been there for years, saying, "Oh god, here comes one of those, another young whippersnappers," you know? "We'll just wait him out." It always seemed like I was in a position where I had to take at least some kind of leadership role. That interested me as I went along in my career.

Mark:
This sounds like, I saw your focus was in organizational behavior. That is something of a shift away from the special education orientation you had before.

Gary:
Yes and no, because you think about it is, a lot of what we do with kids who have special needs is, a lot of it is applied behavior analysis or behavior management techniques. What fascinated me and where I really began to look at that in a broader way was my advisor, this guy Todd Risley, was really interested. Everybody knew you could take and if you sat in a room with a young kid with intellectual needs, if you could control the reinforcers enough, you could get them to do pretty much what you wanted them to do, but could you do that with a larger group of people?


What we began to do when I went to Kansas was look at environmental effects on behavior, management system effects. For example, one of the things we did was we had an infant and toddler daycare center where we actually trained people with intellectual disabilities to be the caregivers.

Mark:
Oh, wow.

Gary:
The way we did that is using some organizational behavior management tools such as effective feedback, we had checklists, quality checklists, we did regular quality checks. As that began to sprout and grow, we began to look at, could we do that with general populations, and then what would that look like if you really tried to adapt it to society in general?


We evaluated things like, if you add the amount of the fine to a handicapped parking space, will it deter parking? Instead of having just the traditional wheelchair thing up on the wall, if you say on there, "No parking, $500 fine," will that influence people's behavior? We found that it did. We began to really, really look at behavior as something. When you get down to it, leadership is just getting people to do what you want with a smile on your face. Those principles, really, I think, carried over.

Mark:
You mentioned that you went there, you went to Kansas with the idea that this would be a program that would help you to get the kind of jobs you would be looking for in the future. Were you looking at a research career at that point? Were you thinking I want to do research, or were you thinking I want to go back to the field and be some sort of practitioner?

Gary:
Well, I really wasn't sure. At that point, I knew that I had a big interest in people with disability, and it began to become much more general when I moved out to Kansas. I became involved with the Center on Independent Living, which really began to look at people with physical disabilities and other sensory disabilities.


I knew I wanted to do something there. I did some research, but at the same time, we ran a couple businesses, successful businesses while we were out there. It made some of my professors angry because I was making more money than they were.

Mark:
Wow.

Gary:
This guy Todd Risley had created this Center for Applied Behavior Analysis, and what he called the living environments group, and so we actually, as part of my work, ran several of the businesses, including the daycare centers and a few other things that we were involved in. I really began to grow in that sense, and so I moved away from more of the practitioner stuff, more into the research, organizational behavior management track.

Mark:
Okay, so when you finished your program, this would've been in about '88?

Gary:
No, it was '86. Wasn't it '86 or '87, somewhere around there?

Mark:
Okay. You went on, you stayed in Kansas, and you did a couple of jobs there. You were a research associate with the Bureau of Child Research as well as you were working with the Unified School District. Can you tell us a little bit about the work you were doing with those organizations?

Gary:
Well, back in those days, one of the newest concepts was this idea of supported employment. I had a contract with the schools, and what supported employment was recognizing that there are some people with severe intellectual disabilities that are going to need ongoing support to be able to say in certain competitive environments.


We created a program there that basically created a job coaching type situation, and we were able to successfully employ quite a few folks that, not just with intellectual disabilities, but with physical disabilities and other sensory disabilities in different locations throughout the city as they were beginning to come up through high school, mostly in their junior and senior year.

Mark:
Wow. Now, I was going to ask you about where you started learning your leadership skills, but it sounds like you've really, right out of college, you were working in various leadership roles.

Gary:
Right. When I look back at that, those years that I took off where I was working in construction or fishing or just traveling around the country, I think those all helped shape my leadership perspective because I think sometimes we think that when we take our first leadership job, that everybody's ready and they want to be lead-ed and they're motivated to be lead, and all you got to do is say, "Let's go, guys."


What I learned was, I think, a very valuable lesson, that people in different, nobody's the same in terms of what motivates them to do their job and do it well. What I learned was that there's a big difference between someone who has a job and somebody who has a career. As a healthcare administrator, I think you really need to understand that.


I can go to one of our physical therapists and say, "Look. We've got this extra project for you. We think it's going to be great. It's going to help you grow," and they can't wait to do it, but if I go to the guy who cleans the floor and say, "Hey, I've got this extra project. We got some more floor over here that we want you to clean," he's going to look at me like I'm crazy.


It really taught me about, when you have a job, you're trying to put food on the table for your family, survive, do those things, and the things that are most meaningful are very different than when you have a career. I think that helps shape that and put that in perspective for me.

Mark:
You recognize that when you are dealing with individuals.

Gary:
Yeah, and also realize that a lot of the hard work's done, not in the administrative suite. It's done out there on the floors and the nurses and stuff like that, so it really gave me that bottom up perspective of how things work. It made me realize that, for a long time, or for a whole winter, I worked on a scallop boat off the coast of Florida.


You look at that and you see the leadership management, and you've got a captain there, and you got the crew. Then the crew begins to develop different personalities, so when the captain's not there, this person automatically becomes the leader just because of their interactions with the rest of the crew. I think it was very helpful, from that perspective, to understand the human behavior part of that and how people interact at a variety of different jobs.

Mark:
You left Kansas to go back to Georgia, where you were the Program Director for Learning Services at the Peachtree Regional campus from 1988 to 1990. What is Learning Services as an organization? What do they do?

Gary:
Well, Learning Services was a for profit company out of Massachusetts. It was founded by a guy named Dan Donovan, and Dan, it was an interesting story how he started, too. His mother had a personal care home, and so Dan grew up in this personal care home where there were always six or eight guys around who were renting rooms and were the clients there at the personal care home, and at that time, many of them had had traumatic brain injuries. There was no programs for those folks, they were either in nursing homes or they ended up in personal care homes or in jail. At that time, a lot of the behavioral issues that go with a traumatic brain injury were considered to be criminal kinds of things.


The company, Dan started the company to provide residential, home based kind of opportunities for people with brain injury. About the same time, maybe a year before I left Kansas, I started getting involved and this was, again, a part of the eclectic experience. I started doing an internship at the neurology department over at the KU Medical Center in Kansas City. I started being exposed to a lot of people with cognitive disorders associated with different kinds of brain injuries, whether they were acquired or traumatic.


I was approached by Learning Services to be the Program Director of a free standing program, and what intrigued me were a number of things. One is, they were really interested in translating applied behavior analysis to that population, which really piqued my interest. Two, it was a chance to move back to the part of the country where my wife and I were from, and closer to our family. Three, they were paying me a pretty good salary to do that, so all those things came together, and then I took that position.

Mark:
That's neat. You've used the phrase "applied behavior analysis" a couple of times. Could you explain what that means?

Gary:
Well, applied behavior analysis is really the science of human behavior. It really looks at analyzing how you shape people's behavior through a variety of techniques. People always think of B. F. Skinner and operant conditioning, but there are lots of other strategies for using cues and reinforcers to, again, shape people's behavior, whether it's on an individualized basis or whether it's on a group. It really is a whole subset of psychology that's called applied behavior analysis.

