Kathy Bizarro-Thunberg Transcript

The following is a transcript of our interview with Katny Bizarro-Thunberg. 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.

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Mark Bonica: Welcome to Forge Kathy.

Kathleen Bizarro-Thunberg: Thank you.

Mark Bonica: You earned an Associate in Science and Computer Information Systems from the New Hampshire Technical Institute in Concord. Why did you go to the New Hampshire Technical Institute and why did you choose Computer Information Systems?

Kathleen Bizarro-Thunberg: Well this is back in 1983 when I graduated from high school and at the time in the 80's, the whole concept of computer information and automation and technology was fairly new and it's something that intrigued me and wanted to pursue it as a career. So, I was looking for something close to home, I was paying for my education on my own and found this program at NHTI.

Mark Bonica: OK, and you went to work immediately out of school for the New Hampshire Hospital Association and so this was in 1985 and you were initially hired as a data technician. How did you come to take the job at the association and did you wanted to work in healthcare?

Kathleen Bizarro-Thunberg: I had no concept of what health care was in 1985 when I took this job. Actually when I was at the tech, I had to do a senior project to graduate and my professor at the time knew the president of the New Hampshire Hospital Association and I was able to do like a 3 or 4 month project here at the hospital association with a couple of other student team members to develop a project for the Hospital Association. The day I graduated from the tech, the president of the hospital association said, "Hey how would you like a job," and I'm like, "Sure," , of course and, , a little kid out of school being offered a job in the field that I had studied in was certainly intriguing, so I started the next month here at the Hospital Association.

Mark Bonica: OK, and you've been here basically ever since.

Kathleen Bizarro-Thunberg: Yes, so yes, and 30 years.

Mark Bonica: That's amazing. So, as I said you've been here ever since, so before we talk a little more about your career and the roles you've held specifically, could you tell us a little about the association and we'll probably jump back and forth a bit kind of between talking about the association and talking about what you actually do and have done for your organization.

Kathleen Bizarro-Thunberg: Sure, the New Hampshire Hospital Association is a trade group or trade association that represents its members. In New Hampshire, we have all hospitals in our state, 26 acute care hospitals and 6 specialty hospitals that are members of the hospital association which means they pay us dues. So that's our major revenue stream is from dues from our membership. Our goal is to represent them, both in the legislature through advocacy at the federal level, through the media, through working with state agencies to represent their interest and therefore the interest of patients in which they serve and that they care for.

Mark Bonica: OK, so you came in '85 and over the next 11 years you worked your way up from technician, to the Director of Information Services, to Vice President for Strategic Information Services. Can you talk a little bit about your early career and how you grew into those roles?

Kathleen Bizarro-Thunberg: Sure, one of the first major projects that I did as a data technician was to work with all the hospitals to collect hospital discharge data. New Hampshire was one of the first states in the country to do a statewide database of hospital discharges, looking at patients who stayed overnight in the hospital and looking at their demographics and their diagnostic and procedure codes to have a real understanding of who's utilizing hospital services. So from that I was able to,, work with lots of different folks in the hospitals, from the CEO down to the medical records person, to really understand,, what this data was showing, what kind of reports were important to senior management in hospitals, and so I was able to work with a lot of people to really understand what was important for generating information, not just data, but information that people could use at their fingertips. So from there, it really just grew to not just generating reports, but being part of the leadership team to really understand what were the important issues and how to gather information from hospitals or other sources to support those policy issues that we were working on. So a lot of things just organically grew from just starting with people asking me for information, to me sort of generating the questions and the interest in gathering the important information to support policy decision making.

Mark Bonica: And you moved up to be Vice President of Strategic Information Services, so what kind of role was that?

Kathleen Bizarro-Thunberg: We started to expand to lots of different types of policy work and again, it needed a lot of data to support that policy work, so it was my job to work with a variety of people to come up with the right kinds of survey instruments or,, value-added reports that could really help people with,, decision making at the hospital level but also working with legislature or state agencies to really educate them about what the hospital's role was in healthcare delivery. Another piece of what we did for Information Services was even internally building our computer systems here at the association. When I first started in 1985, we had two computers with an external hard drive; that's all we had and so part of my role was to build a computer infrastructure that supported all of our staffs' needs that could grow with us as we were growing in our technology needs and our information needs to be able to support what we wanted to do. Ultimately that grew into like website development and e-mail, development and so forth because none of that existed when I first started here.

