The following is a transcript of my interview with Michael D. Peterson. 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.
These transcripts are made possible by a gift from the NNEAHE.
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Bonica:
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Welcome to the Forge, Mike.
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Peterson:
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Thank you very much, pleasure to talk to you today.
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Bonica:
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You went to the University of Maine at Orono and studied
public administration. Why did you choose to attend the University of Maine?
And, why did you study public administration?
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Peterson:
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My folks were both alumni of University of Maine.
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Bonica:
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Okay.
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Peterson:
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I actually had considered going out of state for
college, grew up in northern Maine, but after interviewing at a bunch of
colleges, it was pretty clear to me that I wanted to stay in the state of
Maine and especially in New England if I could. The University of Maine, it
was a natural fit with both folks being alumni. Public administration,
specifically, struct my interest. There was, at the time, no healthcare
administration undergraduate program. Public administration was basically the
closest thing.
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Bonica:
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Okay.
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Peterson:
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It had a lot of similar curricula. That's where I got
into.
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Bonica:
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You have family connection to health care. Your mom was
an OB nurse, and your father was a hospital CEO.
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Peterson:
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Yes.
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Bonica:
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Did that influence your interest in healthcare?
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Peterson:
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Absolutely. I actually tell the story at every job
interview I've ever gone to. I was probably 13 or 14 years old when I first
got exposed to the concept of healthcare administration, following my dad
around the hospital and seeing how he interacted with folks and realized that
he was getting as much reward out of the interaction and vice versa. It was
meaningful work. It seemed like there was something important going on there.
I knew he wasn't a doctor. I knew he wasn't a nurse, but I knew that
healthcare was the industry that I was gonna get into. It struct a nerve that
early in my life.
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I thought I was gonna be a clinician. I used to ski in
high school. One day between races, I was skiing where I wasn't supposed to
be and was out of bounds, ended up falling, breaking my back.
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Bonica:
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Oh, wow.
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Peterson:
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Actually, I had to ski down the mountain ...
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Bonica:
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With a broken back.
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Peterson:
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.. On a broken back, because they couldn't get to me,
basically. Because my dad was who he was, I got to see my own CT scan as I
went in for my CT. The tech said, "Do you want to see your images?"
Said, "Sure." Popped around, and as I was looking at the slices coming
up, I saw the bulging disk and the broken ... The herniated disk and the
broken lumbar and almost passed out looking at my own image. It was pretty
clear to me I was never gonna make it through gross anatomy.
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I had to change gears a little bit and say, "I'm
not gonna be a clinician," but healthcare obviously was still
interesting to me. I wanted to be in that industry, and I figured out that I
really still could add value. Maybe I couldn't be someone who takes care of
patients, but I could be someone who takes care of the people who do. That's
why I stayed interested in healthcare moving along. It was in those early
years.
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To a degree, that was a very big advantage for me,
because I had to focus. I always knew that was gonna be my area of focus. When
I got into college, it just clicked. I consumed every healthcare management
kind of course there was at the time available, and it just clicked. I found
that it came naturally. It was fun to be a facilitator of problems and
solutions, but what I found also was I liked to solve problems, not in a one
to one relationship. I always like to see what other problems are on the
periphery. What solution options are there that could solve things we hadn't
even thought about in the synergy that naturally happens when you look at
things globally as opposed to a one to one relationship
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Did that all the way through my undergraduate degree. As
a matter of fact, I was taking grad level courses in MHA programs out of
other colleges that had an arrangement with the University of Main ...
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Bonica:
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Oh, nice.
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Peterson:
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... Just because there wasn't anything else to offer
there in the public administration. I knew I didn't want to be a city manager
either.
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Bonica:
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Which is kinda of a public administration [crosstalk
00:03:54]
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Peterson:
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That's right. A lot of similarities, strategic planning,
capital planning, communications and so forth, budgeting. It's all the
basics, but I needed that specific healthcare related stuff. Went through the
University of Maine at Augusta, picked up some courses and so forth, and I
basically graduate with my undergrad in public administration. From there, of
course, went to Husson College, and they were just at the onset of trying to
have an accredited MHA program, but at the time, it didn't have enough
accredited faculty to be an MHA, so I have a Masters of Science of Business
with a focus in healthcare administration.
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Bonica:
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That's cool.
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Peterson:
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Which was great.
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Bonica:
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Yeah. You went straight from undergrad to grad?
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Peterson:
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Yeah.
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Bonica:
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Okay.
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Peterson:
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While I was in the mindset ... I was still working full
time, of course ...
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Bonica:
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Okay.
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Peterson:
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... But in the mindset of studying and so forth. I just
kept going, got my masters right after my undergraduate.
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Bonica:
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Your first job in healthcare was as a project manager
for administration services at Acadia Hospital in Bangor, Maine. How did you
come to work at Acadia?
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Peterson:
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Actually, that wasn't my first job.
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Bonica:
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It wasn't? Okay.
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Peterson:
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It was just the first job that's listed on my current
CV.
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Bonica:
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All right.
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Peterson:
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It was too long. My first job in healthcare was actually
in 1988. I was in plant operations at The Aroostook Medical Center up in
Preque Isle.
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Bonica:
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Wow.
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Peterson:
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I was doing everything from running conduit for
electrical lines in the OB floor to pouring concrete for a pad of a satellite
dish for the first tele medicine system in the hospital, painting lines on
the pavement, mowing the grass.
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Bonica:
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Yeah.
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Peterson:
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You name it. I was doing all kinds of stuff in plant
operations.
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Bonica:
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Okay.
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Peterson:
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It exposed me to basically every aspect about the
hospital, which was really cool. I was doing that summers between high
schooling and college. From there during college, I interned for awhile at
the Eastern Maine Medical Center in community relations, public relations.
Right after my undergrad graduation, I went to work for a subsidiary of the
Acadia Hospital called Aspen Ledge. It was an adolescent teen housing unit
...
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Bonica:
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Okay.
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Peterson:
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... For kids with behavioral issues. That's how I got
into Acadia.
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Bonica:
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Acadia. Okay.
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Peterson:
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Between the Aspen Ledge and Acadia Hospital, actually, I
was in the access center at the Acadia Hospital, which was 100 bed acute
care, behavioral psych substance abuse facility.
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Bonica:
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Wow.
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Peterson:
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The access center was basically intake and registration.
I literally was taking phone calls from people at rock bottom and helping
them get into the hospital and get the services they need. Did that for a few
years and realized, "Wow. This is not my gig."
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Bonica:
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Yeah.
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Peterson:
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This is over my head in terms of being able to do this,
hard, hard job ...
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Bonica:
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Yeah.
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Peterson:
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... In terms of it, and I have ultimate respect for
people who can help take care of people at that point in their lives. It's
really trying.
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Bonica:
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Yeah.
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Peterson:
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Did that for three years. Actually got my LSW.
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Bonica:
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Oh, really?
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Peterson:
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Yeah.
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Bonica:
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Wow.
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Peterson:
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LSW too for awhile just to kind of help ...
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Bonica:
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Licensed social worker.
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Peterson:
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Licensed social worker, right.
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Bonica:
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Okay.
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Peterson:
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That wasn't my background. It wasn't my education. I was
still currently in school for healthcare administration.
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Bonica:
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Okay.
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Peterson:
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I needed a change. That's when I moved into
administration and project management, and basically it's because in the
department that we were working at the time, we were all paper-based. These
are patients who were calling in before they were ever registered so they
didn't have a record. We had cabinets full of these in take forms that was
just taking up all kinds of space, and we were filing through stuff. This was
back in 1992, no EMR, none of that and so forth.
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Bonica:
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Sure.
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Peterson:
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I pitched an idea to my boss at the time. I said,
"I think we can do this better with a database. Why don't we?" She
said, "Take some time, couple days, research what options there are and
make a proposal."
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Bonica:
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Okay.
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Peterson:
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I did, and that led to a project that lasted about six
or eight months working with information technology at EMMC at the time. It
led to basically the first computerized pre-patient database for Acadia
Hospital that was in use for many, many years.
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Bonica:
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Did you get something off the shelf or did you build it?
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Peterson:
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No, we built it from scratch.
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Bonica:
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Oh, wow.
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Peterson:
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Basically, I did the research and worked with IT, and we
designed and built it with the staff and figured out how to make it work, and
we implemented it. That was my first exposure to any IT ...
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Bonica:
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Okay.
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Peterson:
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... In healthcare.
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Bonica:
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Because I wanted to ask you about how ...
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Peterson:
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Absolutely.
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Bonica:
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... Made the jump.
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Peterson:
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I'll get there.
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Bonica:
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Okay.
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Peterson:
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It's an interesting track. Anyway, after that was rolled
out, the administration was impressed enough saying, "Here's a guy that
started from scratch with an idea, concept and went all through project execution.
We could use some project management help." I was tapped by the COO, at
the time, said, "Would you liked to come work for us? We are working on
developing out the hospital's department structure." It was a brand new
hospital, remember, in 1992.
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Bonica:
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Okay.
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Peterson:
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Acadia Hospital opened, and it was from scratch, and I
was in on the ground floor. At that time, I then had a matrix reporting
relationship as a result of that project and working with IT. I went to work
for the Acadia COO and the system CIO at the time. That was my first exposure
to matrix reporting as well.
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Bonica:
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Okay.
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Peterson:
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It was great.
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Bonica:
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Yeah.
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Peterson:
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I was effectively the department head of the first ever
IT department at Acadia, got to write policies from scratch, hired the staff
from scratch, and then was also tapped to do some special projects for
administration at the behest of the COO. It was really interesting. It was
never the same day twice, and really that's all I look for in a job is never
a dull moment and never the same day twice. That got me exposed to IT and
started me working down that track as well. A few years later, we had a big
date looming, which was Y2K.
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Bonica:
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Right.
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Peterson:
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The CIO at the time said, "Would you like to manage
that project for the entire system?" Sure. I'm not gonna turn that down,
so 1998, I moved up to the corporate level ...
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Bonica:
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Okay.
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Peterson:
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... And started working for the system as the Y2K
project director.
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Bonica:
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This is ... You moved from Acadia to Eastern Maine
Health Systems?
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Peterson:
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Correct. At the time, it was Eastern Maine Healthcare.
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Bonica:
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Okay.