Mark:
Okay, so you had already started making a transition toward working with people with brain injuries. You said you were doing an internship back in Kansas when they found you.

Gary:
Right.

Mark:
How is working with people with acquired, what's the right phrase?

Gary:
Acquired brain injuries is good, yeah, because some of these folks would have been strokes.

Mark:
Okay, so how is it different to work with people with acquired brain injury versus people with congenital disability?

Gary:
Well, here's the fascinating part. The difference really played into what I talked about earlier in terms of my advisor and his approach to using environmental cues and things in the environment to help shape behavior. If you think about it, if you take someone with an intellectual disability, they have a memory. If you use a lot of repetitive strategies, use the right reinforcers, you can usually get that person to perform the behavior you want them to perform.


In applied behavior analysis, that's called the ABC Contingent, the triad. You have the antecedent, which is your cue, so if you want somebody to touch their nose or imitate, you touch their nose, they do that. That was the behavior, and then the consequence after it reinforces or shapes the behavior. If you take that, those three, that ABC triad and you wipe out somebody who has no short term memory, then reinforcers become almost useless.


What you had to do was really look at creating environments, and we still do this today with people with brain injury, that create enough structure that it cues them to behave the way you want. For example, if someone can't remember appointments, we now have phones that can alarm. You can basically shape their environment to overcome some of the cognitive disabilities that they have, and I just found that fascinating because it was exactly what my advisor was really interested in and what we had been trained to do.


I really wanted to explore that part of applied behavior analysis as it relates to someone who doesn't have a whole lot of short term memory or maybe what we call executive function, or somebody who is impulsive. You take somebody who is impulsive and they behave without even really thinking about that, how do you control that kind of a behavior or how do you influence it and how do you shape it? I found that part fascinating.

Mark:
That does sound fascinating. In the role, in your role as Director, and so you stayed at Learning Services for about four years. You moved from being a Program Director to Regional Vice President, and then to Executive Director. In that time, I'm assuming somewhere in that time you were, you began to supervise clinicians perhaps.

Gary:
I was, basically from day one, in charge of the entire program. I never really got into the day to day clinical kinds of aspects other than doing some research that I was involved in. It was really a leadership position, and it was a, I think I had about 70 employees at my first job at Learning Services, and then it just expanded from there as I began to grow.


It was really a leadership position, but it gave me an opportunity because I was in charge of marketing, I was in charge of the financial aspects of the program, so it broadened my, I guess my management skills, and my management flow, everything I had to look at. That shaped where I went from there, because it really was, I was the CEO of that program.

Mark:
The question I wanted to ask you was, as a more administrative oriented person, how do you establish credibility with more clinically oriented colleagues?

Gary:
Yeah, well the fact that I was a psychologist-

Mark:
That's true. Okay, so yeah.

Gary:
Got my foot in the door. I got my foot in the door, that, okay, this guy's not an MBA. He's not a MHA. He's, even though I had very little background in terms of actually clinically working with people with brain injury, I understood what clinicians did, and so I had a little bit of credibility there. The other thing is, I learned a long time ago that, that's not my job to tell them how to be a good clinician.


My job is to make their job easier so that we can provide the most effective treatment we can to these individuals, so I learned many years ago, never meddle in the clinical aspect of what happens. Hire good people, turn them loose and let them do what they do, and make sure that their values and their goals are aligned with what mine were.

Mark:
You left Learning Services to become the Administrative Director for Rehabilitation Services in the Wake Hospital System in 1992. Why did you leave Learning Services and what was the opportunity at Wake Hospital that you went looking for?

Gary:
Well, Learning Services was beginning to grow, and I think they were going in a direction that didn't appeal to me. It always started based on Dan Donovan's family experience, and I really linked on to that. Dan, he was an attorney who really decided that, I don't want to do this. I want to do something to improve the quality of life for people with brain injuries, and so he started this company with that in mind.


They, at the end of my time there, they became somewhat corporate and I think they thought they were much more important than they really were in the grand scheme of things. I didn't really connect with that, and so I had an opportunity to take over at what was a fairly new program over at Wake Medical Center, where I would be in charge of all their rehabilitation services within the whole hospital system.

Mark:
What were rehabilitation services? What was included in that? What kind of patients did you take care of?

Gary:
These were more acute, and it was an opportunity for me to move up the continuum. Learning Services was really a post acute, post post acute program. If you think about where we were, we would get people with Learning Services who had already been through the hospital. Many of them had been in other programs, and then they came to Learning Services, whereas this was an opportunity to really look at what happened to these individuals from the point of injury, because we're a level I trauma center.


It was an opportunity not only to shape the rehab part of the continuum but I did a lot of work in terms of making sure that there was a physiatry consult as soon as that individual was out of the trauma center and stabilized. For me, it was a great opportunity to look at it, at expanding the continuum of care and my understanding personally of what happens at the more acute level.

Mark:
How did the rehabilitation, how does rehabilitation services, in particular in a hospital like Wake Hospital, fit into the, as you were saying, the continuum of care? When does someone come to the rehabilitation services side?

Gary:
Yeah. The continuum of care there typically would be, someone would be in a car wreck, they'd triage through the emergency room. They would go into the trauma center, be stabilized. Either go, maybe to a step down ICU or directly, depending upon how stable they were, out to an acute rehabilitation program, which is an inpatient, we had 68 beds at that time at Wake Medical Center that were designated just to rehabilitation. Then they might move to more of a day program setting, outpatient and even home health kinds of services.

Mark:
Okay. What were your responsibilities at Wake? What did it mean to be the administrative director? How many people were reporting to you?

Gary:
Oh, yeah. I probably had around 350 to 400 people reporting to me because I was in charge of not only the inpatient rehabilitation hospital, the outpatient services, but also had the acute therapists who would go, work, maybe there's a patient who gets a joint replacement who needs a couple hours of physical therapy. All those folks reported to me as well.

Mark:
Okay.

Gary:
Also our wellness center, which was a fairly large program as well.

Mark:
You left Wake in 1994 and came to the Shepherd Center to be the President and CEO, and you've been there since. How did the opportunity to come to Shepherd Center come about?

Gary:
Well, I got called by a search firm. I had been in the Atlanta area before with Learning Services, so I knew some of the players there. Got called by a search firm, and they said, "Well, we have this great opportunity at Shepherd Center. We'd like you to come down and be interviewed." I said no first. I really had no interest in leaving. My wife's family was close by. We were very happy. I had gone to UNC, so I was close to the University, so I said no.


They called back about three weeks later and said, "Just come down and take a look." I said, "Well, okay. We'll take a trip to Atlanta." I came down to Atlanta and went through the Center and talked to some people, and it just was a perfect fit for me. I had no real desire to move to Atlanta or do this, but when I saw the Shepherd center, and it goes back to what I talked to you about, making that personal connection.