Mark Bonica: Sure, so that's an interesting summary kind of what you've been doing because it sounds like you had both an internal role, kind of running the information infrastructure within the organization. But also you're integrating your knowledge of health care and hospital operations with, doing as you said, survey instruments and so forth and doing it, gathering the kind of information that was useful to the mission of the organization.

Kathleen Bizarro-Thunberg: I think early on, I've always had sort of that dual role of internal support for staff as well as external work with our membership and I really value both because I think without staff being supported, they can't do the work of supporting our members, and vice versa our working with our membership is really important to the work that we do collectively as a membership organization.

Mark Bonica: So going with kind of growing your knowledge of health care, you earned your bachelor's degree from health management and policy, the program that I'm working in now, back in 1992; why did you choose to pursue a degree from H.M.P. and how did it compliment the work you were doing at the time?

Kathleen Bizarro-Thunberg: Well as I mentioned, I sort of got thrown into this work, working with hospitals and trying to understand their industry in order to support what we needed to do as an organization on their behalf. And I really felt like getting a bachelor's degree in that area would really cement what I did already that I learned on the job, but providing more theoretical support and more a broader perspective of health care then just hospitals because  hospitals are one of many different types of providers. So I felt like getting a more formal education in health management and policy would certainly help in the work that I was already doing at the hospital association and I definitely feel like it was the right degree to pursue.

Mark Bonica: Sure, what was it like being a working student because this is an undergraduate program and probably most of your colleagues were not working at the time or were working some sort of little job.

Kathleen Bizarro-Thunberg: It was very interesting because this is late 80's, early 90's when I pursued my undergrad degree and the H.M.P. program was only available in the Durham campus. So, some of the core courses that I needed to do, because not all of my credits transferred from my associate's degree, I was able to take in Manchester. And so the Manchester courses were at night, so I was really with more professional adults who were, who worked during the day and took classes at night. But when I started taking classes in the Durham campus which were day classes with the traditional students, I was the only nontraditional student in the classroom. And so I sort of took it as an opportunity to share my experience with what I already did in health care with my fellow students and hopefully the professors as well because  I just, I felt like I knew that I had a different and hopefully interesting perspective that I could bring to the discussion in the classroom setting. So, , because I didn't live on campus and I, , I was already working in the field, I wasn't really connected to the students at all, but I was connected to the content of the program itself and I have stayed connected to the HMP program and have since I graduated in 92.

Mark Bonica: Yes you have, and you're a huge supporter of the program, so thank you for that, and the job and the hospital association supported your trucking out in the middle of the day to go to Durham.

Kathleen Bizarro-Thunberg: I was very, very fortunate that they allowed me the time to invest in driving to Durham to take the courses and come back to work and be flexible and work at night if I had to make up the work that I needed to do. , they were really more focused on not just, , the 9 to 5 hours, but yet make sure that the work got done and so that's what I focused on and I was very fortunate as an employer to have that kind of opportunity.

Mark Bonica: So, in 1996, you began wearing two hats you were the Executive Vice President for the New Hampshire Hospital Association and you are also the Vice President for Strategic Information Services for the Foundation for Healthy Communities. What is the Foundation for Healthy Communities?

