Patrick Jordan Interview Transcript

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

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

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Mark:	Welcome to the forge, Patrick.
Pat:	Thank you. It's a pleasure to be here.
Mark:	You went to Fitchburg State University in Fitchburg, Mass., where you earned a bachelor's degree in administration and management. Why did you go to Fitchburg, and why did you choose to study administration and management?
Pat:	In my case, my parents both worked. We had five kids at home and there wasn't a lot of money going around, so I was looking for real value in my education because I didn't have a lot of money to spend, and ultimately chose Fitchburg State because it was fairly close by and had the programs that I was interested in. I chose business management because I thought that was the best curriculum for me to learn what I wanted to do in the future, although I think at that age I'm not sure anyone really knows.
Mark:	Sure. Were you thinking healthcare at that point?
Pat:	Healthcare was not even on my mind at that point.
Mark:	Actually, when you graduated from Fitchburg you went on active duty with the U.S. Army. When did you decide you wanted to serve in the military, and did you have family that served? How did that decision come about?
Pat:	As I said, I went to Fitchburg because I thought I could afford it, and during my freshman year I realized I couldn't afford it. At the time there was an Army ROTC program on campus and there were several older friends that I had that were in that program and I learned that not only could I get some great leadership training, but also it would help defray the cost of my education, so entered what was called the simultaneous membership program, which was being a member of both ROTC and the National Guard, so instead of spending my summers working at restaurants in Maine I was traveling around the country and doing various trainings, to include jumping out of planes at the end of my junior year.
Mark:	Yeah, very nice, and along those lines, you served with the 82nd Airborne and Special Operations Command Atlantic at Fort Bragg, North Carolina, for almost seven years, so you did a lot of jumping out of planes, I guess.
Pat:	Yeah, I ended up having 95 jumps in my career, but I think at the beginning of my senior year I had a choice whether I wanted to go on active duty or to stay in the reserves, and I thought long and hard about it and said, wow, I just don't know that I could get anywhere in the civilian world the experience that I could get in the Army, and sure enough that paid off. My first job was as the XO of the largest company in the Airborne Division. I was 21 years old.
Mark:	When you say largest, how many people are you talking?
Pat:	Four hundred and fifty in that company, so yeah, it was a terrific experience.
Mark:	What was the transition to active duty like? You made the decision, going to go on active duty for a while. What was the transition like? What surprised you about actually being on-
Pat:	I fell in love with the military at the end of my sophomore year and I thought about it a lot, and it was just a discipline that I really liked, so I felt it was a fairly comfortable transition. Like anything else, first job away from home and away from family, I think, can be challenging, but in terms of the cadence of accountability, the operational tempo, I just ate it all up. I loved it.
Mark:	The 82nd Airborne is unique even within the Army. What was life like in the 82nd for you?
Pat:	It was a very quick and fast tempo, so when we were in garrison I was usually up at 4:30 in the morning and returned back to my quarters late at night, but we were gone a lot, so we deployed a lot both for training and for real world operations.
Mark:	What kind of positions you hold in those seven years?
Pat:	I had a very interesting career. I was originally commissioned an infantry officer in the National Guard. When I went on active duty, I was part of the Adjutant General Corps, and I was uniquely qualified because I was jump qualified, jumpmaster qualified, ranger qualified, so I had some really interesting jobs. Probably the most interesting job I had was as the readiness officer for the 82nd Airborne Division. In that role, I reported basically to the commanding general of division, and it was my responsibility to make sure that the division ready brigade was ready to go within 24 hours, wheels up, and that included personnel, equipment, training, and all of that.
	The other unique part of that job is that I was part of the assault command post, so if any unit battalion size or above left for Bragg, I was going with it as part of the assault command post team.
Mark:	In the role of readiness officer, you must have been interacting with a lot of upper-level … You said you reported to the CG, and you must have been interacting with a lot of other upper level leaders.
Pat:	Absolutely. It was, again, an anomaly for me. Typically the role was a lieutenant colonel and I was a midcareer captain at best, so I was very junior in the role, but I interfaced with the entire command staff of the division, all of the brigade and battalion commanders. I was at Fort Bragg a long time. Most officers will spend three years in a duty station. I was there, really, seven and a half years, so I saw many different officers come and go and had great rapport with most of the leaders in the division.
Mark:	What were the challenges? Like you said, they outrank you by a lot. When you were communicating with them, how did you work that out? How did you work with them?
Pat:	I think it's true with anything that you do in military or business, it's creating strong relationships, and it's creating relationships around trust, it's creating relationships around expectations, and most folks knew what my capabilities were, they knew what the expectations were, and I tried to consistently deliver on those.
Mark:	You mentioned ranger school, and you were ranger qualified. When did you go to ranger school in your career?
Pat:	I went in 1989, so about four years after being on active duty. [Three 00:05:45] and a half.
Mark:	Okay. Why was this important for your role in the 82nd?
Pat:	The division had not a rule, but sort of an expectation, that most infantry officers were ranger qualified. I had always wanted to go to ranger school, mostly because I wanted to test myself to see if I could do it, but actually becoming ranger qualified had other officers in the division look at me a little differently than they would the normal person from the Adjutant General Corps.
Mark:	Okay. What was ranger school like? What did you learn in that process, especially about leadership?
Pat:	The course is designed to test leaders under combat simulated circumstances. Since they can't shoot at you, they do two things to really induce stress. One is to deprive you of sleep, so the average student gets about an hour of sleep a night, and then they deprive you of food, so I went there at 180 pounds in the best shape of my life and I came out at about 152 pounds, and what you're doing is leading different types of patrols, combat patrols, reconnaissance, search and rescues, all of those types of things, through very difficult terrain, whether it's in the mountains or the swamps, and they're testing you to see how well you perform under stress.
	I think 1% of the Army gets a chance to go to ranger school, and of those that do go there's an attrition rate of about 60%, so what I learned is that I could lead people under very adverse circumstances.
Mark:	How did those lessons, and maybe the lessons that you learned in your military career, how did those translate into your later career?
Pat:	I had the opportunity to serve my country in combat twice, traveled around the world, faced a lot of stress and a lot of difficult decisions at an early age, and I guess from that point on when I faced stressful situations in the civilian world I've said, well, at least no one's shooting at us.
Mark:	Nice. You left the Army in 1992 and got a job as a manager of operations in material management at Massachusetts General Hospital in Boston. What made you decide to get out of the Army at that point?
Pat:	I met my wife. She was a captain in the Army as well. We happen to meet at training at Fort Benjamin Harrison, Indianapolis. She's from Connecticut and went to school in Massachusetts, Stonehill, and we fell in love, and she was scheduled to go to Albany, New York, to a recruiting battalion and I was on orders to go to Korea for a two-year out of company tour, so we made the decision to both get out of the military, which was a very difficult decision because we both loved it, to start our own life and our own family together.