Just like Learning Services was founded by a guy who had a personal experience with traumatic brain injury, the Shepherd Center was founded by the Shepherd family. James Shepherd, who is the Chairman of our Board today, was injured in a body surfing accident. Came back to the United States, had a, was a C-6 quadriplegic, went out to Craig Hospital in Denver which at that time was the only hospital in the country that really specialized in spinal cord injury. Spent some time out there, came back, and when he left there, he was walking with a brace, a crutch.


Family came back, and many families, when they have a catastrophic event, say, "Oh, we should do something." They kept talking with friends. "Well, there ought to be something in Atlanta," so they opened this as four beds in a local hospital, and now it's grown to the largest hospital of its kind in the United States, 152 beds.

Mark:
Wow. What would you say were the skills and experiences that made you the right candidate to take on the CEO job at the time that you were hired?

Gary:
Well, I think of my person, one, of my personality, and one, I don't have a real big ego. The great thing about this hospital is the story's not about the CEO. It's about the Shepherd family's experience, and that really plays into our fundraising efforts. It didn't bother me that it wouldn't be my picture on the front page of the newspaper or the magazine or winning awards. It would be James Shepherd or his mother Alana, who is very active in the Atlanta community, but what really intrigued me was two things.


One, the opportunity to have almost a little laboratory. At that time, we were a 100 bed hospital. I think we had 700 employees. It was a great opportunity to take some of the things that I'd done in the past and overlay those on this great little place that I had total control of. In the large hospital system, I would write these proposals and things would go up to the CEO and two months later they'd say no. I finally told the CEO at Wake Medical Center, I said, "Look, if you're going to say no, tell me day two and then I can start working on the next proposal."


Shepherd was this great opportunity to really make a difference, I thought. I loved the family influence, the fact that here was these family values that had really embedded, were embedded into the culture of the place, and so that was very intriguing. The second thing was, I asked, I was the only candidate that asked for, I randomly picked 10 employees and give me two hours in a room with them. In that two hours, I learned more. Everybody was telling me what a great place it was, and this, you're going to love it here, but that two hours with those 10 front line employees there gave me a really insight into what the center needed. It seemed that my skills were, they wanted somebody who was approachable and somebody who was out there.


One of the things I learned a long time ago is, this is a great story, that at Wake Medical Center, all the VPs and the Administrative Directors would, every third Friday, I think at two o'clock or so we would tour the hospital. We'd all tour and go to all the units in our little suits and ties. We were all guys, so I think I can say this, they called us, they nicknamed us the Penis Patrol. We would, that's what all the staff called us.

Mark:
Right, sure.

Gary:
Then we'd come back to the boardroom, and the CEO would say, "God, everything looks great." All of us are going, "It's the third Friday of the month at two o'clock. Of course everything looks great." I learned then that the more you're out there, the closer, or the more you can desensitize the people to your presence. If you can desensitize people to your presence, they'll tell you what they really think and you'll be able to glean so much more information then them knowing that, "Okay, two o'clock, they're going to show up. Let's everybody tidy everything up, and if they ask us how things are going, we're going to say, oh, they're going great."


That, which started me on understanding the importance of rounding, not necessarily rounding for just to go out there and ask people how things are going, but really spending quality time with people out in the organization, and what that allows me, and it's a very selfish reason, is to keep, I think, a stronger finger on the pulse of the organization so that I know, I can sense when we don't have enough staff or when there's something going on in the organization. It allows me, I think, to get a lot more honest and better feedback from those people out there on the floor.

Mark:
Are you still able to do that as CEO?

Gary:
Always. Yeah, always. That's one of the things that we've learned as an organization. We're moving far, a little bit far ahead, and I'll talk a little bit later about, as we state here at Shepherd, how we really change the culture and really try to make some of those things that we talk about, like rounding for outcomes and some of the other areas, really embedded into what we do here.

Mark:
That's become a popular tool today with, I've heard it called gemba walks. Is it along those lines? Are you familiar with that phrase or things?

Gary:
Well, yeah. Have you read any of Quint Studer's stuff?

Mark:
Familiar with the name, but have not read his work.

Gary:
Yeah, you need to do that, because basically, well, what happened to us as a management team, I came and, again, I really felt like it was a great fit, that I have a weird sense of humor, this place has a weird sense of humor. I think I'm not your traditional kind of, go to the Rotary Club, hospital administrator kind of CEO.


I have a rule that I don't go to any meetings where more than 50% of the people don't know who Jerry Garcia is. That rules out a lot of the local Rotary Clubs and Lions Clubs and things here that I don't have to go to. Our management team, as we evolved and began to look at this, we read that book Good to Great. I'm sure you've read that.

Mark:
Yeah. I have.

Gary:
Yeah, and it was a defining moment. Two things happened to us. One, we read that book and we all realized that leadership and management really isn't necessarily inspiration. A lot of leaders think, "Okay, I'll do this quarterly talk and I'll tell them how great we are and tell them we need to get out there and work harder and, like General Patton, run into the bullets and if you die then it's for a good cause." We realized that that wasn't necessarily the most, it works for a short period of time, but it's not the thing that's going to hard wire excellence into your organization.


At about the same time, we stumbled upon this book by a guy named Quint Studer, and it's called Hardwiring Excellence, and what Quint did, he's a very interesting guy out of Pensacola, Florida. What Quint did was he looked at the literature that was out there, and most of it came from organizational behavior management kind of literature, and he didn't invent it, but he packaged it in a way that made it very, very easy to communicate to a wide variety of people.


One of the biggest problems with healthcare institutions is you have what our staff call the flavor of the month. That, okay, we got a new customer service program. It's called Whatsit or Zam or Wow, and people, they change so much that it becomes almost like a joke. It's like the boy who cried wolf. We wanted something that could, that we felt could last, so what Quint did was he understood that you're only as good as, customer satisfaction is directly related to employee satisfaction, that if you don't have satisfied employees out there who have bought in to the culture that you're doing, that you're trying to create, then you're not going to be successful because nobody ever says what a great CEO you have on a customer satisfaction survey. It's about those people that touch them.


We took Quint's book, and he has a big consulting company and he's a good friend of mine now, and he's mad at us because we never gave him any money to do consulting. We just bought his books. We took some of those premises and some of the things that we knew and we just said, "Okay. These are the things that work. We're going to do them. We're going to be disciplined enough to do them, and we're going to do more of them." Rounding was a big part of that, what Quint says is rounding for outcomes, where the first question you ask is what's working well? Then, what can I do, what do we need to do to improve? Is there anything you need?


What you get is you get this great flow of information that then cycles back into an opportunity for you to then reinforce certain behaviors. We work very, very hard at trying to create a culture that really focuses on, how do we catch people doing the right thing instead of punishing them for doing the wrong thing?

Mark:
Okay. Can you give an example of where that's worked for you?

Gary:
Well, when we started our first employee satisfaction survey in 1995, a year after I came, we were at 62%. Last year, we're at 96%.

Mark:
Wow.

Gary:
That translates into our outcomes in terms of our overall customer satisfaction, which is in the 95th percentile. We try to make sure that, it's very important, a lot people start different programs but they never measure their effect. The research part of me said, if we're going to do this, we're going to make sure that we do pre and post measures to see where we're at after we put all this effort into trying to make this happen.