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Peterson:
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It wasn't Systems yet, but yes.
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Bonica:
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How big was it at the time?
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Peterson:
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EMH ... There were 15 business units at the time.
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Bonica:
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Okay.
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Peterson:
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Probably about 6,000 plus employees representing three
tertiary hospitals, couple of smaller hospitals, for profit arm and two
skilled nursing facilities.
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Bonica:
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Okay.
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Peterson:
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15 different business units.
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Bonica:
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Wow. You were working on policy that affected all of
those?
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Peterson:
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I was working on that project, Y2K.
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Bonica:
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Okay.
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Peterson:
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That all of those boards' representative were my bosses
effectively ...
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Bonica:
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Okay.
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Peterson:
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... Working with the CIO.
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Bonica:
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Okay.
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Peterson:
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That was my first exposure to the system and the
multiple organizations within a system ...
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Bonica:
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Yeah.
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Peterson:
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... Which was really intriguing, because I really
enjoyed starting to get to know and recognize the difference between each
business unit, the hospitals vs the skilled nursing facilities vs the for
profit arm, the pharmacy and collections and warehouse and so forth, and the
culture, the agenda, the vision behind each one of them. It's intriguing how
different they were but how similar in some ...
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Bonica:
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Even though they were all part of ...
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Peterson:
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Absolutely.
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Bonica:
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... Eastern Maine.
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Peterson:
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One system, yet multiple member organizations, different
cultures.
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Bonica:
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Mm-hmm (affirmative).
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Peterson:
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But what was really great about that was the natural
synergy that happens when you bring different people to the table to solve or
work on the same problem. The ideas are amazing and how one organization can
actually be looking out for another when we're all working together. That was
my first exposure to the value of synergy, bringing systems together. I never
forgot that. I'll get back to that later. Y2K, though, was a pretty big
project, $8 million budget, 400 plus people at the peak ...
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Bonica:
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Yeah.
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Peterson:
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... With managing that project, but it was anti-climatic
kind of result. I spent New Years Eve 1999 in a conference room with some
sparkling apple cider, waiting for the things that we knew that were gonna
happen happen, then the next few hours, waking hours, doing some interviews
and so forth with the local TV stations, because it was all over, and nobody
died.
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Bonica:
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Right.
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Peterson:
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It was a dead end job by definition.
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Bonica:
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By morning.
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Peterson:
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Well, a few months of clean up for documentation to get
the legal stuff taken care of and archiving the information.
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Bonica:
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But the lights didn't go out.
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Peterson:
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No.
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Bonica:
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Everything was good.
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Peterson:
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No, everything was good
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Bonica:
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Very briefly ...
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Peterson:
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Sure.
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Bonica:
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... For listeners who maybe were small children at the
time that this happened, what was Y2K? What was the concern?
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Peterson:
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Sure. Well, there was a tactic used in early days of
coding to save lines, save space by abbreviating the year field in most
programs we found from 1970, for example, just down to two digits, 70. We had
to go back into all of these fields when it turned to 2000. Instead of the
computer program, software, or whatever the application might be thinking it
is 1900. It was actually 2000. A lot of software companies or vendors chose
to mitigate the problem different ways. Some expanded their fields to four
digits and put in a conversion table that says anything prior to 1939 would
become a 20 something at that time, so 2000, 2001. Anything since would
remain as a 19, like 40.
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Bonica:
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Yeah.
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Peterson:
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That was one style. Another was basically they said
everything two digits is gonna be 2000 something, and then others decided,
you know what? Our code's too difficult. It's too big. We're getting out.
We're selling the business or we're just gonna end. There were some vendors
that said, "As of December 31, 1999, we're done."
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Bonica:
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Yeah.
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Peterson:
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You better be on a new platform, new software, new application
by then. It was two years worth of work.
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Bonica:
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You had to look at all the systems in the hospital and
try to figure out ...
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Peterson:
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We created the very first, at the time for our system
anyway, complete inventory of all systems, all vendors, all applications. It
just had never been done before, and then had to do a very robust
investigation with every single one of them on high priority. What's gonna
affect patient care? What a failure of this could do. It forced us, actually,
and they're still using it today, many hospitals are, to do contingency
planning based on scenarios. There's no possible way you could plan for
everything, so you think about what happens if the water goes out for any
reason. What do you do? We had libraries of contingency plans built that were
tested, sometimes, just a table top discussion of what ifs all the way to
doing drills. Shut off the water. What do we do? Do we call in the city with
the tanker truck? Do you plug it in to the fire system? You name it. We ran
all these scenarios. It was a lot of work to get ready for basically, what
we've benefit now, disaster drills.
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Bonica:
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Right.
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Peterson:
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Y2K effectively was a great way to tee up disaster
planning.
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Bonica:
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Oh, interesting.
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Peterson:
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That's how we've leveraged the lessons learned that
night. Often, a lot of people say, "A lot of work for nothing." I
said, "No, I think it's the other way. It's a lot of nothing, because of
the work."
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Bonica:
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Right.
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Peterson:
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We did a lot of planning, and there were systems we knew
would fail, but we had vendors who said, "This is the fix. It's gonna
fail. You just go into the code and change the date setting after the
failure, and you'll be fine." There was some work to do the night of.
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Bonica:
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Okay.
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Peterson:
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But those were fewer and further between. The vast
majority of the things it went from 99 to 00. It didn't affect the
application or the function at all. It didn't affect the delivery of care at
all. We just knew it was okay. A lot of time spent putting Y2K approved
stickers on things and so so forth, but you had to check. Heaven forbid. The
lawyers were coming outta school and going, "Okay. We're gonna get
everybody." There's nothing against the lawyers. Nobody knew what was
gonna happen. We just didn't want to put anybody in harm's way.
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Bonica:
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Yeah.
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Peterson:
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We had to go through the due diligence.
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Bonica:
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What was it like managing such a big project relatively
early in your career?
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Peterson:
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Yeah.
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Bonica:
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400 people and ...
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Peterson:
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It was intriguing. I didn't manage 400 people on my own.
I had a team.
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Bonica:
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Right, right.
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Peterson:
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Every business unit had point people and so forth, and
they reported to their local administration and boards and so forth. It was
really about facilitation, and I guess that was the lesson I learned was the
value not in doing everything yourself, but using others and facilitating
getting things done, but also though, being accountable for making sure
things were getting done. It was a great experience, a great education for
me, especially in project management. It was a huge immersion kind of project
management education experience, real world. This is a big project, but I did
also learn the value of deadlines. When there's an absolute non-negotiable deadline,
things change a little bit in terms of negotiating money or quality. Quality
was non-negotiable. We had to deliver. It made pitching for budget fairly
easy.
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Bonica:
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Yeah.
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Peterson:
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You couldn't extend the timeline.
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Bonica:
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Right.
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Peterson:
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We can't kick this down the road a year.
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Bonica:
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We knew this was coming.
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Peterson:
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It was coming.
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Bonica:
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No negotiation.
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Peterson:
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We knew when it was coming, so we had a very clear,
critical path of milestone check off dates. Are we ahead, behind? Allocation
of resources was relatively speaking a little easier when there were absolute
deadlines looming.
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Bonica:
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You'd started at Acadia in Eastern Maine ... Was it
Healthcare at the time?
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Peterson:
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Eastern Maine Healthcare Hospital.
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Bonica:
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You started at Acadia in an Eastern Maine Healthcare
System facility. You moved up to the corporate level, and then after you
finished with the Y2K project, you went on to Eastern Maine Medical Center
...
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Peterson:
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Correct.
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Bonica:
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... Which is also a Eastern Maine healthcare facility.
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Peterson:
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Actually, Eastern Maine Medical Center was where EMHS,
EMH was born. The Acadia Hospital used to be a wing of EMMC, and the
behavioral health wing had just got too big. That creation of that hospital
was genesis for EMH at the time. It was the first, still is, the flagship
hospital of the system.
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Bonica:
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How did Eastern Maine Healthcare, now Eastern Maine
Health Systems, come about? Why did it evolve as a system?
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Peterson:
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It was really because of that.
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Bonica:
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Okay.
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Peterson:
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Now there were multiple hospitals that were being
supported and that the vision there was to be more of a utility or a service
support structure for multiple hospitals.
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Bonica:
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Okay.
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Peterson:
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It was the brain child of a gentleman named Bob Brandow
who at the time was the CEO of EMMC, and they worked together to develop the
support network for these two hospitals. Initially, I think there were only
three employees at the system.
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Bonica:
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Okay.
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Peterson:
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It was really about being a support service to these two
hospitals. From there though, it became a vehicle for supporting other
subsidiaries and affiliates and so forth because of the economies of scale,
the opportunities that that has for negotiating contracts and so forth with
vendors, supplies, payers, you name it. It means the standard low hanging
fruit.
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Bonica:
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Okay.
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Peterson:
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It's evolved since then, of course, as far as what its
intent it.
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Bonica:
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Okay. You went to Eastern Maine Medical Center.
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Peterson:
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Mm-hmm (affirmative).
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Bonica:
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You were the director of surgical and imaging systems.
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Peterson:
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Correct.
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Bonica:
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This is a operational role.
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Peterson:
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Yes.
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Bonica:
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You left IT, and went into an operational role.
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Peterson:
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Yeah.
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Bonica:
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How was that change for you?
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Peterson:
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It was kind of the path I was hoping to look for. Again,
I had always envisioned how do I get from point A to point B, point B being a
senior executive or CEO president of a healthcare organization. I knew that
IT is very interesting, and it exposed me all of the departments of the
hospital, but I need to get some operational experience in clinical areas. I
had, of course, performed work for through the Y2K project these departments.
At the time, the patient care administrator tapped me on the shoulder and
said, "I know your job's coming to and end here. I think we've got some
roles for you." I had just completed my masters program at that time,
and I really enjoyed the mentoring, the teaching component of the project
work that we had at Husson. A lot of the work we did in our master program
was team oriented in projects and learning from your colleagues as well as
teaching your colleagues. My fellow students and I, we got as much out of
each other as we did from the faculty. That's as designed.
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It was a great opportunity for me to practice my new
found skills or newly minted degree by helping to mentor the clinical nurse
department heads of these departments in some of the basics of how to read a
responsibility report, how to prepare a budget, how to report on variances,
and so forth, some of the basic business skills that they just don't teach in
nursing school, but these are department leaders who now have to do that.