Kathleen Bizarro-Thunberg: Well 20 years ago, the Foundation for Healthy Communities was established as a sister organization to the New Hampshire Hospital Association. So the hospital association is a 501c6 organization which is a nonprofit organization, but we can lobby. The Foundation for Healthy Communities is also a nonprofit but it's a 501c3. 501c3 is a charitable organization and so they cannot lobby. The reason why we started the foundation is because we saw there were opportunities for hospitals to work with lots of different policymakers, health care providers around a space where it wasn't just seen as a hospital issue. We wanted to create an opportunity in an organization where we could work on projects, or work on issues that transcended just the hospital setting and so we brought together folks from like the Home Care Association, the Medical Society, long-term care, and other policymakers from the state, from Department Health and Human Services. And they served as our original board members and it has grown over time in the 20 years to be focused on a lot of public health-related issues: tobacco cessation, cancer, collaboration issues, and rural health issues. We also do a lot of work in quality improvement, and so that's where our bulk of the work that we do in the foundation is really focused on more broad community health improvement activities. And it definitely compliments what the hospital association, what the hospitals do at the local level, but it just provides a different space and a different way in which we can organize ourselves to work on those areas.

Mark Bonica: Where does the Foundation get its revenues from?

Kathleen Bizarro-Thunberg: The foundation has a variety of revenue sources; some of it is from the hospitals, so the hospitals from day one knew that this was an important initiative and so they financially supported every year. The other bulk of revenues for the foundation come from grants or contracts. So we will pursue grants for projects that sort of meet some of the community health improvement projects that were interested in. We also contract with organizations such as the Department Health and Human Services to pursue different ways in which to do health improvement because they get federal grants and they're looking for partners to help, actually do the work. And so a lot of times we will partner with the state to get that work accomplished.

Mark Bonica: What's your role with the foundation today?

Kathleen Bizarro-Thunberg: I don't have a formal role as a staff position, but because we're so integrated between the two organizations, we do a lot of collaboration with policy issues with, things that might come up such as rural health issues. There's a person who works in the foundation who is focused on rural health; we collaborate a lot on things that may come up that impact like critical access hospitals and so he shares information with me, I share information with them. Financially, I do, there are staff people who work both for the hospital association and the foundation and one of the roles that I play is working on, how those internal operations function between the two organizations.

Mark Bonica: So the New Hampshire Hospital Association is a dues-paying organization as you mentioned, the members pay dues to be members. What is the value that the organization, the member organizations, are looking for from the New Hampshire Hospital Association?

Kathleen Bizarro-Thunberg:  that's something that we always strive to make sure we understand, what's our value to our members. And in fact this past year, we embarked on an initiative to look at our strategic value to our membership and so we got a lot of CEO's and senior managers together to work with us to determine, , what is that value proposition and how do we measure that. And so we surveyed our members of what were issues that were important to them that we do on their behalf and top of the list is advocacy, both at the state level and the federal level. We also support them with communications with the media, we support them in advocating on their behalf with state agencies and federal issues, so they look to us to come up with the common policies and common positions that we all from the hospital's position should take to best promote them and their ability to serve the patients that they take care of every day.

Mark Bonica: You mention that you're working with the member hospitals to kind of come up with a common position but there's 26 of them and they are relatively geographically diverse, right? I mean New Hampshire is kind of divided; Robert Mock said, , kind of right around Littleton, kind of divides into a North and a South where the North is very rural and the South is relatively rural and in Manchester's 100,000 people is our biggest city. So New Hampshire as a state is pretty, pretty rural but definitely has different geographic interests and impacts; so how do you work with all the members to come up with that common interest?

Kathleen Bizarro-Thunberg: We work on that all the time. For the 26 acute care hospitals, thirteen of them are critical access hospitals which means there are 25 beds or less and they exist in a rural community. The other thirteen hospitals are larger facilities and as you mentioned, are more situated in the southern part of the state where Dartmouth is, our western border right next to Vermont as our largest facility. So we have 13 hospitals, 25 beds or less and we have 13 that go from little, facilities up to, a large hospital Dartmouth-Hitchcock. We make sure that we provide lots of opportunity for a member engagement, and through that member engagement everyone has an opportunity to share their positions, or their interests, or their concerns with particular policy issues. And so we have to take everyone's comments and opinions into consideration when we start setting policies or taking positions. Sometimes we have to understand that there are going to be divergent opinions and concerns about things and so there could be situations where we can't take a position or we may have to have a working group of folks to come up with a compromise position or there may be situations where there are going to be hospitals are going to take a position that may be contrary to what we're doing and we have to recognize that. And so we're always cognizant of, kind of where people are at and try to work with all of those moving pieces as possible. We always hope that we can always come to consensus on everything that we do, but in reality that's not possible and so we try to work with everyone to at least make sure that everyone's aware of where everyone sits on certain things.