Mark:	Okay, so what brought you to Massachusetts General? We talked before. Your background was in business and you served in the military, jump out of planes, ate snakes, things like that, and how did you wind up taking the job at Mass. Gen.?
Pat:	Purely by accident. At the time, my father was the Chief of Staff for the Senate majority leader in the Massachusetts legislature, so he was able to connect me with all kinds of people for informational interviews, so I was literally offered jobs in finance, insurance, and other fields, but none of them felt right.
	Then one day I was connected to the number two at Mass. General Hospital, Dr. Tom Durant, who was an OB/GYN but was also really the lobbyist for Mass. General Hospital, and he had served with Physicians without Borders and all of those things, but he had formerly been a military surgeon, and that was my first meeting and introduction into healthcare and about two weeks later I was offered a job. The first title was the manager of linen. The manager of linen.
Mark:	Oh, all right. Manager of linen. Very nice.
Pat:	But I felt like this was a job that, similar to the military, I could help people, so I said, geez, this is worth a shot.
Mark:	Okay, so you were the manager of linen. What was the position like? What were your responsibilities, and what was it like making the transition from military culture, especially one so strong as 82nd, to a civilian hospital?
Pat:	I think the transition went quite well. My boss, who was a young up and comer, one of the youngest directors at Mass. General Hospital, quickly noticed that I could get things done, and you don't get things done because you order people to do things. You get things done because people want to get things done for you and for the organization, so very quickly I took over other parts of other responsibilities, patient transport, material distribution, and those types of things, and then I had the fortune to be able to help lead some hospital-wide activities, needleless reduction efforts, latex glove products.
	Next thing you know, I'm the chair of these task forces of people who are much more senior to me, doctors, nurses, and these projects went well and I began to get noticed at Mass. General as someone that could get things done in a way that made people feel good.
Mark:	That sounds like an echo of what you did with the 82nd as the readiness officer. You were, again, working with people who are a lot higher rank than you and you were able to coordinate and get people to want to help you, want to work with you.
Pat:	I think that's exactly right. It's about building relationships. Mass. General, I think the time, had 18,000 employees. It was huge. The 82nd Airborne had 24,000. It's easy to get stuck in a bureaucracy and not be able to get things done. The way you get things done is figuring out who people are in the organization and creating relationships with them.
Mark:	Most people who think about the military and the military culture assume it's very directive, and I think it can be, but did you have to change your leadership style a lot coming from the military to the civilian?
Pat:	I think I had to adjust the terminology, but my theory of leadership was that great leaders build great teams, and those great teams then come together to accomplish great good for the organization, and I think that's true in a military organization or a civilian organization.
Mark:	During your time in Mass. Gen., you also earned your master's in business administration from Suffolk University. Why did you choose to do an MBA at this point rather than an MHA, and what was the benefit of getting a graduate degree at this point in your career?
Pat:	Coming out of the military, I had been out of any academic environment for some period of time. To me, I always thought about the MBA as the next step to my business degree, and frankly, I don't think I had committed to healthcare at that point. It was my first job out of the military and I didn't know where my career was going to head. I chose Suffolk because it's co-located really on the same street as Mass. General Hospital and I did an executive program which was every weekend for two years, and I chose that because my wife and I eventually were going to want to start a family and that seemed to be the best course of action for me.
	In terms of how it helped me out, it helped me out tremendously, so at the end of my MBA program I began looking for a job outside of materials management. I wanted to explore the next phase of healthcare. I was actually entertaining a job with one of the insurance companies when the COO of Mass. General found out, and we talked and I said, "Well, I'm ready for the next step, and in the Army I had generals calling me all over the world asking me to come work for them, and no one has talked about any advancement with me here," and he said, "Well, Pat, if you want advancement, you got to tell someone. How would you like to be the director of radiology?", and if I hadn't had the MBA I would not have been allowed to compete for that position, and sure enough, I did compete and earn that position and spent five years as the director of radiology.
Mark:	What were your responsibilities as the administrative director? Who did you report to? How many people did you oversee?
Pat:	I had a dual reporting structure. I reported to the chief operating officer of the hospital, and I reported to the chairman of the department of radiology, a doctor. It was a huge department. There was over 1000 employees in that department, both on clinical side, but also a very extensive research and education infrastructure. The department had an annual operating budget of about $30 or $40 million.
	Probably more importantly, we were earning somewhere around $100 million a year, because it turns out at the time imaging was very well reimbursed, as it really is still today. I inherited a department that had built silos, was not well equipped. We had an aging equipment base and a lot of issues around processes, but what was the most gratifying experience was working with the doctors who had all kinds of great ideas but hadn't had a chance or the capability of really implementing them, and we did a complete reengineering of the department over those five years.
Mark:	What was the transition like coming out of a support function doing materials management related functions to a clinical department?
Pat:	I will say that it was a little anxiety provoking at first. I don't know how an MRI works or how a CAT scan works, and we have very, very smart physicians and administrators that run those departments, and I think at first there was somewhat of an eye towards me maybe not really being the right person for the job, but you stick with it and you set goals and people start to see you operating, and then you start putting together two, three, and four year plans, and then you start executing on those plans and people start to believe that you're the one that can help take this department into the future.
Mark:	In 2000 you left Mass. General and you moved to Newton-Wellesley Hospital, where you took on the chief operating officer role. Was that immediate, or did you take a position that led to that?
Pat:	It was interesting. The Partners HealthCare, which was the parent organization of Mass. General Hospital, acquired Newton-Wellesley in about 1998, and Newton-Wellesley had been and then continue to lose $1 million a month for … Yeah, they did for five years, so it was a very challenged organization. At some point, Partners decided to move the COO at Mass. General into the interim president role, and he asked me to come out as the interim COO.
Mark:	This was the individual that had suggested you take the role as director?
Pat:	That's exactly right, so I followed him out there and for the first six months was still really part of Mass. General, but on loan from Mass. General to Newton-Wellesley, and it was neat. We developed a financial recovery plan and we hit our first breakeven, even a slight profit, six months later, and then from there just really focused on the future, so it was a great experience.
Mark:	Where is Newton-Wellesley Hospital, and can you give us a sense of the size and scope of the organization?
Pat:	Yeah, so Newton-Wellesley is in the western suburbs of Boston. It's a fairly wealthy community. The hospital is about 350 beds, and that includes obstetrics. When I got there, the total revenues were about $120 million. When I left, they were about $450 million. As part of the turnaround plan, we actually did a reduction in force early in 2000, and at the low point our number of full-time equivalents, or FTEs, was about 1351. When I left 14 years later I think the total workforce was about 2400, so we grew dramatically. We had double-digit growth rates every year.