This patient care administrator, his name was Finn Dickinson, had the vision
of saying, "Here's a guy who knows business who's interested in
operations who can help maybe mentor these folks."
|
|
|
That was part of my role. I got to work with six
different nursing department leaders, all those clinical departments, and
part of my job was to help teach them business and financial acumen, some
basic healthcare administration stuff. I'm just coming out of school. It was
a great exercise for me. It also exposed me to working with them, the
clinical service line department management. That was my first direct ...
|
|
Bonica:
|
How is that different?
|
|
Peterson:
|
You're dealing with different things, of course, the
clinicians themselves. Many of these are specialties. There's certification
required and so forth, so all the rules and regs that go along with that. The
individual personalities. That was my first exposure to managing providers,
physicians.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
I had a neurology group. Those were new for me, and I'd
been responsible for projects and support departments up to that point but
never profit loss departments. That was new too. You've got revenue to report
as well as now the expense management. It was really about margin management.
There was a lot of ...
|
|
Bonica:
|
You're not just asking for money. You're having to
generate ...
|
|
Peterson:
|
Produce.
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
And produce the money and become self sustaining or
better, ideally.
|
|
Bonica:
|
Preferably.
|
|
Peterson:
|
That was a great exposure there. Of course, I needed
that background, but I think the biggest thing I took away from that was how
much value I got intrinsically helping others learn this stuff. It was great
when I could see this seasoned nurse leader who had been an amazing clinician
all her life and now was dealing with the nursing staff and LNAs or CNAs and
so forth wonderfully, but really didn't understand some of the basic business
acumen. To watch her just get it and thrive from there was really cool. I was
proud of these people who are sometimes 20 years my senior learning from me
and me helping to contribute into their advancement in their own career and
thus the department and the organization. That was really cool. That's why I
kept getting up in the morning. It was a touch job then too, but I was in my 20s
and working with these major departments in a tertiary care medical center.
EMMC is a 426 bed medical center ...
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
... And a lot of responsibility.
|
|
Bonica:
|
Especially for someone so young.
|
|
Peterson:
|
Yeah. It did teach me a lot of humility. I was humbled,
being given that much responsibility, but I got a lot of good feedback from
the nurses. They were gracious. They were grateful as well, and many of them
said, "Nobody ever taught me this." It was a lot of fun. I really
enjoyed it.
|
|
Bonica:
|
There's often conflict between administration, nursing,
and then medical staff, physicians.
|
|
Peterson:
|
Mm-hmm (affirmative).
|
|
Bonica:
|
Did you run into that? And, how did you overcome that?
|
|
Peterson:
|
Mm-hmm (affirmative). That's a good observation. Many
times it's folks thinking, "I'm clinical. I'm not clerical."
|
|
Bonica:
|
Right.
|
|
Peterson:
|
The administration piece is just, "Don't bother me
with that stuff. Let me take care of the patients." Absolutely. I agree.
I respect that, and frankly, I know I can't. I can't do that. Great. Let me
do everything I possibly can to enable you to do that effectively. However,
the reality is as well, we do need to take care of some of those things or we
can't keep taking care of patients. We need to keep the doors open. We need
to keep investing in technology or resources or people or whatever it is to
keep being about to deliver the mission. Some of the stuff is a necessary
evil, if you will, but the way I bridge that gap, honestly, is just by
listening and having conversations about, "What is it that you don't
understand? What are you resisting? Where's the rub here?" Through
conversations with folks got them to understand my perspective. I learned
their perspective, and we came to a place where we could come together with
either a path forward or a solution, an idea, whatever that served us both.
Frankly, I didn't categorize it as clerical, clinical, administrative or
clinical function. It was just, we're running the department.
|
|
Bonica:
|
Right.
|
|
Peterson:
|
How can we best do that for the patients? That's really
how I led in with [inaudible 00:26:26]. I'd log in differently with different
audiences, speak to leadership or nurses differently than you do to medical
staff and so forth, CFOs. You just gotta understand your audience, so I'd
adapt the message a little bit. All of the time, I found if you keep the
patient at the center, it's hard to argue. You just change the content around
a little bit. Context is always patient first. You're gonna be good.
|
|
Bonica:
|
You did that role for about two years.
|
|
Peterson:
|
Yeah.
|
|
Bonica:
|
Then, you went back to ...
|
|
Peterson:
|
Corporate.
|
|
Bonica:
|
... To corporate.
|
|
Peterson:
|
Mm-hmm (affirmative).
|
|
Bonica:
|
Back to Eastern Maine Healthcare or ...
|
|
Peterson:
|
At that time, it was EMHS.
|
|
Bonica:
|
Hadn't evolved to EMHS ... To be the director of
e-business, so back into the IT ...
|
|
Peterson:
|
Yep.
|
|
Bonica:
|
... IM kind of role. What was e-business?
|
|
Peterson:
|
Good question. It's a little misleading too, because yes
it had IT, IM components, but it was kind of a marriage between that and,
actually at the time, there was this fledgling possibility for healthcare,
which honestly is still evolving today, was this idea of personal health
records and actually moving the EMR out into patients' hand. E-health was
just starting, so e-business was really meant to bridge the gap between IS,
finance, marketing, and the actually clinical record, HIM if you will or the
EMR with, again, the patient at the center.
|
|
|
I had enough experience in all of those areas at the
time that the VP of Business Development Marketing for the system approached
me and said, "Hey. We've got this wild idea. We want to get into
e-health. Would you lead it?" There was no e-business department. There
was no e-health department, again. I always like the idea of if you can write
your own job description, go for it.
|
|
Bonica:
|
Yeah. Okay.
|
|
Peterson:
|
It was just one of those opportunities I couldn't pass
up. I also missed, to a degree, working with the multiple business units,
multiple organizations. That was another reason I was attracted back to
corporate.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
EMMC had a culture. Everybody else had a different
culture and so forth, and I really liked bridging between them and seeing the
values and grabbing the great ideas from one or another. It was a little
homogeneous for me at EMMC. I really like working with the multiple
organizations. It was an opportunity to do both, so I did. We actually became
the first integrated health delivery network in the country to roll out an
e-health product, personal health record, back in 2003 I want to say. Winona,
Minnesota had gone first, but they were just a single entity. We rolled it
out for multiple hospitals across the system, first in the country.
|
|
Bonica:
|
What can you do with that as a patient?
|
|
Peterson:
|
That was the first patient messaging system ...
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
... Secure patient messaging between them and their
provider, scheduling appointments, asking for refills, the first place to
keep track of all your immunizations, allergies, and so forth. It was
probably an idea about ten years ahead of its time. Actually, we talked a
little bit about that. At the time, I was serving as the National User
President of IQ health, which was Cerner's e-heath product, and we talked
about this. This is pretty progressive, and not a lot of people are adopting
it, and how do you get the physicians bought in that this is just one more
distraction for them. Despite the fact that you could save enough money in
stamps to pay for the system, it was difficult to get adoption. At the time,
we never made our target of 5,000 registrants. Ultimately, it folded.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
We under-resourced it in my opinion, but it was also a
little bit ahead of its time.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
PHRs now are coming back and someday Google's gonna
solve that. All the rest of them ... Just everybody will have their irecord
or whatever it is, but we were literally talking about iprescriptions, here's
an information prescription, read these two articles, call me in the morning
kind of thing.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
It was too early.
|
|
Bonica:
|
Right.
|
|
Peterson:
|
At the same time, I was developing out the e-business
department, the structure for managing these projects on the IT side and
working between IT and finance to get them budgeted and paid for. It was
really about building infrastructure at the parent level that's still in
shape today. It was the advent of the first project management office for IT
started from the e-business department.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
It was still a very worthwhile several years.
|
|
Bonica:
|
You added some additional responsibilities in 2003,
became the corporate director for information systems.
|
|
Peterson:
|
Correct.
|
|
Bonica:
|
What [inaudible 00:31:25] to your roles at that point?
|
|
Peterson:
|
That actually came about, because at that time, the CIO
who I was working for, again, matrix between the CIO of the system and the VP
of Marketing and Business Development at the system said, "We have
another project." It was the same guy, Dev Coulver. He's still in Maine
at Health Infonet, said, "We've got another project that's pretty major.
It's gonna make Y2K look like a cakewalk. Are you in?" I said, "Of
course, Dev. I can't turn away from a challenge like that." We at the
time had seven acute care hospitals on I think it was five or six different
clinical information systems, business systems. He said, "We want to
convert them all to one single platform." It was called the, "Together
Project," and we did. I was the project director for that project that
brought all those hospitals to the same platform within two years.
|
|
Bonica:
|
Wow.
|
|
Peterson:
|
Pretty significant rollout, huge budget, lot of work
that got done, and it was a great team effort to do that, but that's where
that evolved from. They just gave me the title of Corporate Director. After
the Together Project, it continued in now we've got a single standard
structure, so we need the leadership at corporate to help facilitate the
rollout of managing these systems ongoing. All of the local IT directors then
reported up through me to the parent. That's how we started managing the
economies of scale and figuring out how to prioritize projects across the
system and so forth. Again, it was a project driven development of
infrastructure as the system continued to evolve and grow.
|
|
Bonica:
|
In 2006, you left Eastern Maine Health System to go to
yet another affiliate, Sebasticook Valley Hospital in Pittsfield, Maine ...
|
|
Peterson:
|
Right.
|
|
Bonica:
|
... Where you spent the next nine years in a series of
positions culminating with being the Chief Operating Officer.
|
|
Peterson:
|
Correct.
|
|
Bonica:
|
Where is Pittsfield, Maine? And, what role does
Sebasticook play in the community?
|
|
Peterson:
|
Well, Pittsfield is about 30 miles west on I-95 corridor
from Bangor.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
The next closest small hospital to the corporate parent
headquarters and the Eastern Maine Medical Center in Bangor. SVH is a
critical access hospital, 25 bed hospital. If fills a very crucial need for
the community where it's a small community, and SVH is like many communities
where the critical access hospitals are the largest employer in town. It was
actually created by a few families in Pittsfield back in the '60s who needed
a place to have their women have their babies. Families got together. Many of
the families are still in town, very supportive of the hospital. It was a
great environment to be going into, first foree into the senior executive level,
into a very supported hospital by the community.