Mark Bonica: So speaking of your advocacy role, how do you, who do you advocate to at the state level?

Kathleen Bizarro-Thunberg: For the state legislature, it's a 424 member legislature which is, the third largest governing body in the world. Yes, and they make $100,, a year; it's a volunteer position, they do not have staff and so the way we work with legislators is that we try to develop relationships with key individuals either it's key leadership or certain legislative committees that we would see healthcare issues in all the time both in the House side and the Senate side. So the way that we do that is again through building very special relationships with each one of them, gaining their trust, letting them know that we're there to provide resources and information as needed. I think that has worked well for us for many years and it’s a formula that we will continue to evolve and really focus on because it's really important to us to develop that trust. The same thing with the executive officer, the governor's office, and other state agencies. It really always boils down to the relationships that you build with key individuals and making sure that they understand, , what we can do at the Hospital Association, bringing the hospitals to the table for whatever it might be. Whether it's with the governor's office or the commissioner of Health and Human Services or the Senate president,, we are there to represent the hospitals' interests and they know that we will be honest and fair and hopefully, depending on the issue, be able to bring people to the table to share subject matter- experts or being there to be part of the conversation to,, make sure New Hampshire stays healthy.

Mark Bonica: Can you give some examples of issues that the association has worked with at the state level in the past that were important to your members?

Kathleen Bizarro-Thunberg: Sure, the state budget has been important which really governs a lot of reimbursement issues for Medicaid, supporting the Medicaid program for making sure that it's available to beneficiaries, major part of that was advocating for Medicaid expansion where it's also called the New Hampshire Health Protection Plan. There are other issues related to financial reimbursement, working with payers in insurance companies, certificate in need, public health issues emergency preparedness such as, , the recent work that we did with the state officials and the hospitals on Ebola, substance misuse and mental health issues are extremely important to everybody. So that's just tip of the iceberg but those are some major ones that we've worked on.

Mark Bonica: Could you talk to one specific program that I saw on your website it's the New Hampshire Health Protection Program or NHHPP?

Kathleen Bizarro-Thunberg: Sure, the NHHPP is the Medicaid expansion; what that means is under the ACA, states were able to expand their Medicaid program to certain beneficiaries that otherwise weren't eligible for Medicaid. And the NHHPP program was after much legislative debate, was approved in 2014. So starting in August 2014, we've had over 43,000 New Hampshire residents that have become beneficiaries of Medicaid expansion program, so that means they have access to health insurance benefits. It's important for citizens because now they have insurance support for the health care services they need. Prior to that, most of these people were showing up in the emergency departments and coming in during a crisis situation; they wouldn't come in just for,, a cough or cold, they come in with pneumonia and so they would be in crisis situation. Now that they have health insurance, they're hopefully getting the right care at the right time at the right place, early and preventive. And so it's important for, these individuals to maintain that health insurance. One of the things that the legislature did when they approved the NHHPP is they put in a moratorium date there, a sunset date, so the program will end at the end of 2016 unless it's extended and so a lot of people whether it's hospitals or other health care providers or substance abuse providers or mental health providers and other people who are very interested in seeing Medicaid benefits continued are hoping to work with the legislature this year to extend the NHHPP benefits to these 43,000 people for longer than the end of this year.

Mark Bonica: You are the Executive Vice President for Federal Relations, how does advocacy at the federal level work and how does that compare to what you do at the state level?