We've created what we call our Culture of Excellence. Every manager goes through Hardwiring Excellence, our own internal training program. We've adapted a little bit and changed it from some of what Quint does, but we, the essence of it is, healthcare is generally, the management style in healthcare is generally negative, especially in nursing. A nurse makes an error and somebody writes them up.


I saw a nurse one day and she was crying. I said, "What happened?" She said, "Well, I gave the medication at the wrong time," and I said, "Well, what happened?" She said, "Well, they wrote me up. You know, your disciplinary action." I said, "Okay. How many times in your career have you given the medication correctly?" She said, "Thousands." I said, "Anybody ever come up and said thank you for giving the thousand doses?" The answer was no. We wanted to tilt that table in the favor of, let's focus on, because what I had learned from my applied behavior analysis background is positive reinforcement is infinitely more powerful than punishment.

Mark:
Let me pause your thought process here for a second. Let's talk a little bit about the Shepherd Center mission and give us a sense of, what is the Shepherd Center? How big is it? What kind of care do you deliver there?

Gary:
Okay. It's a very unique hospital. It's a 152 bed hospital that treats primarily people with spinal cord injuries, brain injury, acquired brain injuries, multiple sclerosis, and other neuromuscular disorders like Guillain-Barre, but mostly it revolves around, at least on the spinal cord injury side, some kind of paralysis. It's a unique hospital in that it's basically a specialty hospital designed to be a one stop shop.


A lot of hospitals, the way they grew was, okay, we're going to add obstetrics or we're going to add open heart surgery. Our strategy was we were going to really develop in a more vertical way by saying, "Okay, what does this small niche of patients need to get from the point of injury to a return to their community?" Our continuum of care includes a 10 bed ICU, which is very unusual because we're licensed as an LTAC, and the only reason is that that's the only category we even fit in.


We would have 10 bed ICU. We have a medical surgical floor for complications. Then we have inpatient rehabilitation. We have a day program. We have an off site post acute brain injury program, similar to a Learning Services type program, and then we have return to home services. Then we have follow up services on top of that. It's really a one stop shop. Within that we have our own urology department, we have our neurosurgeons, we are connected to Piedmont Hospital which is right next door in metro Atlanta. We basically do our surgeries, our physicians, we contract with them for surgery time. Our folks do the surgeries over there.


It's really a unique place. The mission really is to get people home as independently as possible who've been catastrophically injured. These are people who are in life and death situations that we are, our mission is to get them back and get them engaged in their community, whether that's through employment or recreation or a variety of other things.

Mark:
How do people, how do patients come to Shepherd? I'm assuming you don't come directly from injury to Shepherd typically.

Gary:
Well, you can. You can be triaged, there's several small rural hospitals that will send the person up the next day from injury. As long as they're stabilized and can be transported, we can take them fairly quickly.

Mark:
Okay. That's the ICU, isn't it?

Gary:
You would typically be triaged in the emergency room. A lot of times now, because of the economics of healthcare, the trauma center would, they would do the surgery there, and then they would stabilize that patient and then send them to us. Most of our referrals are from either physicians or other hospitals. We've been around 42 years, so we've developed a bit of a reputation for treating the most complex cases in this space.

Mark:
Along that line, how far away do patients come for your services?

Gary:
Last year we had people from 42 states and I think 12 foreign countries.

Mark:
Wow.

Gary:
We are a national and somewhat of an international provider.

Mark:
You mentioned you have several locations.

Gary:
Well, we just have a couple, really. They're both here. One would be our main campus. Then we have a post acute brain injury program that's two or three miles from here. That includes a residential component, and it's more, really, trying to get people with brain injury away from the hospital setting and get them more in the community to do the actual rehabilitation.


Then, across the street, we have a program, what we call the SHARE Military Initiative. It's a program where we serve our wounded warriors who come back from both Afghanistan and Iraq or other kinds of battles with traumatic brain injuries, post traumatic stress disorder, and we've been doing that for about seven years now.

Mark:
How many physicians do you have on staff and what's the relationship between the Center and they physicians? Are they typically, are they part of an employed physician group, or how does that work?

Gary:
We have a variety of different arrangements. We have, I think we have 18 employed physicians who are attending physicians, and they would be the ones who basically are our employees who would do most of the rehabilitation, and they typically divide it up as, a big portion of those are physical medicine rehabilitation docs, physiatrists, who each have teams. Then we have three neurologists who run our MS program, which is the largest MS center in the southeastern United States. Then we have two pulmonology intensivists who supervise our ICU.


Then we have a variety, probably over 100, 150 consulting physicians, which is why it's so good to be connected to a tertiary care hospital, so they simply have to come through the tunnel then and they're able to treat our folks, because our folks may have GI issues. They may have orthopedic issues. Some may have cancer. It's just a variety of things that we need to be able to treat.

Mark:
You have a research background personally, and I saw that you also, the Shepherd Center is involved in ongoing research projects. What kind of research goes on at Shepherd?

Gary:
Well, the basic fundamental philosophy of our research department is, it has to be something that will ultimately improve the quality of life for the people that we serve. We don't do a lot of esoteric research to ask questions that really don't matter, but we have a range of research. We probably have, oh, I think now we have almost 90 people in our research department.


For example, we run the range of, we were the first hospital in the United States to put embryonic stem cells in a person with spinal cord injury. We run from that level all the way to things like understanding effects of peer support, which is pairing a person with a disability with someone who's had a disability, to readmission rates to the hospital. It runs the gamut across a variety of clinical trials, a variety of medical devices, those kinds of things, but it's a fairly well developed program, and I think we have extra narrow funding at about $8 million a year.

Mark:
Speaking of dollars, how does financing work on the rehabilitation side? Who are you major payers?

Gary:
Well, for us, it's mostly commercial insurance because our average age is 40. Medicare is not a huge payer. The Medicare business that we do, Medicare and Medicaid are about 25% of our business. The only Medicare patients we would see would be those patients who leave, and someone with a severe disability goes on to Medicaid. If they can't go back to work, they go on to Medicaid for two years and then they transfer over to Medicare. If they have a secondary complication like skin or whatever, our medical surgical floor, bladder augmentations, other things can serve them.


The breakdown's about 25. Then, that makes up about probably 8 or 9% of the patients that we see. It's not a large amount. Then, our biggest issue is Medicaid. That's changed a little bit with the ACA and the health insurance exchanges, but we get a lot of people that have no insurance, so that they come to us with no insurance, and then they become Medicaid eligible by basis of their disability. About 20% of what we do is Workers' Compensation injuries, and the rest would be commercial insurance.

Mark:
Okay. How long is the average stay?

Gary:
Well, the average length of stay for the whole hospital's about 42 days. If you break that down by disability, for someone with a brain injury, it's about 28 to 30 days where they would stay inpatient, and then they might go six to eight weeks to our day program or our post acute program. On the spinal cord injury side, depending upon the level of injury, for someone who's a paraplegic, maybe about the same, 30, and then another six to eight weeks in our day program. Now, someone who's a higher level injury like a cervical injury, they might stay as long as two months, maybe even three months.