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
This was not going into a broken ship or anything like
that.
|
|
Bonica:
|
To turn it around.
|
|
Peterson:
|
It was under great leadership at the time. Actually, one
of my mentors was the CEO at the time, and he had an opportunity for me. We
were at an ACHE conference, actually. He says, "I got an idea for you.
We're getting big enough that my ... " At the time, Chief Operating
Officer, her scope and scale was getting a little too large for her for what
they really wanted to do. The position I moved into at the time VP of
Clinical Services was brand new.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
One of those chances to write your own job description.
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
Basically, I picked up all of the out patient,
ancillary, and diagnostic service departments and she kept on nursing and the
other departments. Between the two of us, picked up the operational role at
the hospital.
|
|
Bonica:
|
That's a big scope. I'm sure it was more people necessarily
that you had managed before, but it was a broader scope ...
|
|
Peterson:
|
Yes.
|
|
Bonica:
|
... Than what you had had.
|
|
Peterson:
|
And, it was back to clinical.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
That's the thing. That's the point I want to make here.
As Corporate Director of IT, and I was one of three or four corporate
directors, because we had a little different roles but the same title. I was
kind of on a CIO track, and I had to make a decision. Actually, the CIO at
the time, we had a conversation. I had won an award from John Glazer
scholarships and so forth, became nominated for Ones to Watch in CIO Magazine
2005, and it was shaping up like, "Am I gonna be a CIO or am I gonna be
a CEO?"
|
|
Bonica:
|
Right.
|
|
Peterson:
|
I had to make a decision at that time, and I said,
"You know what? I feel like I'm getting a little too far, a little too
disconnected from the patient care. I've lost a little of the fire in my
belly, if you will. I need to get closer. I need to get back to clinical
operations." That's why I was intrigued about going to a member hospital
and getting back into clinical operations so I could get back on, in my
opinion, the CEO role.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
At the time, they were talking, "Oh, yeah. A lot of
CIOs are becoming CEOs." Didn't pan out that way, still hasn't.
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
They're a critical aspect of running an organization and
they should be one of the most depended upon advisors to a senior executive.
Absolutely. But, they're not becoming CEOs and that's ultimately, again, what
I wanted to do since I was 14.
|
|
Bonica:
|
It's a very specialized skill set.
|
|
Peterson:
|
Right. Yeah. I took the opportunity when Jack May, at
the time, was the CEO at SVH. He says, "Here's this new role we think
you could be successful in." I took the shot.
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
I was very pleased. It felt great. I was happy getting
that much closer to the actual patient care delivery. Again, I could never
stand the guts and gore myself, but being able to provide the flumonimous,
the resources they need to draw the blood well or provide the surgeon the
tools they need to do that laparoscopic procedure, that's what I could do. I
felt like back in college, facilitating problems and solutions.
|
|
Bonica:
|
You have all these different operations. Obviously, you
can't become an expert in each of them ...
|
|
Peterson:
|
Correct.
|
|
Bonica:
|
... Which would kind of be ideal ...
|
|
Peterson:
|
Correct.
|
|
Bonica:
|
... To lead, but obviously, that's just not possible.
|
|
Peterson:
|
Right.
|
|
Bonica:
|
How did that affect your leadership style? What did you
have to learn to do?
|
|
Peterson:
|
Well, what I learned to do is execute the old adage of
... I think it was Confucius actually, and I apologize for the cliché here,
"The wiser man has more questions than answers." I learned how to
ask the right questions. I learned how to ask the right people, "Tell me
enough so I can be helpful," and draw out of the experts what it is they
needed, what their ideas, their recommendations. Let's think through the
impact. Let's think about an exit strategy. Let's think about all the
possible options and then together make the best decisions. That's
facilitation of of a solution, not determination of a solution.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
That's what I really learned to do well. I had to do
that in IT long before, because I wasn't an IT geek. I wasn't a guru of
coding, but I knew enough to know how to ask the right questions so the
people who did know the detail so that we got the best answers. From a
leadership perspective, what that taught me was the far more valuable or
beneficial way in terms of meeting true potential is collaborative decision
making vs directorial or top-down decision making.
|
|
Bonica:
|
Let me ask you to extend that a little bit.
|
|
Peterson:
|
Sure.
|
|
Bonica:
|
Most of the time, the people working for you are great,
but sometimes, you've got a problem in there ... Without being an expert in
the area, how would you detect it?
|
|
Peterson:
|
That's why metrics are important.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
Predetermined how we were gonna measure success. What's
the pace we should be hitting, the run rate for these milestones, goals,
whatever it is? Getting agreement upfront by and then vetting them with other
experts. We had a system. I could lean back, turn to another VP of Clinical
Services or Ancillary Support and say, "What are you guys doing? How do
you know when you can wave the flag of success?" You learn from other
people.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
Work with the experts locally and say, "Does this
sound reasonable? Or, if we wanted to get here, what would it take?"
Let's line up the resources, put them in place, and then, we should start to
see this progress. I didn't need to know the detail or be an expert. All I
needed to know is how to keep people on track, hold them accountable,
respectfully of course, but give them the tools and resources they needed to
reach their potential. Then, it just fell out from there. Now, I've always
been an inquisitive soul, so I like to ask a lot of those kinds of questions,
because I want to understand, and I picked that stuff up and retain it. I can
still tell you how long it takes to thaw out frozen plasma, because we ran
into a problem one day in the lab, and I asked the question, "How much
time do you need?" I remember. Now I remember that as now I'm talking
about, "Okay. If we're gonna be getting our plasma from over here, we
better be within 35 minutes."
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
Those are the things that just stick with me, but really
it's about making sure you have agreement with the experts about what you're
gonna be measuring and what's reasonable. What's the aspirational goals?
Then, just measure. It's the discipline of accountability.
|
|
Bonica:
|
You were on the senior executive team.
|
|
Peterson:
|
Yes.
|
|
Bonica:
|
What additional responsibilities were implied by that
role?
|
|
Peterson:
|
Of course, I had to staff some board committees and help
out ... I was given the opportunity to develop and manage facilitation of the
strategic planning for the organization or the last six or seven years. That
was inherently ... I had that responsibility. A lot of report to not only the
local CEO, but the part, and responsibility to system level task forces and
either work groups or task force design short term, looking at something from
a system level. As member organization executives, we had had a
responsibility both to the local organization as well as the system. My
personal philosophy of a system is that strong members make a strong system
and vice versa.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
It's a shared responsibility.
|
|
Bonica:
|
One of the things you talked about when I reviewed your
CV is you were involved in the system level steering committees around LEAN.
|
|
Peterson:
|
Yes.
|
|
Bonica:
|
What is LEAN? Why is that important?
|
|
Peterson:
|
LEAN is important honestly, because the nature of
healthcare today, we have to continually drive down the costs, and LEAN is
about doing just that, the relentless pursuit of the identification and
elimination of waste in our processes. Frankly, healthcare is a target rich
environment for that. A lot of processes we do are truly non value added.
It's either they grew up over time and grew up like a weed, sometimes, you
might hear it said, that really aren't adding a whole lot of value to the patients
who'd be willing to pay for it. Maybe there's some business valued added
steps, of course, registering a patient, billing, and so forth. We gotta do
that to run the business, but a vast majority of our processes are made up of
some of those eight deadly wastes that LEAN teaches.
|
|
|
We actually have rooms dedicated to waste. They're
called waiting rooms. It's a unique take on transfer of manufacturing
techniques and tools, actually originated in Japan after World War II, Toyota
production system, and actually was an American went to Japan, introduced it
to them ironically enough, because nobody in America wanted to hear it after
World War II. It was slow to be adopted in the healthcare industry. Only in
the last dozen years or so that it's become the ingrained way of doing
things, because we just need to drive costs out of the system. The pressure
from the payers and the CMS is not gonna change or stop. We have to get
better at driving costs out without sacrificing quality, and that's really
about the principles of LEAN. Quality's non negotiable, but we can improve
processes to work smarter, not harder, as you've heard.
|
|
Bonica:
|
Right.
|
|
Peterson:
|
LEAN is just a set of tools and techniques to do just
that, but LEAN culture is different as well. LEAN tools are everywhere, and
some of them are intuitive. Some of them are literally a foreign language, so
you've gotta be aware of them and learn some of that discipline, but it's as
much about having a LEAN philosophy in terms of being willing to let go of
control sometimes for leadership and say, "The people who can solve
these problems best for us are the people who work the process or the system
every day." It's the staff, line staff. We have to be comfortable and
willing at the executive level to let got and admit that we don't have all
the answers, bu let's engage the staff, and you can actually turn a group of
employees in to an army of people looking for problems to solve. When that
happens and you empower them to solve them, you can move mountains.
|
|
|
It's exciting work to me, because I love to see the
process, but I also love to see the staff get engaged, empowered to solve
their own problems. Frankly, by doing that, we have a much better chance of
solving them to the best of our ability than just applying a solution that we
think would be best, but we don't know the whole story or worse, somebody
says, "That's great. They don't know what they're talking about up
there. We'll pretend we're gonna do this and let's go back and do it our
way," or necessity is the mother of invention. They end up band aiding
or put a work around a place. Line staff in healthcare are the masters of
workarounds. It's necessary, because they have to take care of the patients.
|
|
|
It's really about harnessing that energy, applying some
tools, and then, support that culture to allow those tools to take root and
really sustain improvement. It's exciting to see more and more healthcare
organizations adopting LEAN and moving forward with that, because it really
can make transformational difference.
|
|
Bonica:
|
Is this something you've retained?
|
|
Peterson:
|
Absolutely.
|
|
Bonica:
|
Try to use?
|
|
Peterson:
|
We're using LEAN here. One of the reason, honestly, I
think I got this job was because of my experience in LEAN. They were
interested in doing that for all these same reasons.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
It's a discipline, and some of it's intuitive. As I
said, some of it is literally a foreign language. We have to be trained to do
it, have the discipline, and then support it from the very top.