Kathleen Bizarro-Thunberg: For the federal issues, each of the congressional delegation offices: Senator Shaheen, Senator Ayotte, Congresswoman Custer Congressman Guinta have staff at the D.C. level or even in New Hampshire. And so it differs a little bit how we work with state legislators because state legislators don't have staff, we work with them a lot directly. Where we do have relationships with each of the congressional delegation members, they all have committee staff who have direct responsibility for certain topic areas in particular health care. And so we have developed, over time, great relationships with each of their offices and their legislative staff people who specialize in health care to make sure that,, everything that's being dealt with at the congressional level, at the federal level that could impact hospitals one way or the other that we're able to communicate those impacts and our concerns are in our support for certain initiatives at the federal level. And so we work directly with their staff to communicate those types of policy positions; we also do a lot of this work through the American Hospital Association, we take, a lot of times we take the American Hospital Association's lead on a particular issue. , they're tracking legislation, they are letting us know sort of some of the nuances of some of the federal language that may be implemented or the implications of a particular position a bill may be going that we can, from our state's perspective, put in our two cents and share it with the American Hospital Association who could advocate for all hospitals at the federal level. Or we also can translate that to our New Hampshire congressional delegation and, compliment what the American Hospital Association is saying from a national perspective and put a state spin those issues.

Mark Bonica: So is your work at the federal level primarily through the congressional delegation and the AHA?

Kathleen Bizarro-Thunberg: Yes, yes.

Mark Bonica: Do you ever find yourself interacting with federal agencies?

Kathleen Bizarro-Thunberg: Yes and no, not so much in a direct way,, a lot of things could be coming up, , one example might be, , working on rules that might come up relative to HIPPA. HIPPA is one of my areas of work that I have developed some area of interest in and so we will write comment letters, we will share issues of, , their proposed rules or if there's things that may come up that a federal agency may have interpreted that we will share those comments directly with those agencies. A lot of times again it's in collaboration with American Hospital Association because we want to make sure that our voices are heard collectively and consistently. And so we will share what happens at the state level with AHA and with those federal agencies.

Mark Bonica: Can you talk a little bit about the relationship between the New Hampshire Hospital Association and the American Hospital Association, how does that work?

Kathleen Bizarro-Thunberg: Sure, there's no formal organization, linkage there.

Mark Bonica: So you're not like a local chapter of the AHA?

Kathleen Bizarro-Thunberg: No, we are a standalone organization and there are state hospital associations in every state of the country. But, we are, sort of our own entities and the membership of the American Hospital Association are hospitals. So we have mutual memberships, so there are many hospitals in New Hampshire that are also members of the American Hospital Association but because the American Hospital Association understands that they need folks like us at the state level to get to their members, , and collectively use us to help support things that are going at the federal level there's a mutual relationship there that we can help each other, , work on, , getting access to membership feedback and also, , being able to hopefully leverage all of that at the federal level.

Mark Bonica: Let's transition and talk kind of specifically about leadership and one thing we hadn't mentioned was you actually earned an M.B.A. 2008 from Franklin Pierce, why an M.B.A. verses an M.H.A.?

Kathleen Bizarro-Thunberg: Well as I have progressed over time with the Hospital Association, I was getting more and more involved in internal operations and supporting the organization by working with our accounting office and working on support of other,, how do we communicate internally and so forth and so I just felt like I needed some other education opportunities,, outside input for how to best do those kinds of internal operations. And I,, did weigh whether I wanted to do an M.H.A. versus an M.B.A. and I really felt like for me, I'm doing the health care,, stuff day in and day out for twenty years,, I think I got that piece of it; what I felt like I needed to round out what I was trying to do more from an internal operations perspective with the business angle. So that's why I pursued my M.B.A. in leadership degree.

Mark Bonica: How many people currently work for the New Hampshire Hospital Association?

Kathleen Bizarro-Thunberg: There are eight of us in the New Hampshire Hospital Association. If we add in the Foundation for Healthy Communities, there's about 12 or 14 staff members or about 20, 22 people combined.

Mark Bonica: OK, it sounds like you guys are a busy organization and working with all the members and all the others; thinking about your role as a leader in your organization what is your leadership philosophy?

Kathleen Bizarro-Thunberg: You've probably heard it sort of sprinkled into some of my other answers before, but my philosophy is relationship building. And without relationships with a variety of people, you really won't go very far, very fast, so I really value the breath and the depth of relationships that I build with a variety of people. Whether it's with legislators or state agency people, or with our hospitals or even internally with staff here, I really feel like if you can't build those relationships you can't be an effective leader.