Mark:
We talked a little bit about the departmental structure of your organization, but in terms of service lines, what are the, how would you divide up the broad kinds of services that Shepherd provides?

Gary:
Well, when I came, gosh, now 22 years ago, we had 38 department heads and I think we had about 70 patients in that day. It was a typical, traditional way healthcare had grown. Most healthcare organizations grow horizontally. To me, it reminds me of that old telephone game, where you sit in a circle and someone tells something, and then you laugh when it gets to the end and it's totally different? I just felt like information needed to go more vertically than horizontally.


We changed. When I came, we changed to a product line kind of, service line kind of mentality where we had three major service lines. Now one is the brain injury program. One is the spinal cord injury program, and then all of our outpatient services. We really huddled under those three, and I'm a big firm believer in the fewer managers you got, the better off, you can have more people.


We may have, for example, the head of our spinal cord injury program is a physical therapist who's a good leader and a good manager. She also has the nurses report directly through her as well, so everybody in that program reports up to one area so that, I just think it makes communication a lot easier.

Mark:
Talking about reporting, who makes up your executive team by position?

Gary:
Well, we flattened that. We used to have, we do have Vice Presidents and we do have Directors. We have a Senior Management team, really, that's about 12, 13 people right now. We didn't change the titles, but we used to have an Executive team that met once a month or twice a month. Then we had a Senior Management team, which would be the rest of the Directors, and what we found was we were talking about the same thing at both meetings. It became redundant.


We flattened it so that we have a Senior Management team now, and while there are some reporting relationships, information flow really just goes out to that group. Who would, I'm responsible for the entire organization. We have a VP of Clinical Services who handles most of the clinical services, and she's only done that for about 5 years. I used to do both. I used to be the COO and the CEO, but it became, as we grew, it became a little overwhelming.


The primary people that report to me are our marketing department, research, our foundation. We have a very large foundation. We raise quite a bit of money a year, every year, which is due to the generosity of our community. I also have all the facilities report to me, and then the VP of Clinical Services really has most of the clinical areas, and human resources reports up through me as well as our CFO.

Mark:
In the time that you've been there, the organization has grown quite a bit. You were talking about how you've restructured the organization to be flatter and to have fewer managers, so talking about strategy and how that relates to the decisions you made about growth in your time, it looks like you arrived, it was about an 80 bed facility maybe, and now you're up to-

Gary:
Yeah, somewhere in there.

Mark:
Now you're up to about 150 beds. You made a number of decisions to expand and to establish other programs. How do you go about making those decisions? What goes into that decision process?

Gary:
Well, as an administrator, you're faced with, this was back in, gosh, 1994, '95, right, post DRGs. The big buzz word was, we have to cut costs, which it always is in healthcare, and reimbursements were pretty much flat at that point. You can really make a couple of decisions. You can say, "Okay, we're going to just cut costs and, okay, try to survive under these reimbursement payments," or you can grow.


We felt that there was a huge need, for example, when I came, we just did spinal cord injury, but there's this huge population of people with brain injury that need very similar services, so we opened the brain injury unit which has now become as large as our spinal cord injury service. We made the decision as a team that we were going to focus on growth, and that there was a need and we felt like, that if we provided a high quality product at a reasonable cost, people would come. That's been the case so far.

Mark:
How do you go about making a capital expenditure, like deciding we're going to build a new building, or we're going to expand the product line, something along those lines?

Gary:
Well, it all goes back to doing a business plan. You have to do an effective business plan. You have to document, one, that the need is there. Two, that you're going to get paid for it, and three, that you can create a high quality service and make some money by doing that. It's all data driven.


I'm a behavioral psychologist. If I can't see it, feel it or touch it, so we make those decisions, but there are some points where you just have to, there's this instinct, and people call it instinct, but what it is is it's learned experience. You made these decisions in the past and they've shaped your ability to make them today, and so you just make a decision. We based each of these decisions because our last capital project at our 25th anniversary was, I think it was a $90 million project where we substantially increased the size of our footprint.

Mark:
How have these expansions changed the culture? This is a, you've talked quite a bit about culture and how you have tried to nurture it. How did making those decisions to expand so significantly affect the culture, and how did you make sure that the culture was sustained and nurtured in the way that you wanted it to be even as you added on? You must've added on many, many more staff members to do all this.

Gary:
Well, when I came, we had, like I said, around, I think it was 600, or somewhere around there. We now have 1,200, so we've doubled our staff. It makes it so much harder. It makes the Senior Management, it means you really, really have to embrace those must do kinds of things that we felt were really important, like rounding, like recognizing employees. You really had to embed that in the culture.


The ultimate success of any good culture is when you don't need management. When the employees look at each other and say, they self police. "We don't do it that way here. You're not going to stay here if you do do it." What we really focus on is driving that culture down to, we want the guy who cleans the floor to be, to understand what our culture is. It's been really, but that was on our mind. Every time we grew, we just said, "How are we going to maintain," because we walked a line.


When I came, we were $48 million in gross revenue. Now we're $200, this year I think we'll do $210 million. Yet, we have that family experience overlaid on this. We're constantly walking that line of being a $200 million organization that's based on some family values that we really want to protect. That was huge on us, and we really had to program for that and really had to make sure that the culture was something that could be translated to a larger size.

Mark:
You've been at Shepherd, and you've been leading the organization for some 22 years now. How has your strategy process, so the way you look at, look into the future and make projections and make decisions about how the organization's going to go, how has that evolved and how do you go about thinking about that now?

Gary:
Well, I think this is, the biggest thing is understanding that healthcare is probably the least data driven business in the United States. If you look at how healthcare evolves, in many cases, it's fads. Take for example years ago when all the, one hospital system started buying physician practices. Everybody felt like they needed to own the physicians.


Then they realized, if you buy these docs, you got to pay them more. You got to overlay all these really rich hospital benefits to all their employees. I remember going to a seminar on physician reimbursement at the Cleveland Clinic, and their goal was to only lose $8 million over their physician practice.


I think what we've really, what I've learned is you can't jump into the water until you really understand how deep it is. It's like this whole thing now with population health. Everybody's throwing out this thing, population health, we're going to help you do this. I think what people don't understand is that to really do population health, you have to influence individual behavior. For example, you can, okay. I can put all the incentives in the world in place to get a diabetic to take his medication on time, but I can't control the fact that he's washing down that medication with a box full of Twinkies.


How are we, as hospitals, equipped to influence that kind of behavior? I think people jump into this before they really realize the complexity of it. What I've learned over the last twenty-some years is, don't be the first responder, but don't be the last.


We have a joke here that, if we're a train, we want to be somewhere maybe four cars from the caboose. We don't want to be the first guy up there because look how many health systems got into the insurance business and three years later are out of the insurance business, but yet, they put millions and millions of dollars into infrastructure.


For us, and our challenge is quite different. Here we are, a 152 bed, stand alone hospital that serves people from all over the United States in a world that's moving towards regional and local ACOs. How are we going to be able to break into every ACO that sends us referrals?