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
Otherwise, it's just another program de jure, but we can
thank some innovators like Swedish Medical and Virginia Mason and so forth
who have paved the way in healthcare to say, "LEAN can work in
healthcare."
|
|
Bonica:
|
You were named Chief Operating Officer in 2013.
|
|
Peterson:
|
Correct.
|
|
Bonica:
|
What did that change in title represent for you in terms
of the leadership structure at ...
|
|
Peterson:
|
Sebasticook.
|
|
Bonica:
|
... Sebasticook Valley Hospital and your role?
|
|
Peterson:
|
At that time, the COO became the CEO, and I was the CAO,
which was relatively unique in New England. There weren't that many CAOs,
Chief Administrative Officers. Before she became the CEO, we had a CAO and a
COO. Again, for a small hospital, it was a little unique, but it was just
titles. We both had operational responsibilities. When she became the CEO, I
basically adopted some of the responsibilities that she had, became a leader
within a dyad model, working with the CMO at the time, the medical staff office,
and picked up the responsibilities for the specialty surgeon practices and so
forth, hospital lists and ED docs and so on. Basically, I retained all my CAO
responsibilities plus that ...
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
... Became COO, and we didn't backfill the COO other
than with me.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
It was just an expansion of role and responsibilities.
|
|
Bonica:
|
Okay. After nine years at Sebasticook and almost 19
years with Eastern Maine Health System ...
|
|
Peterson:
|
28 if you go all the way back ...
|
|
Bonica:
|
Oh, okay.
|
|
Peterson:
|
1988.
|
|
Bonica:
|
Okay. Let me back that up.
|
|
Peterson:
|
29, now. [crosstalk 00:48:09]
|
|
Bonica:
|
Yeah, because you started ...
|
|
Peterson:
|
Yeah.
|
|
Bonica:
|
... In high school.
|
|
Peterson:
|
'88.
|
|
Bonica:
|
Right. So, '88 right after high school.
|
|
Peterson:
|
Yep.
|
|
Bonica:
|
Okay. After nine years at Sebasticook and 28 years,
depending on how you count, with Eastern Maine Health System, you left Maine,
and you came to Berlin, New Hampshire to be the President of Androscoggin
Valley Hospital. Before we talk about your current role, can you tell us a
little bit about Androscoggin Valley Hospital and about Berlin, New
Hampshire?
|
|
Peterson:
|
Sure. Absolutely. Berlin is an interesting town. Of
course, it was a mill town up until very recently. It was the second largest
city in New Hampshire.
|
|
Bonica:
|
Really?
|
|
Peterson:
|
Behind only Manchester.
|
|
Bonica:
|
Yep.
|
|
Peterson:
|
But when the mill closed and didn't come back, there was
an exodus of people, honestly, because the jobs. It's, I believe, on its way
back up. It kind of hit rock bottom, plateaued, and now the economy is
starting to come back. It is your pretty typical small New England community.
The values here are very similar to the values I've found and seen in small communities
across northern New England. Honestly, that was one of the main attractants
for me, because I did spend a little time in southern Florida while my wife
was in grad school, and it taught me fairly clearly that, nice place to
visit, but I really fit in northern New England.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
It was really about the values, the sense of community,
the sense of working together, but autonomy and independence and pride in
accomplishment of things I think is rooted in this part of the country.
Berlin's very similar to many small towns across northern New England, Maine,
New Hampshire, Vermont, especially. 10,000 people roughly in town, but the
greater Berlin area if you think of Gorham and Jefferson, Randolph, up toward
Milan, as far as Errol, New Hampshire. We serve about 30,000 roughly people
in this general vicinity. Androscoggin Valley Hospital's a 25 bed critical
access hospital that actually you can see is a little bigger physically than
many critical access hospitals, because it was built here in the '70s when
there was 30,000 people here in Berlin alone. It was built originally as a 94
bed hospital.
|
|
Bonica:
|
K.
|
|
Peterson:
|
Gives us some definite advantages. There's some good
space here we can utilize, but we are still a critical access hospital. 20%
of our booked business is inpatient. 80% roughly is in outpatient services.
We have a group of specialists, a lot of sub specialists you wouldn't expect
to see in a small rural area, neurology, pulmonology, cardiology through a
collaboration with a catholic medical center, and a number of other
subspecialties. Again, somewhat unique to critical access in small towns.
|
|
Bonica:
|
How do you bring in all these specialists to a
relatively small facility, relatively small town? How do they build enough
business to support themselves?
|
|
Peterson:
|
That's a great question. Part of it is having enough to
warrant expense and having the demand to warrant the capacity if you will.
It's really about collaborating, collaborating with, for example, the cardiologist
we have here is through a collaboration with Catholic Medical. We've
collaborated with other small hospitals that jointly together, you have
enough volume to support a full time provider, because part time providers
aren't all that frequent or it's hard to find them to begin with. They don't
want to come work part time. If you're just out of school and you're staring
at huge student loans in the face, do you want to work part time? It's really
about having that critical mass, so collaboration's the name of the game for
those things. You have to. We're working with Dartmouth, for example, to help
with our radiology program or lab working with other small hospitals. You
gotta get to that tipping point, that critical mass, so collaboration is
really how to do that.
|
|
Bonica:
|
Okay. You have Valley Birth Place and women's services
...
|
|
Peterson:
|
Mm-hmm (affirmative).
|
|
Bonica:
|
... Is one of your major product lines.
|
|
Peterson:
|
Yes, yes.
|
|
Bonica:
|
Can you tell us a little bit about that?
|
|
Peterson:
|
That's our women's services lines, OB and delivery. It
is now only one of two places in the north country, northern New Hampshire
where women can have their babies. Incredibly important, because this is a
huge geographic area. We're very proud of that service. It's one of the
leaders in the region. We do a great job. The staff up there are really
compassionate folks as are all the staff here, but especially up there, they
love what they're doing. It shows. It's one of our best areas.
|
|
Bonica:
|
Roughly how many FTEs are employed here?
|
|
Peterson:
|
320 employees.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
About 51 active medical staff. We have a pretty good mix
too of employed vs contracted or independent medical staff, and it's worked
out well.
|
|
Bonica:
|
You are a member of North Country Healthcare, the newest
integrated health delivery network in New Hampshire. When did this
affiliation come about and what was the genesis of that?
|
|
Peterson:
|
It officially became a system on April 1st of this year.
It's brand spanking new still, but it was brainchild of a couple of folks who
are still now in administration of the system, Warren West and Russ Keene.
Russ was my predecessor here, the CEO at AVH, and Warren was at Littleton
Regional. Actually, the concept started a number of years ago, thinking about
how we can better serve the population of the North Country by doing just
that, working together, collaborating to find those critical mass
opportunities or driving out costs and driving up quality. It's really what
any system exists for is to do those two things. Frankly, I believe because
of the realization that competition is counter productive, especially with
struggling economies and everybody is fighting for a piece of the pie, if you
will, that isn't getting any bigger at this point. Collaboration is far more
productive, far more cost effective, and it was about bringing them together
with that vision of bringing four critical access hospitals to the table to
help leverage economies of scale and share best practices across the North Country.
|
|
Bonica:
|
How did this system convince regulators that allowing
the four critical access hospitals that are basically the sole providers in
this are to ...
|
|
Peterson:
|
Work together.
|
|
Bonica:
|
... Work together, come together, and not say,
"Well, that's anti-competitive, and we can't allow it."
|
|
Peterson:
|
I'd actually have to defer to Russ and Warren ...
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
... A little bit on that, but from my understanding, it
wasn't easy.
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
We actually had to make agreements that for a period of
time anyway, the system would not require the exit of any service line from
any one of those given communities. We had to make commitments to the Ags,
and we are not intending to remove or take away any service line from any of
these communities. The intent is truly to grow and enhance our ability to
deliver specialty services close to home, but again, there's the angst and so
forth, because I think everybody sees the writing on the wall. Duplication of
services is not cost effective. We're about driving out costs, so does that
mean we're gonna have to travel across the valley or up to Colebrook or vice
versa in order to get access to the services we need? That's not the intent,
but everybody sees regionalization of services lines kind of makes sense
intuitively. How are we gonna make sure that we can continue to deliver the
local missions without jeopardizing or becoming too overburdened in terms of
cost? That was one thing I know we had to do with AG before we got the blessing
...
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
... To move forward was to make a commitment that we're
gonna study the opportunities and study the right models and so forth in
northern New Hampshire, but we will not remove specific service lines for a
specific set of time. That was I think was got us over the hump. We got the
blessing to move forward.
|
|
Bonica:
|
That's just really interesting. Typically when I think
of a system, I think of something like Eastern Maine where you've got an
Eastern Maine Medical Center, big hospitals ...
|
|
Peterson:
|
Right.
|
|
Bonica:
|
... Anchor, and then small hospitals ...
|
|
Peterson:
|
Right.
|
|
Bonica:
|
... Orbiting around it ...
|
|
Peterson:
|
Right.
|
|
Bonica:
|
... Whereas, this a merger of equals.
|
|
Peterson:
|
It is very unique. Honestly, that was one of the things
that attracted to me to this role. I'm not a guy that moves around a lot. I
may have moved around in my career, but it was always within the same system,
actually lived in the Bangor area for the last 21 years. To uproot my family
and move to New Hampshire was a pretty risky undertaking for me. I need to
feel very comfortable with it. One of the attractants was this new system.
This was a system of equals, as you said, four critical access hospitals
coming together to try to achieve something. There is no 800 pound gorilla
here.
|
|
Bonica:
|
Right.
|
|
Peterson:
|
It's not somebody saying, "You will practice the
way we do it, because it's the way we do it." It's an opportunity for
the four hospitals to come together and say, "We're all critical access
hospitals so we're automatically speaking the same language." There
really is a difference between critical access and PPS, or the prospective
payment hospitals. Sometimes, things get lost in translation. "Why do
you do it that way?" "We've got a cost report we need to worry
about." That's why we look at things a little differently. That lack of
awareness or understand wasn't even an issue. We'd all be living it.
|
|
|
The other attractive part, I'll be honest with you, is
I'm the first of the new presidents. Right out of the gate, I'm gonna have
tenure, if you will, over the new presidents that are now being hired. When
we come together to solve problems as a system, there's no baggage. I will
not have had worked with these folks in the past as competitors and be
carrying this memory from years ago, "You kind of slighted me on that
deal two years ago."
|
|
Bonica:
|
Right.
|
|
Peterson:
|
No, we're starting from scratch. All that learning
curve, if you will, is a nonissue. We will get to collaborate and work from
this point forward, which is great. That's a real advantage, I think. Just
knowing that there isn't a 800 pound gorilla out there, even if it's not,
because I know. I've worked at those, and I've been at the system and watched
it. That's not the intent. That's not where people's ... There's no malicious
effort to do that, but the perception, however, "They're so arrogant.