Mark Bonica: What would you say are the characteristics and behavior of a good leader and how do you aspire to those yourself?

Kathleen Bizarro-Thunberg: First and foremost, you have to be a good listener and you have to be diplomatic, you may have strong opinions but I think you also need to take other people's opinions in mind and somehow or other you have to be skillful in bridging those variety of opinions to coming up with a common good or a common goal. And so I think being a good leader is, , trying to forge and bring all those relationships together and making sure that everyone feels like they've been heard and that they've been engaged.

Mark Bonica: How did you come to believe that those are the key aspects of leadership and who did you learn leadership most from do you think?

Kathleen Bizarro-Thunberg: I don't think there was one individual I think,, there have been many people that I've interacted with that I've,, come to observe and sort of take bits and pieces from different people as far as how that works well and how I think they're good leaders or good role models and try to,, model those myself and, try to put my own personal spin on it. So examples would be someone who's a good presenter, who convey their thoughts well or someone who is a really good listener and who is willing to provide compromises or variety of opinions on the table to bring consensus. And so I think, , there are other qualities such as, , being calm, cool, collected and, , not just being someone who's off the cuff, . There are certain bad characteristics that you sort of observe in people that you want to learn from as well and I think there are, I think every day is a learning opportunity, so I don't think that I'm a necessarily good leader today. I'm always a good, , leader in training I think any one of us would be a good leader in training because I think it's always, , there's more to learn.

Mark Bonica: Let me, let me rephrase these same questions now because that's talking about kind of internal leadership, but the New Hampshire Hospital Association is really an external leadership, it's an influencing organization, so as of now in your role as external leader person who is a thought leader trying to change or influence behavior in the state what would you say is your leadership philosophy there, is it different?

Kathleen Bizarro-Thunberg: Not necessarily different, but I hope that as a leader I am seen as someone who's trustworthy, who is a good listener that is willing to take in other people's opinions and also share a variety of views that people would recognize as, , something for consideration that's important. But again, I think I also want to be seen as approachable because if you're not approachable and you can't communicate well, people aren't going to come to you or see you as someone who is of authority. So in the legislature for example, , I want to make sure that if I have to testify that people recognize me as someone who is going to be forthright and share information that is valid and important to the issue and that I'm also approachable for, , follow up or compromise whatever it takes to convey the positions of the hospital. So I think it's really, really important to make sure that, , I'm representing many people not myself, I'm representing other people and that I want to make sure those qualities are first and foremost.

Mark Bonica: How did you learn that leadership style of leading, being a thought leader in the community, who did you learn that most from or was that also something that you kind of picked up here and there, you think?

Kathleen Bizarro-Thunberg: I think I just learned it over time again ,I , I haven't really had one person who's been a mentor to me, I feel like I have taken a lot of good qualities from a lot of people and sort of internalized those and practice them hopefully every day.

Mark Bonica: So you mention mentors which is the next thing I want to kind of ask you about. You're saying you didn't really have any one mentor, but you do you look back on your career and say this person kind of reached out to me helped me here, helped me move or learn particular things?

Kathleen Bizarro-Thunberg: Yeah definitely, I think there have been many people in my career especially here at the Hospital Association who have given me opportunities to grow, to take risks, and to let me, , be successful or fail as needed, , sort of provide me that running springboard to do what I thought was important and necessary on behalf of our membership. So without that kind of, growth opportunity or, just saying "go try it,” just see what you can do and, come back and let me know how things are going.  without that ability to do that, I don't think I'd be where I am, so I think there's been a lot of folks that I've worked with over the years who in their own ways have just said, , do it. And so I try to do the same for others as well and try to, suggest to people "hey if you don't ask, you don't know" and so, give it a shot.

Mark Bonica: You have taken a number of our students as interns over many years and we were talking before we started recording about that as a mentoring kind of relationship. Can you talk a little bit about your experience with interns and this will be a little advice for the current students, what makes a good intern?