Essentially, that 22 years has given me the experience to say, be tempered. Look at data. Try to make informed decisions and strategic decisions, and again, instead of putting the infrastructure into something, try to prepare more for, okay, if then kind of relationships. If the world goes like this, then what do we do as an organization to respond? That's been more of our strategy.

Mark:
How has health reform, you mentioned the ACA, how has all that affected your business?

Gary:
It hasn't. To this point it really hasn't affected it that much. We're busier than we've been. In fact, unfortunately, we've got a waiting list right now of patients. We're trying to look at developing some more beds as soon as we free up some space. It really hasn't affected what we do yet. There was this anticipation that you were going to see all these narrow networks, and that people weren't going to be able to leave certain systems, but we haven't really seen a whole lot of that effect yet.

Mark:
Okay. Staying with the strategy, at the strategic level, how do you interact with your Board?

Gary:
Well, our Board has to be our strategic partner. One of the things that you have to make clear, and that I've worked hard over the last 22 years, is the Board understanding what their role is. The last thing you want the board doing is managing your organization because most of them don't really understand healthcare, and so what we've worked really hard at is, what are the things that are really important to the Board?


That is, so our strategy is not, okay, let's bring all the Board in, go make a retreat, and have them come up with a strategic plan. That doesn't make sense because most of these guys are in the insurance business or some other business that, totally unrelated to healthcare. What we do is we pick selected Board members. We develop what our strategic objectives are, and then we vet them to the Board and say, "What do you think? Does this make sense? Here's how we came to this conclusion. From your experience as a business person, or as a civic leader or whatever, does this make sense to you?"


The other thing we've done is we've really embedded them in the quality process of our organization. We have a quality committee that's made up of Board members and a variety of other goals, and they actually do the physical quality round of the organization where they go through the center with a checklist, and they do that quality rounds of the center.


We did that because we wanted them to understand the complexity of a healthcare organization, because you have so many Boards that, okay, if you feed up to them, "Okay, we had a medical error, and here's what happened," they freak out. They say, "Oh my god, how could that happen? How could that possibly happen?" We wanted our Board to understand that there may be 20 steps in the process that could have gone right or gone wrong that can lead to a medical error. We wanted to embed them in the middle of that so there's nothing, and we wanted to do that totally transparently.


We really wanted the Board to be involved in that because our strategy is focused around quality, that we want to be the best in the world at what we do. I guess, if you do that and you do it at a reasonable cost and you can't survive, then it's probably time to go do something else.

Mark:
Speaking of quality, does Shepherd have a principal quality improvement methodology that you've embraced?

Gary:
Yes. We use, but what we've gone to is more of a, we run like a lean organization. We don't really call it Lean Six Sigma, but what we have or, we've hired three, there's a kind of emerging field in healthcare now of these healthcare process improvement folks, and Georgia Tech has a very innovative and unique program here in Georgia. We actually have, in our quality department, three of those young folks who, what they do is they really look at our processes with a fresh pair of eyes, because none of them really have long clinical histories in healthcare, and help us to really understand how we can improve that.


We've tried to really empiricize that to make it really a measurable kind of thing. We use Lean Six Sigma techniques. We use a lot of process improvement. We don't have a flashy name for what we do because it's all the same. Again, if you go back and you look at all of those process improvements about identifying a problem, measuring and looking at the process, identifying a fix, measuring it again, and then measuring it at intervals after to make sure that it stays in place, what you fix. It's not rocket science. A lot of people make, especially consultants, make it out to be rocket science.

Mark:
How does somebody come to be on the Board?

Gary:
Well, we have a nominating committee, and the nominating committee basically takes nominations and actually actively goes out and seeks people. Then that comes back to the Board. We've really tried to shape our Board in a different way. Initially, a lot of our Board were friends of the Shepherd family and people who were donors to the organization who we wanted to reward for their service and their support of the organization.


About, oh, 15, 12 years ago, 15 years ago, we spun off a separate foundation Board. That Board really is the, its own 501(c)3. The foundation is at the, serves at the sole whim of the hospital to raise funds to support it, but they primarily do the fundraising. We've really tried to shape our Board into a little more of a strategic Board by bringing business leaders and folks who, other healthcare leaders who can help us to look at the world and make key decisions.

Mark:
One of the areas I'm interested in is talent management and leadership development. Where do you expect to get the next generation of senior leaders for Shepherd, and what kind of leadership development program do you have there?

Gary:
Well, we have a fairly intensive one. In fact, we're very fortunate that we're able to promote people internally. For example, when we promoted Sarah, who will be my successor, to her job as VP of Clinical Services, every position that we've filled down the line was done internally. We really focus on that.


We have an internal and external leadership development program. It includes our Hardwiring Excellence program, which every manager goes through. Then there are, we've developed competencies, and each manager is responsible for taking those, what we call our up and comers, and working with them on an individualized plan to say, "Okay, where do you want to be in 10 years?" In fact, I just met with a young woman here who has just been promoted internally about where her goals were and helping her to map out a strategy.


We also understand that we're probably not going to get every bit of talent from within. About 5 years ago our Chairman James Shepherd asked every senior manager to give a retirement date, an expected retirement date. Then what we did is we went back and analyzed whether we could, we had someone internally, who those candidates were, what skills they needed to grow, and in some of the jobs, we said we don't have anybody internally. What we put in there were basically time frames for when we would begin to look at recruiting from outside.

Mark:
What you're describing is succession planning, and you mentioned early on, you were getting ready to retire. You just mentioned you have a successor identified. What was that process like?

Gary:
Well, we basically had, we've been working on this for the last three, four years. Again, we identified competencies, and we came to the, as we moved closer towards it, we had looked at engaging a search firm. We also, I spent a lot of time out there externally and other rehab centers, and I'm a CARF surveyor, which is a national accreditation organization, and to be quite frank, I just didn't see anybody more talented than Sarah, then the person we had internally.


The second consideration, which was huge for us, was our culture. You can bring, I've seen so many organizations where they develop a certain culture, they bring someone in from the outside who has a whole different philosophy of what they ought to do, and they wreak havoc. A lot of CEOs don't last but one to two years because they get sideways with their board, they don't understand the culture they're coming into, and so we said, "Why roll the dice and take that chance?" The Board met. We did some psychological testing, talent testing for Sarah. Looked at some of those issues, and the Board made the decision to go ahead and promote her.

Mark:
What was her background?

Gary:
Sarah started here 32 years ago as a physical therapist, has worked her way up to, she was a supervisor and then the Program Director of the entire spinal cord injury program. About 5 years ago she was promoted to basically our COO position, and has done that for about the last five years. What I tell people, we're trading up.

Mark:
As President and CEO, what keeps you up at night? What do you worry about?

Gary:
Well, what I worry about is always the safety of our patients. That's the number one concern. I want to make sure that we provide, the last thing you want to do is get that call that said, "Oh my god, guess what just happened?" Knock on wood, we've never had one of those calls, and we're very, very proud of that. I worry about the longevity of the organization, and I frankly worry about whether or not the healthcare world of the future will support the kind of culture that we've created here.