They're just imposing their means of practice on me, and if I wanted to go
work and practice like they do in Burlington or Lebanon or Bangor, wherever,
Boston, then I would've moved there. Let me practice the way ... " No.
It's really about best practices, sharing the best practice, and those can
come from anywhere, including four small hospitals.
|
|
Bonica:
|
Yeah. That's fascinating.
|
|
Peterson:
|
It was really somewhat unique in the country, I believe,
of four similar sized hospitals coming together like this.
|
|
Bonica:
|
Yeah. I was wondering if it is maybe the only one.
|
|
Peterson:
|
I don't know.
|
|
Bonica:
|
Okay. [crosstalk 00:59:15]
|
|
Peterson:
|
It's certainly the only one in New Hampshire. It's the
only one I've ever seen ...
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
A system, usually evolve the way you've described.
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
A large, tertiary care center being the hub and spoke model
and it all feed to that. This is four hospitals coming together to better
serves the population of the area we cover.
|
|
Bonica:
|
I wanted to ask about governance ...
|
|
Peterson:
|
Yes.
|
|
Bonica:
|
... Now that Androscoggin is a member of the North
Country System. Traditionally, the president reports to a local board.
|
|
Peterson:
|
Mm-hmm (affirmative).
|
|
Bonica:
|
What is reporting structure?
|
|
Peterson:
|
I've ... Back into matrix reporting. I am responsible to
the local board. I have a board chair and a board committees and a full board
as traditional structure, but there's also a parent board that the local
board reports up to in terms of ratifying our strategic plan and our budget.
That's pretty traditional with systems and board governance structure as well.
Personally, I also report directly to the system's CEO, which is Warren West.
I've got my "boss," the board at AVH, and my boss Warren West, the
system CEO. It's really making sure all the things we're doing are in line
with the best interests of both, the member organization and the parent, the
system, as much as possible. Sometimes, there will conflict in those things.
We have to work those through, but ultimately, I do have a dual reporting
line, in you will.
|
|
Bonica:
|
How does someone come to be on the AVH Board?
|
|
Peterson:
|
They are nominated by a nominating committee made up of
the current board members based on need. We're actually going through a
governance optimization project right now as it were, identifying a matrix of
skill sets, representation, geographic representation, and so forth, of the
make up of our current board. We identify members of the community who have
the capacity and interest in doing so, reach out to them, vet them through
the nominating committee. They get ratified by our local board first. New
board members, that is, also have to be ordained, if you will, by the parent
board ...
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
... To sit on the local board.
|
|
Bonica:
|
You're looking for geographic representation?
|
|
Peterson:
|
Yes.
|
|
Bonica:
|
You want somebody from Gorham and somebody from Berlin
and ...
|
|
Peterson:
|
As wide as we can ...
|
|
Bonica:
|
Right.
|
|
Peterson:
|
... For our primary and sometimes our secondary service
area.
|
|
Bonica:
|
What else are you looking for aside from geographic ...
?
|
|
Peterson:
|
It depends on really, honestly ... In an ideal setting,
you'd want a good cross-section of skills or interests based on what the
hospital is actually going through at the time. We don't have board term
limits right now, but we want to keep fresh ideas coming, but for example, if
we were getting into a major construction project, we might want to have
somebody on the Board who's got construction management experience. If we've
got a lot of things going on with contracts or payer negotiations, we might
want somebody well versed in the insurance industry or banking, legal, you
name it. We always want to have representation of the community as wide and
broad a demographic of representation we can get, clinical, business,
financial, legal, and so forth. Again, it's gotta be a good cross-section of
who they represent is our community.
|
|
Bonica:
|
Do some of your providers sit on your board?
|
|
Peterson:
|
Yes. We always have providers. President of the medical
staff, by by law, sits on the board as well as we have a board member at
large who's a physician. We currently don't have nursing on the board, but
we're working on that as well, because it's always a good idea to have that
clinical representation right at the board level.
|
|
Bonica:
|
How many board members do you have, typically? Probably
fluctuates a little bit.
|
|
Peterson:
|
It does from time to time. We'll get a variation based
on departures and so forth, but by laws allow for anything ... I've got it
right here. We've got new by laws. 18's the maximum. I think 12 is the
minimum. Honestly, you want a good enough number so that we can do a lot of
work through committees, and we don't want to overburden. It's a volunteer
position. These are people with day jobs. We want to be sensitive to that,
but right now, we have 16 board members, and we're considering whether or not
we're gonna backfill the other two vacant positions to get to 18. Sometimes,
a small board is a little more nimble and efficient, but it's also, again, we
want to spread the wealth and figure out do we have all of the areas of
interest represented. We're going through that process right now with our own
governance committee, evaluating are we gonna keep it at 16 or drop it to 14
through attrition or nominate and grow some more folks.
|
|
Bonica:
|
What's the work of the board? What do they actually do?
|
|
Peterson:
|
They are responsible, ultimately, for the quality of the
care that we deliver. That means they are responsible for making sure that
the providers that we privilege and credential here will meet the needs of
the community at the quality that the community expects. Ultimately, that is
their job. They're also have a responsibility to hire the Chief Executive and
execute the policies to achieve the vision of the organization. In a
nutshell, that's it. They have entrusted me and my team to the responsibility
of managing this community asset, and that's effectively I work for them.
Nobody else in this building does, but they have empowered me to put into
place organizational structure and policies and procedures and so forth to
execute the vision of the organization, which is a collaborative definition
with administration and the board.
|
|
Bonica:
|
Where does strategic planning happen?
|
|
Peterson:
|
Yep.
|
|
Bonica:
|
In this organization?
|
|
Peterson:
|
Board level.
|
|
Bonica:
|
Board?
|
|
Peterson:
|
Absolutely. This is something that ... Strategic
planning will now also take place at system level as well, because strategic
planning at a member organization has to support a system vision in strategic
plan. This is a unique time for us. The system is so new, there is no system
strategic plan, so we really don't have a current strategic plan for AVH. We
have a working plan. We have a tactical plan just to stay on budget. We do
have those things that we're trying to achieve for growth and service and
equality and so forth. That's an operation plan. A long range strategic plan
we'll get into next year. We do actually have a three year work plan at the
system that we're getting into strategic planning now, but in other systems
I've worked in and member organizations and so forth, best strategic planning
happens at the board level, but it happens with engagement by the medical
staff, the community, including the patients we serve, the departmental
leadership, and the line staff, working, administration, just facilitating
all of that, calling out, "Where do we want to go? How do we best, cost
effectively get there? How do we grow the quality? What's our standard going
to be and how do we keep pushing that standard higher?" That fleshes out
the strategic plan. I see myself as the facilitator, not the definition of
that strategic plan.
|
|
Bonica:
|
You report to the board ...
|
|
Peterson:
|
Yes.
|
|
Bonica:
|
... As well as the CEO of the system.
|
|
Peterson:
|
Yes.
|
|
Bonica:
|
How do they evaluate you? What are they looking at?
|
|
Peterson:
|
Very clear goals ...
|
|
Bonica:
|
You did a good job. These are the things you did well.
|
|
Peterson:
|
Yeah. I've actually just yesterday reported the six
month update status on the hospital goals to the board committee that's
looking at that. There are 45 items that said, "This supports our work
plan. This takes us to where we want to be to get ready for the long term
strategic plan." If we had a strategic plan, it would be the items on
the operation plan that support the strategy. It's very clear, very objective
as well. How are we doing with the margin, service, quality metrics, people,
turnover, retention, recruitment, blah, blah, blah, engagement, results, and
so forth? How are we doing in the community? Are we giving back? Are we
supportive of volunteerism and so forth? There's very clear defined metrics.
There have to be, because my departments have clear tactics and goals that
will feed up to the hospital goals. I'm measured based on the hospital's performance
based on those metrics. That's the objective part.
|
|
|
Subjectively, it's about how are we doing with building
and nurturing relationships? Honestly, I believe that these roles are all
about relationships. Nobody gets anything done on their own. We need each
other and other people to get these things done. It's impossible to achieve
full potential doing things by yourself. This is really about relationship
management. The subjective part of my evaluation is really, how are you
doing? Have you built relationships with key community members, city
management, key providers, the regulators, legislators, you name it? That's
how I'm evaluated.
|
|
Bonica:
|
What are the major challenges of running a hospital in
the North Country?
|
|
Peterson:
|
Recruitment, retention of high quality professionals
that want to live in the North Country, and that's always a challenge. That's
not unique to the North Country. I think it's unique to rural American. There
is an assumption that you can't get good help up here. This is the B team, if
you will. I have not found that to be true. You just have to make sure that
you find the best fit. There are great providers, great staff who want to
live in a rural community that then take advantage of all that these
communities have to offer. You just gotta take your time to find them and the
retain them. Sometimes, it takes a little bit, because we don't have all the
amenities necessarily you'd find downtown Boston or something like that, but
there are different amenities.
|
|
Bonica:
|
Right.
|
|
Peterson:
|
It really about making sure we tweak the package we're
offering to find the right candidate, spend the time doing it once instead of
making promises, having disconnection, and then having this revolving door of
in and out. That's just timely. It's costly and so forth. It defeats morale
too. That's number one. Number two is we don't have necessarily all the
access to services we would like to have and sometimes need, because of that.