Mark:	So you went through a downsizing initially, and then a growth phase.
Pat:	Yeah.
Mark:	How did you make the decision to make the downsizing, and how did that grow?
Pat:	It was very challenging. We had weekly meetings with all the leaders in the organization. We asked them to develop the plans. We asked them to work with adjacent organizations to them to make sure that those plans made sense. I think we ultimately implemented about 470 ideas, ranging from $1000 savings to $400,000 savings.
Mark:	That's how you turned around the million dollar loss that was … The bleed that was going on.
Pat:	That's right. From there, we just turned … What was our future going to be? We knew there was a need for this healthcare enterprise in our community. We knew that they had been losing market share for several years, and we decided on a strategy to really co-brand the hospital with our academic partners, so working with Mass. General in adult medicine and working with Brigham and Women's Hospital and Women's Health.
Mark:	When you say co-brand, what does that mean?
Pat:	We literally would create joint programs, so for example, we had a Mass. General Hospital for children's pediatric floor, an outpatient center, at our hospital.
Mark:	At Newton-Wellesley.
Pat:	Yeah.
Mark:	So people would say, "I'm coming to the Mass. General program at Newton-Wellesley."
Pat:	That's right. We probably had 20 of those that were going on. In addition to that, we incorporated the Mass. General Hospital residents into our training programs, so over time what we did is really built up the brand and the trust in our organization from the communities that we served.
Mark:	How much clinical integration happened over that time between Mass. General and Newton-Wellesley?
Pat:	It was all based on centers of excellence, so for example the Mass. General Hospital spine program, the pediatric program I talked to. Our obstetrics program integrated with bringing a women's obstetrics program, so our leaders at Newton-Wellesley would actually have appointments at those institutions and actually report quality education and all of those kinds of metrics up through those departments.
Mark:	Was there fungibility between the flow of staff between the two organizations?
Pat:	It would be clinical staff, especially providers.
Mark:	Okay.
Pat:	Especially providers. Less so below that.
Mark:	Sure. Okay. Well, that makes sense. How did the relationship work between Mass. General and the other Partners facilities and Newton-Wellesley? How did you become the decide to … Or, not you, but the leadership at Newton-Wellesley decide to become a part of Partners, and then what was the relationship ongoing?
Pat:	That's really two separate questions. The first question, so I wasn't there when Newton-Wellesley decided to become part of Partners, but it was a time when there was significant merger and acquisition activity taking place in the state, so for example, shortly before Newton-Wellesley decided to join Partners, Waltham Hospital joined the CareGroup, so everyone was trying to get together. Newton-Wellesley was deciding between the CareGroup and Partners, and ultimately a committee of chairs, medical chairs, trustees, and senior managers decided that Partners was the best choice for them. Once it became part of Partners, then it took, like anything else, relationships and trust to begin building programs that would add value to both of the organizations.
	I think one of the smart decisions that Partners made was putting Dr. Jellinek as the interim and then ultimately the president of Newton-Wellesley Hospital. This was someone that had, at the time, 25 years experience at Mass. General Hospital. He knew all the players. He had been the COO for a long period of time, but more importantly than that, he was the youngest chair of psychiatry in the history of Mass. General Hospital, so he had the clinical and business relationships and had earned and build that trust over many years.
Mark:	What is the role of the chief operating officer at Newton-Wellesley?
Pat:	I like to think that a chief operating officer is looking over, certainly, the day-to-day activities of the organization, making sure that the trains run on time, but he or she is also looking out the next three years, making sure that we have plans for capital, for reinvestment, for space, for the plant and facilities, making sure that we're focused on the quality and safety in a way that will position us well in the future, making sure that we're looking at patient experience and colleague engagement in a way that helps make this institution thrive in the future.
Mark:	Where do you draw the lines, and I assume that this probably applies here in your current role as well, but in general, where do you draw the lines around this is the COO's responsibility and here are the other senior leaders, the CFO, CNO maybe. Where do you say, well, day-to-day operations, this is me, but these things go over to-
Pat:	I don't think you really draw lines. I was the interim president for Newton-Wellesley, right, and if you asked me what my job was then I would have said I'm out looking at the next five to 10 years, I'm out trying to build relationships with providers in the community, with other organizations, and then I'd probably say and I'm going to make the trains run on time and do all that, and I don't think it's lines. I think it blurs, so I think it's incumbent for the organization to have a very strong senior leadership team that likes to work together, and that's what I have had at Newton-Wellesley. That's what I feel like I've had here.
	It changed over time. When I first went out to Newton-Wellesley, everything but nursing and finance reported to me directly, sometimes through a VP or director. Over time as we recruited in new senior leaders, we would often make changes to the org chart, so for example, we might want the CFO to get some operational experience, so I would move buildings, facilities and environmental services and security to the CFO so that that senior leader could get some experiences they hadn't had before, so I think the org charts are different in every organization, and ideally they're changing to help the organization grow and develop and also to help individual leaders grow and develop as well.
Mark:	How did you grow into the role as chief operating officer? You'd had some experience in managing materials. You now had some experience managing a clinical organization. COO is a big job.
Pat:	It was a very big job. I think I sometimes look back and I'm grateful that I was so young and so inexperienced that I'm not even sure what I was walking into. I think sometimes the tasks that I see that are facing us today are more daunting because I now know they're daunting. Back then, I was 36 when I went out to Newton-Wellesley. I don't think I knew how daunting it was. I just kept thinking next steps, next steps, next steps, and somehow it all worked, so sometimes I think ignorance is bliss.
Mark:	Well, how did you grow into the role, would you say? What were the things you really learned in that role that you maybe hadn't learned up until that point?
Pat:	Well, certainly I learned about the full breadth of clinical services. I had much less exposure on the inpatient side before going there, and over 12, 13 years I learned quite a bit about that. I learned more about the surgical theater. Based on my career at Mass. General, I had sport services and outpatient practice, but I'd learned there … But I think more than anything else I learned about me, and I look at the person that went there 36 and the person that left there at 50 and they're two dramatically different people. The one that left at 50 is more mature, more experienced, more seasons, but I also think that I had some events that took place that changed me as a leader.
Mark:	Can you give an example?
Pat:	Yeah. I don't remember the exact year, but sometime around 2009 or 10 I became very interested in 360 evaluations, so I wanted to bring that to our leadership team because we were evolving as a leadership team, and the hospital was having spectacular results but I thought we could do better, so I volunteered to take the 360-degree evaluation, had a coach signed, and I asked for feedback from my peers, all of my direct reports, and corporative executives at the Partners level, so the results came back and I met with my coach and for the most part they were very good.