Again, I'm really proud of what we've done here, so it's all those things that I think they worry about. Do you have the right people in the right place? I really have, in my professional life, I've learned a long time ago, I don't worry about work much at home. I really have tried to separate my personal life from here. I'm not even sure my wife knows, she knows where I work, but I'm not sure she knows what I do. I think you've got to be very, very careful about that. You can be absolutely consumed by this.


When I first got out and took my first job at Learning Services, my wife was a nurse and she worked the evening shifts, so we never saw each other. I wouldn't get home until eight, eight thirty at night, and then we had our first child and I said, "Gosh, I'm never going to see this kid grow up." I really, and I really try to reinforce that with our staff. In fact, we have an unknown, an unnamed Senior Manager here who spends too much time here, and I actually scored her down on her performance evaluation for spending too much time here, got her attention.


What we know is that people who overwork, workaholics, aren't very effective. We really, really try to promote that work life balance here. That's so important with the Millennials now, this new generation. That's been an extremely challenging group of people to work with in that, they're, that's almost imprinted on their genes, is that work life balance.

Mark:
If you could go back to 1994 as you got ready to take the reigns of Shepherd as CEO, what advice would you give your 1994 self?

Gary:
Well, I'd probably, to be a better listener. That's something I've had to really work on in my career, is that you think about it, I made the, when you're the CEO of an organization, you've got 100,000 things on your mind. Someone comes in your office and they're telling you something that may not be in your top 10 of priority situations, you have to understand that that's the most important thing to them.


It took me a while, to the point where I even had to, I set up a thing with my staff that if they felt like they were losing me during a conversation, they would put one finger in the air, to prompt me to come back and remember. That's probably the one thing I would have worked on better, was to be a better listener.

Mark:
What surprised you as you took on the role of CEO? When you first took on the role of CEO, what surprised you? What was different than you thought it would be?

Gary:
Well, I thought that it would be easier. I was coming into an organization that was relatively stable, but I was also coming into an organization that was pretty set in its ways. When I got here, in the first, oh gosh, six months, we changed the name. We changed the logo. We added a brain injury unit. There was things, we totally revamped the management structure. A lot of times, organizations get complacent, and this one was a little bit complacent. We burned in effigy that this is the way we used to do it. Actually made a sign and had a bonfire outside, and we burned that.

Mark:
Did you really? Wow.

Gary:
In a symbolic way, is that, I don't want to hear that this is the way we've always done it. It took a while to really, for example, we had no pay scales here. People would, there was no top end of the pay range. I'll never forget, I knew I was in the right place when we used to do this holiday talent show every year. I'd only been here, I came in July of '94, and this would've been December of '94.


A group of staff got up and sang to the Twelve Days of Christmas, and they started on the first day of Christmas, Gary took from me. They went through two PDOs, all these things. I felt like if I'd only been there six months and they felt comfortable enough to get up and make a joke out of it, then I was in the right spot.

Mark:
Oh, nice. Let's transition and talk a little bit about leadership specifically. If you could encapsulate your leadership philosophy, what would it be?

Gary:
One word, consistency.

Mark:
Okay.

Gary:
That, to me, is the most important thing. So many times you have people who, the worst thing you can do is have a leader you don't know what they're going to do. What I tried to do was to create an environment where one, we gave people an opportunity to make, to help make decisions and help shape decisions. Now ultimately, it's not a democracy. I've got to make the final decision, but I wanted them to understand the process. Again, let's look at the data. Let's do this.


The other thing is that they knew what decision I'd probably make, even if I wasn't here. The consistency thing is a huge part of that. I think people make leadership skills much more complicated than they need to be. It's about treating people fairly. It's about, again, reinforcing the behaviors that you want, getting to know people personally. I want to know who people's children are, those kinds of things.


Then you go to a Steven Covey workshop, and they're, god, that's my worst nightmare. There's all these words like synergy. Define synergy for me in a behavioral way. Nobody can do that. How do you translate that to, as a mentor, to young people and say, "Okay, I want you to go out there and create some synergy." What the hell does that mean? Just keep it simple. Again, I'll go back to what I said before. Get people to do what you want them to do with a smile on their face, and that's really what we've tried to focus on here.

Mark:
Yeah. It sounds like important characteristics, caring about people, listening. How did you learn that? Where did you learn those skills? It sounds like you were a natural leader, if that's fair.

Gary:
Well, yeah. I think a lot of it came from the sports in my, the sports background, which made me a fairly disciplined person. Believe it or not, I was a center, so next to the quarterback, the center is the leader by, they make all the calls and get people in the huddle, do those kinds of things.


The other thing that shaped me, and this is going to sound weird, was the Boy Scouts. I was very active in the Boy Scouts. I was a Senior Patrol Leader of about 50, 60 11 year olds, which may be the hardest job I've ever had in my life. All those things shaped through my life, it just seemed like whenever there was a challenge and there'd be a group of people, people would look at me and say, "What do we do?" I just felt comfortable doing that.

Mark:
Can you give an example of a leadership lesson that maybe you had to learn the hard way?

Gary:
Yeah. When I first came, at the other, in my position at Wake, I was, I moved up through the ranks. People knew me, and they adapted to my sense of humor. What I had to learn here was, when I first came, whatever I said people took literally.


I had to be very, very careful, because I have a sarcastic sense of humor, and I may say something that I mean in a humorous way, but it was amazing, after I'd been here the first couple of months, how many times people, the rumors would become I'd said something up on the floor, and that was going to happen. I had to be very, very careful what I said out there because people were literally taking that to heart. You underestimate what the power of your words are, I think, in a leadership position like this. You have to be very careful.

Mark:
What do you look for when you're hiring leaders?

Gary:
Well, we want someone who we, who we feel, the first and foremost, will they fit in to our culture? We do some kind of personality, we also do some behavioral interviewing kinds of things to look at that. We ask questions about their sense of humor. We have created some scenarios that asks an employee to look at their compassion. An employee comes to you and their mother's dying and they can't work this weekend. You absolutely have to have them. What do you do? How do you problem solve through that? What takes precedence? We try to look for people that really fit our culture, that one, are accountable, two, they're compassionate, they understand data and how to use data to make decisions, and they're just generally nice people.

Mark:
You've mentioned data a number of times. How do you ensure that your leaders are using data?

Gary:
Well, we have a scorecard. We basically, our senior management team, our performance is judged by the board on a scorecard that we develop every year. It's like a balanced scorecard model where we take the 10 most important things, for example, what's the goal of our internal employee satisfaction, and we raise the bar on that every year. What's our customer satisfaction? What's employee turn over look like? We basically prioritize what those issues are that we want to be judged on, and then we use that data to do it.


If any manager wants to develop any kind of a new program, they need to then, we have a business plan format where they, here's the data that's required. Here are the questions you need to answer before we even consider that. We tried to make data an integral part of what we do.

Mark:
Did you have mentors, a mentor or mentors, earlier in your career that you look back on as having really helped shape you?