Kathleen Bizarro-Thunberg: Absolutely. , I have over many years done many, many students, I have to say 99% of them have been awesome to work with I think, , anyone who is an undergrad in health management policy already knows in their heart that they want to work on health care issues. What an intern would do with the Hospital Association is, , you're not working in the health care facility, you're not working directly with patients, but yet you are creating policies and opportunities for those who do work with patients to make those environments better for everybody. And so my philosophy always is if you're coming in as a student and don't know what you really want to do in health care, come here because we will get you in policy, we will get you in advocacy, we will get to you in doing data collection, will get you doing communications, . It runs the gamut as far as what we can touch or who we can put you in touch with, and I find that very exciting to turn a student on, , to get them excited about health care and health policy and, , because it can be kind of dry, it can be very esoteric, but when you start getting your hands into it and you actually experience the relationship building early on as a student and seeing how what they can do with data collection or, , talking to people or doing some research for us how it really does absolutely impact patient care. And so, getting them excited gets me excited and that's why I still do it every, every year if I can.

Mark Bonica: I want to ask you about being a woman and being a leader. You have held a number of leadership positions both internal as your organization as well as taking on leadership roles in the community. How do you think being a woman has affected your experience in either of those aspects of your job?

Kathleen Bizarro-Thunberg: I never have consciously had a negative or positive I guess it, being a woman in health care or being woman leader, the woman part hasn't been a factor, and I guess I would say. It's more of how I hold myself out as a professional and how I,, want to interact with people; I've never felt like being a woman in this role or in New Hampshire or in any of my national experiences benefactor.

Mark Bonica: I wanted to also ask you about work-life balance and we also chatted about it for a few minutes before we started recording, , many of the, as , many of the students in HMP are young women; clearly they're looking to start a professional career and most likely want to have a family at some point. Could you talk to work-life balance and kind of how have you made that work?

Kathleen Bizarro-Thunberg: I would say that this advice is for women or men, OK, because any one of them should pay attention to work-life balance. It's something that I am very cognizant of, , when I was going in and taking my M.B.A., it was at night, I work full time during the day and I had a young child and I was single mom. So she was four, five at the time and so having to work all day, make sure that she was well taken care of and then go to school at night and, , see her later you put the homework off until, , your kid goes to bed and so you're just do that. And from a work perspective, I think you have to really be very careful about what you take on and what your roles are and that you really can say no sometimes to projects that may put you over the edge as far as time commitment is concerned or you want to make sure you're doing a good job. So really what it comes down to is communication, communication with your family, communication with your bosses and with your staff because I also had staff who report to me as well and so everyone needs to be aware of kind of where you're at, what you can do, what you can't do, how they can help you,, don't be afraid to ask for help, and somehow or other you make it happen.

Mark Bonica: You are very active in the American College of Healthcare Executives, ACHE, when did you get involved in the ACHE, and how has that been important to your career?

Kathleen Bizarro-Thunberg: I got involved in the ACHE back when I was at UNH as a HMP student, I became a student member of ACHE. I think I recognized early on in my career that being part of professional organization was really important to me, not just from the education perspective, but from the networking and also from being able to help others in the profession improve their professional career. , it sort of comes back to the work that I do with students and preceptors being involved in ACHE, I'm able to help healthcare executives who are already in the field do more, improve themselves as a leader, improve their opportunities in their career, and to be able to work with them directly to help make connections and network and so forth. So it's for me, it's an opportunity to give back to the profession by continuing to stay involved in that kind of organization so I felt like it's really important to do that.

Mark Bonica: Talk about some of the positions you've held and what are you doing right now for ACHE?