	It said, if I recall, that I would be considered in the top 5% of leaders across the country, but there were two areas where there were problems, and one was self-awareness and the other was self-control, and I dug into the results, read the comments, and frankly I was devastated. What I'd learned was that I can be an intimidating person, and I think I always knew I could be intimidating, but I don't think I realized that the negative impact that that had on the people around me, so that was a life-changing event, and that impacted me positively both at work and, I think, at home.
Mark:	Do you think that was maybe an outgrowth of your military experience?
Pat:	I think that had a part in it, for sure. Maybe the preponderance of that. I'll still never forget having the discussion with the coach and recognizing that I was aware that I was intimidating people, but not really understanding how that impacted them, the devastation that that could have, even by just a stare, even by just a stare.
Mark:	How did you work on it?
Pat:	Really, the first thing we did is devise a plan, and the plan was that I was going to tell everyone that I worked with that if I was getting into that mode where I was intimidating people where they were going to give me a signal, and the signal was to just grab their ear and shake it, à la Carol Burnett. I then went out and presented the findings to every single group and had a discussion and talked about examples of how I'd exhibited this behavior and then asked them to help me with this plan by shaking their ear when they saw I was doing it.
Mark:	Did they actually do it?
Pat:	They actually did it, and it didn't take long. I get somewhat emotional about this because I feel like such a better person today than I did then, and I feel like I'm having an even more powerfully impact on the people that I work with every day.
Mark:	Did other senior leaders follow your example and submit themselves to the 360, or was it just you?
Pat:	No.
Mark:	Just you. [inaudible 00:28:22] emotional experience [inaudible 00:28:25].
Pat:	I think when I described what it was like to go through it, yeah, and by the way, if there were 10 pages of comments, most of them were, "Oh, my God, what a great person to work with. He inspires us. He makes us better. He supports us." All very positive, but when you think about what you had done to a few people it doesn't make you feel good about yourself.
Mark:	Sure, so you worked on it, and you feel like you've made progress.
Pat:	I feel like I've made tremendous progress. I was very happy about it. I'm a happier person.
Mark:	Would you recommend that experience to other leaders?
Pat:	I would, but I think you have to be ready for it. I think you have to be ready for it and you have to be ready to do something with it, and maybe most leaders wouldn't have the same experience that I had because maybe they wouldn't be of such an outlier in certain parts of something like that, but I think it's a very useful tool and it's meant the world to me.
Mark:	Do you still do it? Have you done it recently?
Pat:	I haven't done it recently, but I do ask for feedback continuously.
Mark:	Okay, and you feel like people are candid with you about it?
Pat:	I do. I do.
Mark:	You mentioned you were the interim president during the last year you were at Newton-Wellesley.
Pat:	Correct.
Mark:	How did that come about?
Pat:	My boss, Dr. Jellinek, was asked to go up to Partners to be the chief clinical officer, and that left the opening there. I was appointed the interim president and served in that role for 14 months.
Mark:	Was there any thought that maybe this was a tryout and you would be the permanent president?
Pat:	I actually competed for the position. I wanted it very badly, and in the end a person outside of the organization was chosen to lead the hospital. It was very challenging for me, because it was a place that I loved and felt that I had built, but that's how things happen. I was quite frankly … The way I look back at it is that I was happy that my first big career disappointment had happened when I was 49 years old.
Mark:	At that point you made the decision to move on?
Pat:	I spent a year at Newton-Wellesley after that. I was interested and considering whether or not I would stay there with the new president but I was also looking on the outside, and actually, I had been looking at Lahey Hospital for many years, so Newton-Wellesley Hospital is about 25 miles from my home in Reading, Massachusetts, so I passed Lahey twice a day for the 13, 14 years that I went to Newton-Wellesley, and all of a sudden the opportunity presented itself to come here and I made the jump, and that was after spending 21 years at Partners.
Mark:	Wow. That's a long time.
Pat:	Yeah.
Mark:	Before we talk about your current role, can you tell us a little bit about Lahey Hospital & Medical Center?
Pat:	Lahey was founded post-World War I by Dr. Frank Lahey, who was a World War I surgeon, and he believed that all care should be integrated under a single roof, so he started the Lahey Clinic in downtown Boston. They didn't have a hospital, so they would rent surgical space and other hospitals. I think for some time they looked at building a hospital or partnering with other hospitals in the Boston downtown market.
	Ultimately, the leadership decided to move to the suburb, so in the 1980s, the Lahey Hospital & Medical Center was built in Burlington. It is a large integrated group practice. All the services can be found under a single roof, so we have about 550 doctors, probably another 200 advanced practitioners, and literally all the care is taking place there, so if you go to the fifth floor you'll find the fifth floor cardiology outpatient clinics and across from them are the fifth floor cardiology inpatient units, so all the care is literally under one roof.
	Like many other organizations, the hospital decided that it needed to be bigger in order to compete in the external environment, so three or four years ago the Beverly and Addison Gilbert hospitals joined the system, and then just about 18 months ago the Winchester Hospital joined the system, so we have four acute care hospitals. We have a significant amount of subacute services, including skilled nursing facilities and home care.
Mark:	What is Lahey best known for?
Pat:	We changed the name from the Lahey Clinic to the Lahey Hospital & Medical Center a couple years ago. We did that because I think many patients thought we were just really an outpatient facility, which isn't surprising given the legacy of the place. I think people knew that you could come here, see your primary care doc, get an x-ray really quickly, and be in to see a specialist in the same day, so I think it was known for integrated care for those that knew us. What we are trying to do today is retain our customers and the patients from our community to stay local and not go downtown, so we're trying to be a high-quality, high-touch, low-cost provider, and we work very hard at it.
Mark:	You raise a point that I wanted to ask you about. You're close enough to Boston that people could easily say, "Let me go to Mass. General." You have a very competitive market with a lot of amazing world-class care. What makes Lahey unique and what keeps people from going downtown, as you mentioned?
Pat:	I think what differentiates us is the level of integration. Literally today we are working with our sister hospitals to keep people local in the community. We're moving 60 patients a month that used to come to LHMC are now staying at Winchester Hospital. By the way, the patients from Winchester Hospital that used to go downtown are now coming here, and in fact, over the last five years, Beverly Hospital has seen growth every single month since the two entities joined together.
Mark:	Why is that? What's driving the growth?
Pat:	The growth is the fact that people are less willing to drive downtown because of insurance products and consumer cost and what's being passed on to consumers. It's sometimes more expensive for even the consumer to go downtown, and I think we've done a better job of talking about who we are and what we can accomplish.