There are other agencies that are struggling with that same thing, behavioral
health, substance abuse issues. Again, pretty common to most cities, towns in
rural America. We struggle with them here in the North Country as well. On
top of that though, we also have the issue of transportation. This is a very
large geographic place. The spots for points of care are at quite a distance
in many cases, and there are a lot of people who just can't get from point A
to point B. We don't have mass transit. We don't have the opportunities for
bus lines and so forth. That becomes a pretty big issue for us. Beyond that,
it's just managing the razor thin margins that any small hospital is up
against on a regular basis, anyway.
|
|
Bonica:
|
Speaking of razor thin margins, most community hospitals
have 50% or more of their revenues coming from government sources ...
|
|
Peterson:
|
Yes.
|
|
Bonica:
|
... Such as Medicare and Medicaid.
|
|
Peterson:
|
Yes.
|
|
Bonica:
|
What's the pair mix at AVH?
|
|
Peterson:
|
We're about the same. It's closer to 60 plus percent of
Medicare, Medicaid. Self pay makes up a small portion. It's gotten better,
honestly, with the ACA, the exchange products since 2014, '15. We have a seen
a decrease in our bad debt, and that's great. The exchange products have
actually done what I think they intended to do was reduce the burden of bad
debt. Commercial payers are about similar to a lot of small hospitals in
rural New England. We're very dependent on the Medicare and Medicaid payer
systems.
|
|
Bonica:
|
How does the payer mix affect your strategy?
|
|
Peterson:
|
We have to make sure that we're maximizing our critical
access hospital status, which means we've gotta think about that cost report
and allowable costs all the time. We have to think about serving the state
and federal government in terms of meeting their requirements and needs. We
take part in as many of the projects and so forth that we possibly can to
maximize the return there, the leverage the opportunities they both have in
place, demonstration projects like ACOs and so forth. We want to take part in
that, and we have those payer mix, because that's our population. We wouldn't
be serving our mission if we didn't take advantage of those things an
actually deliver for those payers.
|
|
|
It changes our strategy somewhat, because we have to be
mindful of the fact that we are cost based, and sometimes, they don't
reimburse as well as the commercial insurance. It forces us to be cost
conscious while maintaining the high standards of quality that CMS requires.
We have to do better with less money, and that's just pure and simple.
|
|
Bonica:
|
What would you say are the skills, competences, and
abilities necessary to become the president of an organization like
Androscoggin Valley Hospital?
|
|
Peterson:
|
I think first and foremost is relationship management,
just being able to work with multiple audiences, multiple people, clinicians,
providers, lay person, board members, the communities, technical staff, you
name it. It's really about facilitation of all these parties and their
expertise for the good of a common goal. I think being inspiration, having
fairly decent communication skills to get people to actually follow your
vision is pretty important, but primarily, it is about relationship
management, I believe. Gotta know what you're talking about at least as well.
There's some level of aptitude and intelligence ...
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
... Is required, and I pride myself on having a great
memory. I can remember a lot of things, numbers and plans and so forth. You
gotta be able to quickly call upon experiences and apply them. I think there's
a definite advantage in dealing with abstracts and what I call spherical
thinking. It's about interrelationships between, "We're talking about
this over here, but remember last week, we were talking about this over here?
Maybe if we do this instead of just this, we can do both." It's really
about the interconnectivity of problems, solutions, ideas, concepts, and so
forth. That's what I find very ...
|
|
Bonica:
|
And something you mentioned you had been fascinated by
all the way back to your training.
|
|
Peterson:
|
Yeah. A synergistic approach to looking at solutions.
|
|
Bonica:
|
Okay. How did your experiences as the Chief Operating
Officer at Sebasticook Valley Hospital prepare you for this role?
|
|
Peterson:
|
Very much so. The CEO, actually all of my CEOs, at
Sebasticook ... I had three different CEOs there were very supportive leaders
in terms of my own career development and enhancement. They gave me a lot of
opportunity to help staff or support their functions as CEO. I was exposed to
staffing a board committee, supporting the development of our final reports,
and so forth. It really prepared me for the concept and the role of the Chief
Executive beyond just the day to day operations. However, the importance of
understanding the day to day operations is critical, I believe, in order to
actually lead it. From the Chief Executive level, you gotta understand what's
going on and what the impact potential of any decision or strategy or
direction that you might take the organization in will have on the day to day
operations, because that's where the rubber meets the road. That's where we
actually take care of patients and actually do the billing and keep the
revenue cycle going. It was critical to understand the inner workings before
I could theoretically effectively lead an organization through any kind of
transformation.
|
|
Bonica:
|
You had several years of experience as you were saying
in the senior executive roles.
|
|
Peterson:
|
Mm-hmm (affirmative).
|
|
Bonica:
|
You are not the president of a hospital, and you've been
in that role for about eight months now?
|
|
Peterson:
|
Eight months, yes. It seems like about ten minutes, so I
think that's a good sign.
|
|
Bonica:
|
What surprised you most about actually taking on the
role?
|
|
Peterson:
|
This was the hardest question I saw there. What
surprised me the most? I think knowing ... I've always had a sense of
humility, the sense of, "This is such an important responsibility."
Many times, consciously, on the drive into work, I will say, "Please,
Lord help me make the best decisions today, because there are 320 families
depending on what we do." Being good financial stewards of this
organization mean supporting all these families of the people who work here.
That's humbling. I walk in not only proud to have that responsibility, but
humbled by it as well.
|
|
|
What has surprised me most I guess is the sheer
immensity of that responsibility when that buck stops here. Ultimately, I do
have the board and I leverage the board to my advantage honestly to say,
"It's never just me making a decision." I leverage my team. They're
amazing people. They're incredibly talented and intelligent, and together, we
make the best decision. I know I have the support, and I believe when I take
something to the board or Warren, this has been vetted. This is the best idea
we can come up with. Based on this talent pool and a brain trust we have,
it's probably gonna work. I'm comfortable there, but what's surprising is the
responsibility, the accountability is still mine.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
At the end of the day, I need to be able to stand up,
and I have on occasions already ... I own it. Regardless of where it happened
or when it happened, it's my responsibility. Even if I didn't make the
decision, I'm responsibility for it. That's incredibly humbling even more so
than I thought. Before when I was helping facilitate a decision as COO,
advising the CEO or saying, I think we outta do this, and here's what could
happen, might happen, did happen or whatever," still was there
responsibility. Now, it's mine.
|
|
|
On the upside, again, I do have all kinds of resources I
bounce ideas off of. Warren is a very collaborative leader as well, and I've
contacted him, saying, "Hey. Let me bounce this off you. What would you
do?" I still have my father, honestly, who's now retired, but he was a
CEO for 27 years. I regularly call him and say, "Hey. What do you think
about this?" I may not always take everybody's advice, but at least I
have those opportunities to use people as a sounding board and get some perspective.
I'm a life learner. I think, again, if I ever assume I know all the answers,
it's time to stop. There's always something new, never a dull moment, never a
same day twice. I'm learning every day. That I think was the most surprising
is how important it really is to be willing to stand up and say, "It's
on me."
|
|
Bonica:
|
As the president?
|
|
Peterson:
|
Mm-hmm (affirmative).
|
|
Bonica:
|
What keeps you up at night? You're laying in bed,
staring at the ceiling, what are you thinking?
|
|
Peterson:
|
If it's not the usual where is the margin this month or
how am I gonna take care of that, it's really about making sure that we're
doing the best in the eyes of the community, the patients. Have we made a
decision ... It varies from night to night. Many nights, I'll be honest with
you, I sleep pretty well. We're doing okay.
|
|
Bonica:
|
That's good.
|
|
Peterson:
|
Usually it's ... I've thought about this as well, the
theme here is really, "Was there something we could have done
differently or better in the eyes of the patient?" Even a good decision
or a good outcome, "What could we have done better?" That's what
keeps me up at night. We need to have a strong financial position. Sometimes,
there are tight months and so forth. I'm glad to say right now, we've been
doing well. As far as I'm concerned, I'll do everything in my power to make
sure we keep doing well and running in the black. That helps. It's really
about how can we make sure we deliver the highest quality these patients
deserve.
|
|
Bonica:
|
Let's transition to talking about leadership.
|
|
Peterson:
|
Sure.
|
|
Bonica:
|
What would you say is your leadership philosophy?
|
|
Peterson:
|
I consider myself a servant leader. I'm here to support
the people who take care of the patients, run the business, do the billing,
you name it, run the processes in place, take your traditional org chart, the
diagram, the pyramid and flip it on its head. We're here to support the
people at the front lines, and I really believe that my job is to do nothing
more than make sure that we create and foster an environment where people can
meet their true potential.
|
|
Bonica:
|
What would you say are the characteristics and behaviors
of a good leader? How do you aspire to those yourself?
|
|
Peterson:
|
I think the ability to listen, the ability to recognize
one's own limits, and amalgamate great ideas from multiple resources before
making a decision or taking an action, and considering the impact of those
action prior to execution without being paralyzed by analysis, being will to
take responsibility for the outcomes, deal with the consequences, the courage
of your convictions, if you will, but also the willingness to make yourself
vulnerable and recruit first and then rely on the talent and expertise that
you surround yourself, recognizing how best to build the team. You don't want
just a team of homogeneous kind of styles or approaches or whatever.
Actually, one of my favorite leadership books was Lincoln, "On
Leadership."
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
President Lincoln actually populated his cabinet after
he was elected president with some of his adversaries, and really it was to
force the conversation about different perspectives and in the interest of
the country at the time to make the best decisions. If it was just my way or
the highway, you're gonna miss something. He consciously populated his
cabinet of advisers with his opponents, and people thought he was crazy at
the time, but at the end of the day, it was really about making sure you
didn't miss something. That's a talent as well, making sure you populate your
leadership structure around you with complementary styles and expertise and
so forth, so the team is more powerful than any one.
|
|
Bonica:
|
Can you give an example of a difficult leadership
lesson? Maybe you had to learn the hard way.
|
|
Peterson:
|
Sure. One of the challenges of being a leader at this
level, because usually people who aspire and achieve this level are pretty
confident people, and they're problem solvers to begin with and somewhat
impatient. There's a degree of impatience there, and that's not a bad thing
for an administrator, and a desire to to well and move forward quickly and
just keep moving on. Solve the next problem, bring it on, bring it on.
Letting people make their own mistakes and learn from them is difficult, and
that was one of the lessons I have to learn here.
|
|
|
Actually, one of my colleagues who made the transition
from COO to CEO a few years ahead of me, I tapped him for some insights,
"What is the number one you've gotta learn to do well when transitioning
from operations to the chief executive role?" He shared with me,
"You gotta watch out for this. Don't solve all the problems yourself.
Let people learn from their experiences and mistakes, even though you know
its a mistake. You gotta make sure it doesn't negatively impact the organization.