Kathleen Bizarro-Thunberg: I've had a variety of positions within the ACHE. When I first became a member, there was a local chapter called The New Hampshire Health Executives forum and I got involved in leadership positions there ultimately taking on the president role. That transferred over to a chapter model when they started developing tapped as throughout the country and so we developed the first and only tristate chapter for ACHE which represents New Hampshire, Maine, and Vermont and that was one of the very first chapters that were organized for ACHE. And so we were able to bring together various groups that already existed at three state level and bring them under one umbrella because we're fairly, geographically close enough to be able to do that. Vermont couldn't do it on their own they're very small, Maine was very small as well so, , it made sense for us to do that, so I've stayed engaged with the Northern New England Associate Healthcare Executives and became their president at one point in time. Since then, about three years ago, I was, well prior to that, I served on the national is ACHE nominating committee. The nominating committee is a group of individuals who actually select the board of governors which is the national board of ACHE and so we were able to meet with a lot of national leaders who wanted to serve in that role, interview them, and select them as board members. I really enjoyed that process because you really get to learn a lot about why ACHE is important to people and why they wanted to continue their service and inspired me to want to do that as well, so I put my name in the hat into the ring and I was luckily selected to be a border governor member so I've been serving in that role for three years so my term is up in March.

Mark Bonica: Oh, wow OK, what kind of things do the board of governors deal with?

Kathleen Bizarro-Thunberg: We do a lot of strategic planning and so as a national organization, they represent over 44,000 health care executives nationally and internationally. And so as a member server organization, which is what I do at the state level and I'm the only person on the national board who is this association executive, all the other members are CEO's or senior level people in the health care organizations, so we look at a lot of strategic planning making sure as a membership organization we're meeting the needs of our members. And so, what is that, we survey our members to make sure that we are providing what they feel is important, education, networking, and opportunities to improve their leadership qualities, all the things that are important to me as well. And so we make sure that, , the organization's financially viable and that they were providing value to the members that were being innovative that we're looking forward to the future, maybe beyond what some health care leaders are thinking today, we're trying to think ahead of them to bring value when they need it. And so we're trying to create some innovation in our programs, in our projects that would be hopefully fascinating and interesting and, it's something that people will continue to want to be a member of.

Mark Bonica: How is it important to be a member of a professional organization early on for aspiring leaders, whether it's ACHE or some other organizations, and I'm thinking, in particular, for, , students who are maybe in H.M.P. or maybe, , early career and why get involved early rather than later.

Kathleen Bizarro-Thunberg:  No matter what you do whether you're a plumber, or whether you are an engineer, whether you are a physical therapist, every one of those professions has a professional organization and the reason why professional organizations exists is because there were people who are interested in what you're interested in, first of all, and they understand what you do, but they also are providing great opportunities for you to meet people who could help you advance your career, who could help you network with people that you otherwise wouldn't have known outside of the state, nationally, internationally, and provide you with professional education that you may not necessarily be able to get on your own. For example, , when I met my husband he's an engineer, and he's very involved in local chapter, , professional engineering organization and he's been elected to a national board so he, , in that profession same thing, , whether you are doing health care,, whether you're  a civil engineer, there are huge opportunities for learning from each other.

Mark Bonica: So let's close on this last question: what advice do you have for people who are just getting started in a career in health policy or health care administration, what should they be doing to be successful what should they be reading, listening to, talking to, what kind of organization should they be looking to be a part of?

Kathleen Bizarro-Thunberg: Well as we just said, , if they're looking to be part of an organization find out who those professional organizations are, if it's health policy or health leadership, ACHE, if it's financially oriented, HMFA, there's many of them out there. If you aren't part of professional organization, you're sort of behind the eight ball, I think as an early careerist, , there are so many opportunities that these organizations can provide to you whether it's, , interview skills or resume review or, , having opportunities of talking to professionals who are already in the field, how else you going to get that? I think the other advice is to start meeting people who do what you want to do, that you aspire to be. If you aspire to be a CEO, start talking to some hospital CEO, if you want to be a financial specialist, talk to someone who's a financial specialist because you're not going to really understand the profession unless you get a variety of opinions of people who are doing it today. Ask them how did they get there, how did they become successful, what should you do to get yourself in that position; you're not going to know unless you ask. And certainly reading is important and being current in your profession is very important, but I think again sort of back to the original thing of, what I feel like is important to be successful is building those relationships early and often.

Mark Bonica: Great, thank you so much for your time today, I appreciate it.

Kathleen Bizarro-Thunberg: Thank you for having me.