	We still have a ways to go, but for example, if you look at liver transplant programs, the number one live living donor program in the Commonwealth of Massachusetts last year is the Lahey Hospital & Medical Center. Our colorectal department is world-famous and world-class. In fact, Pat Roberts, our division chair, is the president of the United States Colorectal Society, so we have some great clinicians here and we're starting to get the word out that we have them here.
Mark:	You have teaching programs here, then.
Pat:	We do. We are affiliated with Tufts and we have residents and fellows and we have a research program here.
Mark:	Like other nonprofit hospitals, Lahey conducts a periodic community needs assessment. What is a community needs assessment, and why do nonprofit hospitals perform this assessment, and then specifically, what are the results of Lahey's assessment?
Pat:	Yeah, so the simplest answer why we do it is because we're required to by regulations.
Mark:	Sure.
Pat:	Of course, in Massachusetts this is monitored by the attorney general's office, but our needs assessment, I think most hospitals would agree that doing a comprehensive needs assessment with the communities and the community agencies that we work with is critical to planning future operations, so we do work through the CHNA system and we go out and we do surveys of providers, we do surveys of members of the community, we do surveys of the various agencies that treat them.
	We work very closely with police, fire, department of healths around these communities to determine what are the top priorities that we have, and then we try to come to consensus and then we try to build services and operations around that. I would like to tell you that it's a lot more clean than that, but it's really challenging to do this kind of work, but, for example, Lahey has made big investments in how we're helping our communities to combat the opioid crisis as that has emerged as one of the top challenges to certainly this community and many other communities in this area.
Mark:	Does the system do a single community needs assessment, or does each affiliate to its own?
Pat:	It's both. It's really a tailored approach, so we hit the primary service areas of each of the hospital and then we take all of that and combine it to get a system overview of what's important by what we call hot zones.
Mark:	Let's talk a little bit about you and what you do here. How did your experiences at Newton-Wellesley and Mass. General prepare you for the job that you're in today?
Pat:	I think as leaders we learn from our histories and our experiences. I think one of the neat things that I learned is just because it worked at Newton-Wellesley doesn't mean it's going to work here. You come upon organizations with very different histories and cultures and really very different mixes, so for example, from a personal standpoint learning for me, Newton-Wellesley was largely a private practice hospital, meaning that most of the positions, when I got there in 2000 only 5% of the physicians were employed by the hospital.
	By the time I left it was probably more like 35 or 40%, but here at Lahey all 750 providers are employed, so it's a different model. Now, that model was probably fairly similar to Mass. General, but I'm at a different level of the organization and I responsibility for it all here, so that has been a learning curve for me, and by the way, what makes it great.
Mark:	What departments on a day-to-day basis now report to you? What activities, what major activities?
Pat:	Outpatient activities, departments of surgery and medicine, particularly. I spend a lot of time there, but given my role I have breadth in all the ancillary departments, I have breadth into the inpatient departments, so it's hard for me to distinguish because almost everything, a lot of things, come to me.
Mark:	Who makes up the senior leadership team?
Pat:	Our CEO is Joanne Conroy, who's an anesthesiologist. She's been here two years. Myself, I've been here two years. The senior vice president for HR is Darleen Souza. She's been here two years. Our CFO has been here one year, Vinny McDermott. Tracy Galvin has been here 25 years but has only been the chief nursing officer for the last year. Andy Villanueva is our CMO. He's been here 35 years, but in that role a relatively short period of time. Nicole DeVita is the COO of our large practice in Peabody. It's a multispecialty outpatient practice with some inpatient services, and she's been in that role for probably a year and a half, so it's a very young senior leadership team.
Mark:	It is. How did that happen to come about? Was it just coincidence or was there some decisions made?
Pat:	I think it's deliberate. What happened was, as Beverly and Addison Gilbert hospitals joined Lahey, there was no system infrastructure, so as we were courting Winchester and bringing them into the system was the realization we have to create a corporate system. I think that was activated probably sometime in the middle of 2014, which left a leadership void at the Lahey Hospital & Medical Center.
Mark:	I see. Is your scope the Lahey Hospital & Medical Center, or are you system-level, or both?
Pat:	For me, it's interesting, and this makes the job rewarding but also challenging, so as my COO title I have responsibility for Lahey Hospital & Medical Center, but I also have system responsibility, so I'm accountable for supply chain, real estate and facilities, and process improvement systemwide, so it's a job that gets me … I get to see a lot of different things almost every day.
Mark:	What kind of support do the hospitals that join the Lahey system get from being part of the system?
Pat:	I think some of the things that they get, first off, is key role in governance, so the way that we designed the system was that each entity would have three board seats, and then of course we have … There's nine board members all coming from the hospitals, and then we have some lay board members, so I think the first thing they get is an equal voice, and I think that's critically important.
	Obviously by coming together we are able to leverage our size and build economies of scale, so for example, one of the things that I'm responsible for is our GPO implementation. We've saved $13 million in supply costs over the last year and a half and we are still working at it. I think they get access to capital at a greater degree, so there's all kinds of financial reasons, but make no mistake about it, when you go from being an independent hospital to being part of a system there are challenges that come with that, and we're still learning about how to develop and put this system together in a way that it works efficiently for all members of the community.
Mark:	Do those previously independent organizations retain a local board as well, or is it strictly a system-level board now?
Pat:	Typically they have a local board that's largely responsible for quality and safety and charitable giving.
Mark:	Okay. What keeps you up at night as the chief operating officer? You're laying in bed, you're staring at the ceiling, and you're thinking about something you've got to get done. What would that be?
Pat:	Healthcare is a very challenging market and I think that's particularly so in Massachusetts, so there's a significant focus on cost and cost reduction. In Massachusetts, it's even more severe than other states since we've passed chapter 224, which is probably some of the most aggressive healthcare cost containment legislation in the country, and it holds the healthcare market from growing no more than, I think it's 3% a year, but if you think about that, the commercial payers are only paying, at best, 3%. Oftentimes our federal payers are paying at a lower rate every year, so my net revenue increase, price increase, year-over-year, is about 1%.
Mark:	When you say the chapter 224, I'm sorry, I'm not familiar with, so it limits the amount that you can raise prices? What is it it's limiting?
Pat:	It tells the market that healthcare spending cannot go up over 3% a year, and the insurance companies are therefore holding price increases through their contracting to something that can help meet that, but that's all in the face of rising costs for me, so if I'm getting a 1% rate increase every year, net, federal commercial, and I want to give my colleagues a raise, call that 2%, that's on 70% of my costs, my outpatient pharmacy costs are up 15 to 16% here and nationally. New products and new technologies are coming out every year that if you're a patient you're going to want. We estimate that our structural rate gap every year is $35-$40 million in the current reimbursement environment.
Mark:	Wow, so how do you adjust and stay on track?