Gary:
Yeah. There was a couple people that I think I would look at. One was my advisor in college, Todd Risley. I think the guy was a genius. He was a very, very interesting character and one of those people that was able to look at things in a very, very broad way and in a very macro, at a macro level and really look at problems both from the social issues and so he taught me to be a big thinker and to look at, the answer isn't always this minute thing that you might see or the first thing that comes to your mind.


Then, I worked with a guy named Doug Vinsel who was at Wake Medical Center, and Doug went on to be the CEO of a couple local hospitals down in Raleigh. What Doug taught me was compassion. He was very much one of those guys that if an employee had an issue, the employee came first, we'd find a way to make that work and work around it. Those are two people I think that really shaped who I am.

Mark:
If you were to step back and say, and answer this, what does a good mentor do?

Gary:
Well, a mentor sets a good example. In fact, I was just sitting here with this young woman today, and she, before she left she said, "You know, I've been here for 10 years, and what I most appreciate is that you walk the walk and you set the example, and that you're, that we see you as another human being, not this kind of CEO guy who is intimidating or we need to be afraid when he comes in the room and things like that." I think a mentor is someone who can provide good feedback.


One of the biggest problems with how we manage people is that, one, managers don't know how to give good feedback, and more importantly, we don't teach people how to take feedback. We really work hard here at making sure that feedback meets the guidelines of something that's going to improve what we want to do. The other thing we do is we, I think being a good mentor is not waiting.


In healthcare, if you get two performance evaluations a year or feedback on your evaluation twice a year, a lot of places, that's a lot. What we try to do is really, really step that up. We have what we call high, medium and low performers, where at least three times a year, every manager's meeting with their employees, and if they're a high performer, they want to re-recruit them. "We want you to be here, what can we do to make that happen?"


If they're a medium performer, how can we get you to be a high performer, and if they're a low performer, you got 30 days to make this work or we're going to have to make a change. Here's the goals and competencies we need you to do. Creating that kind of a feedback loop, I think, is a very, very important part of what a mentor should do.

Mark:
Do each of your leaders actually sit down with their employees, a couple times a year, and tell them, "Hey, you're in one of these three categories?"

Gary:
Yes.

Mark:
Does everybody know where they sit?

Gary:
Yes.

Mark:
Oh, wow.

Gary:
That's an important part of what we do, because we're a pretty laid back organization. If you come in, there are no uniforms. Our therapists, they're up crawling on mats with patients. They dress in jeans. That part is the family atmosphere, but it's not an organization that tolerates mediocrity well. We want you to be accountable for meeting the goals and objectives of what we want you to do, but we want to make that as pleasant experience as we possibly can.

Mark:
How do you make sure that your managers are really doing that, because I've seen, in different organizations, everybody winds up being a high performer, and that's just not true. How do you make sure that that inflation doesn't happen?

Gary:
Well, one, we will not accept, we basically look at the bell shaped curve. Everybody, we will actually counsel managers who come in with everybody at the same score. We force them to make a decision. We will actually send back their evaluations until they do make a decision, because nobody can be the same. There has to be a distribution there that is differentiating between your high performers and your low performers, and so we really force that issue and make them do that. Say, "We're not going to accept this until you get within those parameters."

Mark:
Do you have a, some sort of, you mentioned some sort of bell curve. Do you actually say, "And you have to identify the low ones, and we expect you to have low ones?" Is there an expectation there?

Gary:
Right, and if there's someone who comes in two years in a row and doesn't meet the basic expectations of the job, then they go into a corrective action program, because there's no excuse. If you've been there two years, either we, and the other thing you need to understand is a big part of whether an employee succeeds is, did you do your job as a manager?


One of the things we do with every new employee is, at 60 days, we bring all the new employees back in and the first question we ask them is how did we do? It's called connect the dots, because we want to make sure, one, before you can discipline an employee, you've got to understand, did you give them all the training they needed to do the job? Did you give them the tools they needed to do the job, and have they been adequately prepared to do that job, because that's a management responsibility.


We want to make sure that that first 60 days, that we've done our part. We invite them to say what didn't work well, what did you, is there something you didn't get so that, because it's like a marriage. That first 60 days are really, really important. If we let a good employee walk out the door, then we really didn't do our job.

Mark:
Do you have a formal mentorship program at Shepherd at all?

Gary:
Yes. Well, what we do is we have, again, I referred you back to those up and comers and the succession planning kinds of tools. Each of those people has a formal mentor who puts the education plan together with them, that continuing education plan. Now, you can be mentored by anybody. In the organization, you're welcome to come to me and say, "Here's a skill I would like to learn. What can we do and how would we do that," and I'm more than happy to do some of those things.

Mark:
If you had to pick one book that early careerists who are interested in being leaders in a healthcare organization should read, what would you recommend?

Gary:
I would recommend Hardwiring Excellence by Quint Studer because I think it provides, in a very simple methodology and in a very understandable way, ways that you can improve your organization. We've tried some of the techniques that are in there, and they work. Things like thank you notes. We have a culture that, we're very big on thank you notes. I write probably, about four or five a year.


You ask about how do you ensure how senior managers do the things you want them to do, we have a rounding log where, it's computerized, where whenever a manager does a rounding session with an employee, they're required to go in and fill it out. It talks about, okay, what's working well? What do we need to improve? Is there anybody who needs to be recognized? That goes into a computer file. We monitor that and at every quarterly management meeting, we put, by name, the managers up and who's filled out, who's done how many roundings and where they've done them.


It also is a feedback loop so that if someone's recognized for good behavior and it's somebody who reports up through me, they will actually send me a copy of that. It automatically goes to me so the next time I'm out on the floor, I can see that employee, I can say, "Hey. Sarah told me about this great way you handled this very difficult family. I really appreciate you taking the extra time to do that." It gives me an opportunity to provide some meaningful immediate and sincere reinforcement. Having that accountability loop is really important.

Mark:
You mentioned it right at the beginning, and we've mentioned it a couple of times. You're coming toward the end of your career. What are you going to reflect back on, do you think, and look at as the most meaningful part of the work you've done?

Gary:
I'm just really, really proud of the fact that we've been able to help some, I look back at, again, I'm a data kind of guy, the numbers of people went home. I think the thing that makes me happiest is when, and this is going to sound really, really weird, but when a family comes back and they come back to the Center, and this happens all the time, it's pretty amazing. They'll come back, and the first person they go see is the person who cleaned their floor or cleaned their room.

Mark:
Really? Yeah.

Gary:
Yeah, and what that means to me as a manager is that that family created a relationship with that person that was meaningful enough that they wanted to seek them out, which means that our job of driving that culture down may have stuck, in that it was a meaningful relationship that was created there, which is what we want our staff to do. Those are the things.


The other thing that makes me happy is when people tour through here and they say, "God, everybody seems happy." People think that happens just naturally, but it doesn't. I think it's really, really an important thing.

Mark:
Well, that sounds like a nice place to end this at, so thank you so much for your time today. I've really enjoyed hearing your story.

Gary:
Okay, Mark, I've enjoyed talking to you. This is, when you can lay out your life in a short period of time, it's cathartic in a certain way, so thanks for giving me the opportunity to do that.



No comments:

Post a Comment

Note: Only a member of this blog may post a comment.