You still have the ability to veto or stop the process, but you gotta let
them learn, and you can't tell them. They have to know it. They have to learn
it themselves."
|
|
|
That's difficult, and I have learned that already. I've
taken that into account and have had people almost go down a path, and I
continually just ask them the questions and try and draw out and so forth and
maybe do some of the things, and they start to realize the error or the
unanticipated issue it caused that I anticipated, but I can't just tell them
no. That's not growing anybody that way. That's difficult, and that was
probably the most challenging part to me is to let go of the desire to say,
"No. Let's do it the right way. I know it's the right way. I know you'll
know it's the right way eventually," but to let them do it their way.
|
|
|
The advantage there is maybe they're gonna do it a
little differently than I may of assumed, and it was the right way, and there
is an opportunity in there. There's an advantage to that. At the very least,
a couple of times it actually happened where maybe I understood what somebody
was gonna do, they did it, and I was thinking, "I'm gonna have to have
this what did we learn from this conversation," but instead it was like,
"Oh, that aspect I hadn't considered so it actually works really well
and frankly great. Let's go forward." It has worked out favorable, or at
least one example where we almost got to the point where we were pulling the
trigger on something that I knew what was gonna be a bad situation if we
pulled the trigger but I needed my senior director to know that herself.
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
I let it get to that point, and she stopped, and came
into my office says, "You know what. I think I've re-thought this, and
after thinking this all the way through." I exhaled, "Great. Glad.
Let's go in this direction instead," but that was probably the most
challenge, because I just wanted to get this done and move on to the next
problem and keep moving, but part of my job also is to grow the next level
and develop and mentor people, and that's what I really enjoy. There's some
risk inherent in letting people on their own, but there's also value, great
value in that.
|
|
Bonica:
|
Speaking of ...
|
|
Peterson:
|
Sure.
|
|
Bonica:
|
... Making mistakes, in your experience, where do junior
leaders make mistakes? Do you see a pattern?
|
|
Peterson:
|
Yeah. Historically, it usually just comes with the lack
of experience and wisdom of especially ambitious folks, and I applaud
ambition. Great. As much experience as you can gain as fast as possible
that's great for people who aspire to this level. It's really about the lack
of knowing limits or truly understanding there's things you may not know. I
always want to recognize I'm sure there are things I don't yet know I don't
know, and that's what I see is a basic pattern is they think they know what's
going on, but there may be nuances or aspects of something they just haven't
been exposed to before and jumping forward very quickly that might lead
somebody into the wrong direction, you only gain that experience. I think
that's pretty natural. It's a natural evolution of the growth of wisdom,
frankly.
|
|
Bonica:
|
What leadership advice do you most often give junior
leaders?
|
|
Peterson:
|
Take the time to vet the idea through your counterparts,
peers, and colleagues. Learn from other people's experiences. You don't have
to do this on your own, delegate the authority to actually execute it so that
you don't have to do it on your own. That's most of time. You can get a lot
more done through other people than doing it all yourself but making sure
it's the right thing to do. There's an amazing group of talent around New
Hampshire, around the country that are willing to offer advice and share
their experiences, and so forth. All you gotta do is take the time to tap
into it. I believe personally that it's the stronger person who's willing to
say, "I don't know. I need help." Than the person who says, "I
don't need help," and then, makes mistakes or limits their ability to
achieve the best outcome.
|
|
Bonica:
|
Did you have mentor early in your career?
|
|
Peterson:
|
Absolutely. A number of mentors.
|
|
Bonica:
|
How did that person or people help you develop as a
leader?
|
|
Peterson:
|
Again, my father was one. I watched how he behaved. There's
just this sense of values that he taught me as a child. That's where it
originated, but then, watching him as a senior executive and CEO as a
hospital, it helped me recognize the importance of doing the right thing for
the patients first. Everything else was secondary to that. You had to figure
out how to manage the rest of it, but it was really about the commitment to
the mission.
|
|
|
I had a number of other mentors. I had mentioned Jack
May who really taught me about how do you manage. How do you work with a
board? How do you work with a system? How do you work a room? He was a great
politician. He was always smiling, and always making friends. How do you
build and manage relationships? I had another gentleman. Ken Hughes was a
mentor of mine, a formal mentor of mine at the EMHS days, and he just taught
me a lot of the basics of here's senior level executive stuff you gotta be
aware of, thinking about managing politics and thinking about multiple
aspects of any problem or solution and impact analysis, and so forth. They
all influenced me in different ways. I always observed everybody I work with
or for as well, and what I try to do is analyze and recognize, "Here's
something I want to emulate" and as important as ... I don't want to
repeat that behavior. Here's the stuff I wouldn't want to do. Basically,
everybody I've ever worked for I learn from and I try to do the same for
folks that work for me.
|
|
Bonica:
|
My next question was do you mentor other leaders now?
|
|
Peterson:
|
Yes.
|
|
Bonica:
|
What do you get out of being a mentor?
|
|
Peterson:
|
Actually, it's the pride. I'm asked often in an
interview, "What's your proudest accomplishment?" It's the people.
It's watching people achieve more than they thought they could and knowing
that somehow I contributed to doing that to calling out that talent that was
inherently in there and enabling it to come forth and flourish. That's the
proudest moments I have is watching somebody go from a director to a senior
director to an executive level or to achieve something they wanted to achieve
even if they didn't believe themselves they were capable of doing it just by
asking questions, leading them to solutions, providing them resources, and
helping guide them along the way. That's my favorite part.
|
|
Bonica:
|
Are you mentoring anyone outside of AVH now?
|
|
Peterson:
|
Not formally currently, no, but I have many times as
part of my role in the college and as a fellow in the American College of
Healthcare Executives. I've taken on mentor projects as well, but internally,
I've got a few relatively new senior directors that I'm mentoring directly
and growing them, because again I think part of our obligation at healthcare
leaders is to ensure the next generation of leadership.
|
|
Bonica:
|
You mentioned the American College of Healthcare
Executives.
|
|
Peterson:
|
Yes.
|
|
Bonica:
|
That's a professional organization ...
|
|
Peterson:
|
Yes.
|
|
Bonica:
|
... For healthcare executives, obviously. How has your
membership in that organization been significant to you as a professional?
|
|
Peterson:
|
It's a great networking resource. Attending the cluster
or attending the sessions and then the regional chapter, the Northern New
England Association of Healthcare Executives is a great way to just connect
with other people in a similar role. It's how we tap into the talent in the
region and saying, "Have you ever dealt with this? What would you do in
this case? What are some ideas?" It's how we share innovations and best
practices. That networking is probably the most substantially important
beyond ... That's the education. Now as a fellow, I have to keep my
certification up, and that's a requirement, but I enjoy the life long
learning going to hear from the expert speakers and so forth about topics
that the College provides, reasonably prices and available. It forces that,
but also it is an opportunity to continue to learn. That's why I like the
college very much.
|
|
|
Being a member of the College also requires adherence to
a set of ethics, and frankly, I live by them. I think I need to demonstrate
them as well. It allows me that structure that I can always depend on,
thinking about how do I make a certain decision. Let's pull out the College
Code of Ethics, and they're entrenched in my values, but you can read these
things and be guided a little bit. The College provides that source of
resource from across the country. Some of the best minds in our industry put
these together and refine them and contemporize them every year. It's an
amazing resource.
|
|
Bonica:
|
If you had to pick one book for an early careerist
healthcare administrator to read, what would you recommend?
|
|
Peterson:
|
There're probably two.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
I'm not sure I could pick one.
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
One is, "The Servant."
|
|
Bonica:
|
Servant leadership.
|
|
Peterson:
|
"The Servant" by Jim Hunter.
|
|
Bonica:
|
Oh, "The Servant."
|
|
Peterson:
|
"The Servant."
|
|
Bonica:
|
Okay.
|
|
Peterson:
|
Yeah. Really it's a parable, and Jim Hunter wrote it.
It's a fairly easy read, but it talks about this concept of servant
leadership. It makes you stop and think about your own style and what you're
in leadership for. That's definitely one. The other one, honestly, I really
like a lot is Fred Lee's, "If Disney Ran Your Hospital." Just one
of those book that makes you stop and think about what are we really chasing.
Why are we doing this, and how do we best get to the results that we want?
It's hard to argue that Disney knows what it's doing in terms of managing an
experience.
|
|
Bonica:
|
Yeah.
|
|
Peterson:
|
This is really about pulling that all together but tying
it to the embedded values of healthcare as an industry and getting people to
do the right things for the right reason, because they believe it's the right
thing to do, not because their in fear of noncompliance if they don't. You
know what I mean? Fred Lee does a great job of talking about things like
compassion and so forth in that book. I'd highly recommend either or both of
those books.
|
|
Bonica:
|
Last question.
|
|
Peterson:
|
Mm-hmm (affirmative).
|
|
Bonica:
|
What advice do you have for early careerist who are
planning a career in healthcare administration?
|
|
Peterson:
|
Get plenty of sleep now. No. I would think that they
would be best served to build their network, build relationships, spend time
shadowing people, get to know as many people in the healthcare organization,
but also look inwardly and say, "Why are you doing this? What's
important to you? What's motivating you to be a healthcare leader?"
These are not easy jobs, but it's some of the most rewarding, as I had hoped,
most rewarding work you can ever imagine. Being able to make a difference in
people's lives daily is really important. It's a privilege to be able to take
care of people when they're vulnerable, scared, hurt, sick, don't want the
service you're providing. It's an honor to work with the talent, the
physicians, the clinicians, the nurses who sacrifice so much of themselves to
take care of the patients every day. Being the leader of an organization that
allows that to happen is an incredibly rewarding job, so I would highly
recommend that they make sure that that's what they're in this for.
|
|
|
This is not prestigious, and you're never gonna get rich
doing this stuff. Some people do, but usually in a non-profit, small
community hospitals, mm-hmm (negative). It depends on how you determine wealth.
If you want to go home at night, feeling like you have made a difference,
this a great job, and as long as you're comfortable with some stressful
situations and dealing with dynamics ... If you don't deal well with change,
wrong industry. Go do something else, but if you do and are willing to stay
committed to your core sense of values and the mission of the organization
resonates with you, the vision of the organization you're inspired by, then
go lead it. It's the best job on the planet as far as I'm concerned. I know
it sounds a little cliché, but there is no better, more rewarding job than
being a part of taking care of people, making a difference in their lives.
|
|
Bonica:
|
Thank you so much for you time today. It's been great.
|
|
Peterson:
|
No problem. Thanks very much. I appreciate your time
too.
|
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