Pat:	There's really two options. One is to grow and the other is to change the model, so we're trying to do both, and most organizations are, so we're growing. We're trying to grow. In fact, we've done a great job recruiting patients to our system. We're, I think, one of the only health systems that's growing inpatient business year-over-year. Most of that is that we're retaining more care in our community that used to go downtown, but the other is to change the model, so you'll hear about risk contracting and population health and all of these things and we are in that game, but we are not fully in that game, and that's what most hospitals are like.
	For example, and this was true here, it's true at Newton-Wellesley Hospital, I might go to a meeting with the CFO and find out that MRIs are up and I'm really happy, but then I might go into a meeting with my population health folks that tell me MRIs are up and I'm not so happy because my medical costs are going up, so we're transitioning between business models, and any student of business knows that when you're changing business models it's a time of great peril. Now, the good news for us is that every hospital is really experiencing this, but it's challenging.
Mark:	Are you part of an accountable care organization, any accountable care organization?
Pat:	We are accountable care organization.
Mark:	Okay, you are. Okay. How does that affect the way you do business?
Pat:	In many ways it's done some very good things. It's focused us on quality, so for example, as part of the ACO and with our commercial payers' alternative care quality contracts we have quality gates that we have to … So that has focused us on trying to do things like preventive care, like diabetes management. It's forced us to do those things that are the right things to do for the patients. On the other hand, we're being measured on total medical expense and some might argue that if you're being measured on total medical expense you may be not utilizing the full effect of the healthcare system to the benefits of patients. I don't think that's true, but it's a different way of looking at this. The entire healthcare system, for the last 20, 25, 30 years, has been based on a fee-for-service, driving up utilization, driving up volume, and now we're in both, so it's a bit schizophrenic.
Mark:	How has health reform, and particularly the Affordable Care Act, effectively Lahey? Were these changes already in the works and happening through market pressures, or was it primarily a result of legislation?
Pat:	I think in Massachusetts we were ahead of the Affordable Care Act.
Mark:	That's true.
Pat:	I think we've and Massachusetts has been experiencing this for some period of time. In fact, as the Affordable Care Act was being promulgated I'd get calls from my colleagues all over the country saying, "Hey, what's it like?", so I think that kind of legislation has certainly had an impact, but I think it's also just the realization, federally and statewide, and even with us in healthcare management, 20 years ago when healthcare cost hit 9% of GDP, folks said, geez, when it hits 10% the world is going to collapse. Well, it's at 18 or 19% now.
	One fifth of every dollar is going to pay for healthcare, and when you're spending that kind of money on healthcare, guess what you're not spending it on? You're not spending it on defense, teachers, firemen, policemen. It's a significant piece of the pie, so we're trying to do things differently and better, but we're also doing that in the face of an audience that has very high expectations.
Mark:	You mentioned you are the coordinator, I may not be using the right term, but you are in charge of quality improvement for the system?
Pat:	Process improvement.
Mark:	Process improvement. What kind of strategy do you use there? Are you using lean or something particular?
Pat:	We don't subscribe to a single strategy. I have folks that are both lean trained and Six Sigma trained. We try to have a mix of tools that we can bring to bear. Right now we've hired five folks, we'll probably be up to 10 by the end of the year, that we're deploying around the system to reengineer our services. We have a major focus in primary care right now and we'll soon spread that to our specialty clinics, and we're doing it for a couple reasons. We're trying to get rid of waste, we're trying to speed things up and make it easier for patients, but we're also trying to make it create better lives for our providers.
	One of the outcomes of the Affordable Care Act and other types of legislation is meaningful use, so we just implemented Epic 15, 16 months ago. It's a major change to the lives of our providers, and we have to work now to realign our operations and our systems to make sure that they have a quality of life as well, so I think we're going to see a lot more of that. I had eight of these people at Newton-Wellesley Hospital who paid for themselves because they were helping us to deliver care and deliver services in a better, more efficient manner.
Mark:	Just jumping back a bit, how are you engaging with payers on reforms such as bundled payments, readmission reduction, risk-based contracting, and other changes?
Pat:	We have our hands in almost every till, so we're currently working on five bundles. We've done joint replacement bundle for several years. We added four more bundles this year. We have the alternative quality contract with Blue Cross Blue Shield and with other payers and we've got the Medicare ECO, so we have our hands in a lot of different pots, like many institutions, as we're trying to experiment and figure out how to we deliver care in a better manner, how do we prevent readmissions, how do we do the things that will reduce the cost of healthcare, lead to better outcomes for patients, and also make sure that we have the right business model for the future? Again, it's a little bit schizophrenic these days. Again, it's a little bit schizophrenic these days. Hello again, it's a little bit schizophrenic these days.
Mark:	How do you develop a strategy here at Lahey? You mentioned you're thinking three years out when you're the president, five, 10 years out, how do you go about developing that kind of big picture movement?
Pat:	Yeah, I think it's a combination of understanding where the market is going. It's understanding what your core strengths are and maybe what your weaknesses are. That's probably something that most organizations struggle with, and understanding the minds of consumers and what they're going to need. It's also understanding the technology and looking at demographics and seeing what's happening. It's complex. In the old days, I think people used to develop 10-year strategic plans. I think we talk about two to three years now because things can change so quickly.
Mark:	I wanted to transition and talk a little bit about leadership.
Pat:	Okay.
Mark:	What would you say is your leadership philosophy?
Pat:	I would say my leadership philosophy is hire great people, give them the vision and mission, and let them do their thing. Make sure they have the resources to do their job, help them and teach them to hire good people who believe in the mission and the values, and allow them to do their jobs.
Mark:	On those lines, where do you expect to get the next generation of senior leaders for Lahey?
Pat:	We're grooming some of them right here today, so we've got a cadre of young middle leaders who aspire in getting great mentoring for the future.
Mark:	How do you go about doing that? How do you go about finding and identifying talent like that, that you think, "That's a future senior leader"?
Pat:	I always describe it that I want to hire people that I have to reel in every once in a while, not ones that I have to kick in the butt. I try to hire personality, I try to hire people who have passion to do the job, but also people who are willing to listen and take feedback. I've done this in a variety of ways. Probably one of the most challenging ones I ever did is I was hiring a new CIO and it was a very important hire for me. This was several years ago, so I made it a condition of the hiring that any candidates that got through to me I would get to visit them in their workplace for a day and I would want to meet their staff, I would want to meet their customers, and I would want to meet their boss.
Mark:	Their current boss.
Pat:	Customer and boss.
Mark:	Okay.
Pat:	I actually hired someone doing that who since then has only been promoted further, and it was a great experience for me to do that and I think it was a great experience for the person, and people said, "Well, geez, why would anyone let you do that?"
Mark:	I have to say, I've never heard of that.
Pat:	I said, "Because you know what? High performers have already told their boss they're ready for the next opportunity." High performers are so confident and know their organization loves and needs them that they tell their boss when they're considering another opportunity, because that's how much confidence they have and should have.
Mark:	At what point in an administrator's career development does Lahey start to really groom them for advancement into senior ranks?
Pat:	Yeah, I would say we're still working on that, so the system has come together just recently. We're merging three, maybe four, different cultures. We have just started the Lahey Leadership Academy over the last year and a half where we are developing centralized curriculum based on needs assessments and then delivering that out to the leadership ranks, but I think we still have a long ways to evolve, and I think healthcare, based on my experiences in other places, has a long way to evolve.
	In healthcare, if you looked at the dollars that are spent on training and education, you'd probably be impressed, but if you dug deeper you'd see most of that training and education is going to physicians and nurses and maybe other clinicians.
Mark:	On clinical skills as opposed to leadership?
Pat:	Yeah. There isn't that investment in the nonclinical, into the leadership and management types. You see a lot of organizations spending more there and doing more there, but, like healthcare, which has largely been a cottage industry, there aren't a lot of best practices until really now with the increased expenditure in technology, there hasn't been a lot of that best practices learning. I think you're starting to see it develop, but I compare it to the military's training and education system and we have a long ways to go.
Mark:	What do you look for when hiring leaders and evaluating them? You mentioned somebody you have to rein in [inaudible 00:54:06], and what else do you look for?
Pat:	I look for someone that cares about the mission, that's passionate about the mission. I want someone that wants to attain results and make this organization the best that it can be. I want someone that can create relationships, because you can't get anything done without relationships. I always like to think about managing my leaders on outcomes, not on competencies, so my perfect scorecard for manager or director or VP is going to be where are they at in patient experience? Are they above where we want them to be? Where are they at with colleague engagement? Where are they at with their financial metrics? Where are they at with their operational and throughput metrics? Where are they with the community in terms of the metrics around that? So I believe in a balanced scorecard and I believe in using that to make sure that we're attaining the goals for the organization.
	I've seen it times and times again. The classic example, I think, is the Medical University of South Carolina, where they had a pillar system for goals and they had, say, 10 organizational goals, and at the end of the year they showed the results of those 10 organization goals and they basically had a sad face next to everyone. They hadn't attained the organizational goals, but if you looked at the leadership evaluations, 95% of the leaders exceeded the expectations could well, how can 95% of the leaders exceed expectations and the organization not meet its goals? There's something fundamentally wrong there, and I think that's true in a lot of healthcare organizations, and it's taken a lot of hard work and discipline to fix that.
Mark:	What characteristics and behaviors make a good leader, and how do you aspire to those yourself?
Pat:	I want someone that's kind and compassionate, and I've learned that the hard way. I want someone who's loyal. I want someone who cares, and when I say cares, cares enough to give direct feedback, cares enough to give reward and recognition. I want people that pass the praise down the chain and when something goes wrong shoulder the responsibility but then do the right stuff to correct it to make sure that it doesn't happen again. Honesty and integrity are just … Can't operate without them, and once they're violated it makes it very difficult for that relationship to continue, so I look for people that are go-getters, who I believe in, who inspire their colleagues and want to just do a great job for our patients and for our staff and to make this a better place for patients to get care and for people to work.
Mark:	Who would you say you learned those values from most?
Pat:	I've had the fortune both in the military and in healthcare to really work for some great leaders, and probably most of my values come a little bit from all of them. I think I've literally had the fortune never to really work for someone I didn't believe in. I think I'm very lucky that way. I often tell young people today, and by the way, it shocks me now how often I use the term young people, because there was a time when I was that young person. I was always the youngest person in the room, but even today I tell people, "You know, you can work for someone that maybe you don't believe in as much and you can probably learn a lot. It's just probably not as rewarding as you'd like it to be, although over time you'll probably remember those lessons well."
Mark:	Did you have a mentor, or mentors, in your career?
Pat:	Many, and still do, and still use them.
Mark:	How did those people help you out?
Pat:	They spent time with me and created an environment where I could talk about issues and concerns and problems. My first mentor was Captain Nick Miller. He was a Green Beret captain, and he was the company commander, I was the XO, and every day we would do PT together. After PT, we would grab coffee, showers, and we would shine our boots, and we would just talk about lessons of leadership, all the time, and he created an environment that was so open that I felt like when I had an issue that I was dealing with that I felt I could go to him and talk about it, and I've been fortunate enough to have that, I think, in almost … I've had it in every part of my career.
Mark:	You've been able to find someone that you could do that.
Pat:	Yeah. Absolutely.
Mark:	Were they typically supervisors like the captain was, or are they people outside your chain?
Pat:	I think it's both. I think if you create strong relationships, I've always had a boss that I could go to and discuss those issues with, whether peers or even folks that might report to me that you can run through issues with. I think if you create open, trustful relationships, many people can be mentors.
Mark:	How important is it for young folks to find mentors?
Pat:	I spend a lot of time advising young people on careers, and I think mentors and networking are inextricably linked, and I don't think you find great jobs … You can be lucky, and I see so many kids today and maybe it works, I just don't know, I haven't had to look for a job in a long time, but everyone is on the LinkedIn and applying online. For my world, you get jobs because you know people, and because the best case is you're being recruited all over the place. Well, you get that by developing strong networks, and as you're developing strong networks I think you develop mentors and relationships and people that you can count on for advice, so I think it's incredibly important. I often tell kids, I'll have a young person that comes in here, and I tell them, "Think about everyone you've met. You've taken the time to meet them. Think of them as part of your own personal Board of Directors."
	I had a kid who I met who every quarter gave me an update, give me an update on e-mail, so three years later when they needed to see me and wanted some help for some advice I remembered who they were. I had another person, actually about my age but I had mentored her, she wrote me a letter every year on January 1, 15 years. Never asked for a thing in between. On the 15th year her son graduated from college and she asked if I could help them network. We got him a job. Do you see what I'm saying? So you've worked to create or start a relationship, don't lose it. Maintain it, and by the way, easier said than done. Easier said than done. I myself have been guilty of not maintaining an important relationship.
Mark:	How do you recommend people go about building their network? Staying in touch, it sounds like?
Pat:	Yeah, I think it's seeking people out. I start by trying to learn about people, so for example, you came in here today and what did we do at first?
Mark:	We chatted about my background.
Pat:	I wanted to know you and meet you and learn about you, A, because it's interesting for me, B, it's something I might draw on in the future, but by getting to know you now I've got a connection. I think it's caring about the other person more than about yourself that allows you to do that kind of things, and it can be tough, because I live in a pretty hectic world. I'm probably seeing less people than I would like because of the current operational tempo that I'm working on, but it's going out and meeting people and then not being afraid to ask someone, "Hey, do you know someone here?", and it's asking people for help. Sometimes I think people are afraid to ask people for help, but my experience tells me that people like to help if they can.
	I was talking, but this was back at Newton-Wellesley, one of my young leaders was having a family clinical issue and said, "You know, what should I do?", and I said, "Well, you know," and I thought back and I realized they didn't have a strong relationship with our chief medical officer, who's a really talented guy, so I said, "Ron, here's what I would do, and I would do it for two reasons. One is he's going to actually have the expertise to help you with this family clinical issue. More importantly, he's going to love doing it and you're going to create that relationship," so that's how I look at it.
Mark:	What leadership counsel do you most often give to young leaders? Is it about relationships, mentoring, something else?
Pat:	I would say it's about relationships. One of the things that I'm finding more and more is people are getting way too comfortable with e-mail and thinking they're solving problems by using e-mails, so more and more of … And I've had to talk to some senior people about this. Get up, get out of your office, and go talk to this person face-to-face. Recognize that you guys have a different view. Solve it. You're both good people. You both, I think, care about the organization, so get face-to-face and solve the problem, and I would say that's true about most things.
Mark:	Would you say that's one of the areas where young leaders most often go wrong?
Pat:	I think so. I think so.
Mark:	Any other touch points that you find yourself correcting young folks on? I'm thinking here now because I teach primarily undergrads, and they're going to be going in as early careerists.
Pat:	I don't know if I'd say this is a trend yet. I would say that one of the best pieces of feedback I ever got was when I first got out of the military and my boss said to me, "You know what I like about you, Pat? You're listening 70% of the time." I had never been given that feedback, and I was used to listening 70% of the time because I was in the Army and I was junior, but it stuck with me and I can be very quiet in meetings, whether it's meetings that I'm attending, senior, wherever level, and when I speak everyone listens because they know I'm not going to be repeating something that someone else said.
	I'm going to be offering something different, a different view, a different analysis, a different thought process, than what's been … Because I don't repeat things, and when I finally do speak people are interested in hearing what I'm going to say, so I think listening is a pretty important …
Mark:	So listen 70% of the time.
Pat:	Yeah.
Mark:	Or more, maybe.
Pat:	Maybe more.
Mark:	Can you give an example of a difficult leadership lesson somewhere in your career that you had to learn the hard way, and what did you learn from it? How did you overcome it?
Pat:	Back when I was first starting in the civilian world I was materials management and there was a lot of focus on reducing cost. We had two vendors that did our linen. One was a private company and the other was a consortium, and the consortium was owned by most of the downtown hospitals. About 80% of the linen went to the private provider and 20% went to the consortium. The cost for the consortium was a third higher, so I could save $1.2 million by moving from the consortium to the provider, so I raised this to senior leadership and was asked to come back.
	"Well, we can't just do it on price alone. We need to understand service," so I spent the next three months devising metrics that measured service. In the end nothing happened and I felt very frustrated by it, so I don't know if the lesson … One of the lessons are is don't get frustrated by those things. There are lots of things that happen. The other is I could have asked the senior leader up front, since we owned a piece of that consortium, "Do you think this will ever happen or am I wasting my time?", so I don't know if that's a good example.
Mark:	Sure, sure. If you could go back to 1992 and give yourself some advice as you're transitioning out of the Army and into healthcare, what would you tell yourself?
Pat:	I can't think of a thing.
Mark:	Really? Just let him figure it out.
Pat:	I can think of a thing. I don't think we in this life know … I don't know what kind of different viewpoint I would have had. I know when I got the job my father, who was then alive, was very proud. I had no idea that I'd still be in healthcare today. I thought, maybe I'll spend a couple years there and who knows what's going to be next? But to be honest with you, I'm 52 years old today. I don't know how long I'll be in healthcare or what's next for me now.
Mark:	That's a neat perspective.
Pat:	I don't know.
Mark:	All right. Well, two last questions. One, if you could pick any book for a young careerist, early careerist, to pick up and read, what would you recommend them?
Pat:	I can't just pick one, so I'm going to give you three.
Mark:	Okay.
Pat:	Monday morning quarterback, "Monday Morning Leadership," "FM 22-100," the Army leadership manual, and "Good to Great."
Mark:	Why those three?
Pat:	"Monday Morning Leadership" is, I think, just a great, easy lessons for new supervisors, and I think it tells it in a story format that I think is illustrative. "FM 22-100," I think, gets to the core and basic principles of leadership, and I remember those things today and try to follow them. "Good to Great" is, I think, a great example of companies that oftentimes face some hard truths about who they were and what they were about, make changes, and then excel to excellence, and at least the data that you use supports that rise to excellence from maybe mediocrity.
Mark:	Last question. What advice would you give early careerists who are embarking on a career in healthcare management?
Pat:	I'd give a few things. First off, I'd say your first job is probably not going to be your last job. It's hard to go into the exact right job. You don't know. For example, some people would have told … Some people did tell me, "Don't go out to Newton-Wellesley. They're losing all kinds of money," but I wouldn't have made my career the way I did if I hadn't, so sometimes hard challenges can lead to great opportunities.
	I would tell folks that, here's the keys to success in the organization. Find out what the organization thinks they need. Find out what you think they need. Figure out your key contributions and how they can be measured. Make sure the chain of command knows what you're doing, and then deliver results. It's really that simple, and when you're done with one cycle, do it again. When I first got to Mass. General radiology, one of the first things that I was apprised of was a new goal to reduce operating expenses by 25% in the next three years. I think I mentioned with the team of physician leaders that I had in that department, we developed a massive reengineering plan which included using technology.
	There was something on the market, kids today will probably laugh, but voice recognition technology. Well, I was spending $4 or $5 million a year in transcription cost. There was really no fully operative product out on the market, but there was a company that was in beta called MedSpeak, and we signed a deal with MedSpeak, which was later acquired by IBM, and two years later we were spending $100,000 on transcription, so we were innovative, we were creative, we saw what was happening in the market, and I was most proud when the CEO of Mass. General, who has hundreds and thousands of these projects going, was interviewed by New England Cable News Network and cited radiology's voice recognition.
	The reason they knew that is because I insisted on briefing him every quarter on what we were doing. One, because I knew we were going to attain results and I wanted him to know about them, but two, because I wanted access to him in case I needed some obstacles removed, so it's being forthright and consistent about making sure your message is getting heard, and that's true for any organization.
Mark:	Thank you so much for sharing your journey with us today.
Pat:	Thank you, Mark. It's been a pleasure, and I look forward to seeing you in the future. It's great to meet you.