The following is a transcript of my interview with Patsy Aprile. 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.
Mark: Welcome to the Forge, Patsy.
Patsy: Thank you. Glad to be here.
Mark: The University of New Hampshire is only
about a 20-minute drive from Maine or the Maine border, so I'm pleased to
finally have a guest from the Maine health care community on the podcast.
Although you are in Maine it seems like your early career roots were actually
in New Hampshire.
Patsy: That's correct, yeah.
Mark: You attended Colby-Sawyer College and earned
a bachelor's degree in medical technology. Why did you go to Colby-Sawyer and
how did you choose medical technology?
Patsy: Actually, Colby-Sawyer my best friend in
high school, her mom had gone there, and so she took us for a ride to
Colby-Sawyer and at the end of the day I had applied to some private schools as
well as public schools that I actually got more financial aid from the private
school. That's how I came to have my education at Colby-Sawyer.
Mark: Okay, why medical technology? Did you know
you wanted to do something in healthcare when you went there?
Patsy: Yeah, I know I wanted to do health care but
at the time I had thought well, I'm not sure I want to be a nurse. This was a
course that was offered at Colby-Sawyer and so I moved ahead with it.
Mark: What is medical technology for folks who
...?
Patsy: Medical technology is laboratory science, so
it's the study of the chemistry of the body.
Mark: You thought you wanted to do clinical
science-
Patsy: Correct.
Mark: After you graduated what was your first job
out of college?
Patsy: My first job out of college was in the
laboratory at Salem Hospital in Salem Mass, and when I worked there I was a
generalist in all areas of the laboratory so I did blood bank, hematology,
chemistry, microbiology and it was a fantastic job. I loved it.
Mark: All right, when did you make the transition
into leadership? When did you move out from that? Did you stay as a technician
for a while? When did you ...?
Patsy: I did. I worked in the laboratory for 19
years.
Mark: At Salem?
Patsy: No, I had moved at that point to New
Hampshire and I was working at the Elliott hospital, and again I was a
generalist and then there was a position open in the laboratory as a supervisor
of Hematology. I applied for the position and I got it. Then after having that
position for a while then I moved up to the ranks of laboratory manager, and
then laboratory director. That kind of was my progression in the laboratory.
Mark: This is all at the Elliot?
Patsy: Yes, it was.
Mark: Did you have any mentors that were
encouraging you to move along in that in the laboratory realm and moving up as
a leader?
Patsy: Yup, when I was in the laboratory there was
a gentleman who had been the director of the laboratory at the Elliot Hospital
for over 30 years, and once I got the supervisor position he couldn't have been
any more supportive of me as an emerging leader. He mentored me primarily in
terms of finances as it related to the laboratory and what upper management
would be looking for and thought in terms of reports and the up and downs of
the reports, as well as the profit and loss statement. He was a great mentor to
me, very, very supportive.
Mark: It looks like in 2005 you moved on to be the
executive director of clinical services at Catholic Medical Center.
Patsy: I did.
Mark: Tell us a little bit about that position and
how did that come about.
Patsy: All right. This was during the time when the
two hospitals in the city of Manchester merged together, and so the Elliot
Hospital and Catholic Medical Center merged together and after three years they
actually de-merged. When they de-merged there was actually two positions one
was the director of laboratory services at the Elliot Hospital that I was
fortunate enough to have been offered the position. At the same time a Catholic
Medical Center they came to me and said, "I'm going to offer you some
progressive leadership here, and if you stay with us I'll make you the
executive director of clinical services, so not only will you able to see the
laboratory but we'll give you other areas," and to me that was such a
great opportunity that I decided to move to Catholic Medical Center and take
that position.
Mark: Oh neat. What were you responsible for as
the executive director of clinical services?
Patsy: I always saw several of the outpatient areas
including of course the laboratory but also the pharmacy, the wound center, the
eye center, clinical nutrition, food services. Later, I also oversaw the start
of a new program, which was the gastric bypass program.
Mark: I think I misspoke, you actually took that
job in 2002.
Patsy: That's correct.
Mark: Then you left in 2005 to go to Goodall. The
position you took at Goodall was vice president of operations. That's correct.
Tell us a little bit about that position.
Patsy: Sure.
Mark: Actually, first, what was Goodall Hospital?
How big was it? Beds, employees.
Patsy: Goodall Hospital had a little over 900
employees, I think it was 940 employees. It was a small hospital in terms of
inpatient, it's an average daily census was only about 23, 25 at the time. I
had a very good sized outpatient service line, and during the years that I was
there it actually grew and moved into other geographic areas.
Mark: Goodall was in Sanford, Maine. You left New
Hampshire, left Manchester area moved east and north up to Maine. Now, as vice
president of operations tell us a little bit about that job, what was that?
Patsy: Sure, so that job was actually in large part
and expansion of what I was doing at Catholic Medical Center. I oversaw, a lot
of the same departments but then I also had additional new one, so I oversaw
the pharmacy the laboratory, but then I also had the Health Information
Department, the admissions department, some on the physician practices.
I also had human resources and
as that, that was a wonderful learning opportunity for me because not only was
I able to help with all of what you think of in terms of human resources, which
is the hiring and the disciplining and the orientation, but also I learned an
awful lot about benefits and compensation. That was a great learning
opportunity for me. I actually went on to actually also be the compliance officer
for the organizations.
Mark: What is that?
Patsy: Compliance officer in essence is a mandated
position by the centers for Medicare and Medicaid, and they're essentially
looking for every organization that accepts funding from the government to make
sure that all of their billing practices are handled in an ethical manner.
Mark: How did your position as vice president of
operations, how did you fit into the overall leadership structure? You're
pretty close to the topic at point.
Patsy: Sure.
Mark: Who did you report to and-
Patsy: In that role, I reported directly to the
CEO. Below the CEO there were a few other vice presidents, so there was a vice
president of elder care services, there was the chief financial officer, and
then there was also the chief nursing officer, as well as myself. That's,
again, we were pretty much all at the same level reporting directly to the CEO,
but having different lines of responsibility.
Mark: Okay, Goodall was kind of struggling at the
time when you arrived on several fronts, and one of those was the noncompliance
issues. Compliance issue that you talked about. How did you address that issue
and the other issues that were going on at the time as a senior leader?
Patsy: Well what I've come to learn is that, if you
have the proper structure in place below you with people that are competent to
do the jobs that are required, as well as simply being forthright in saying,
"This is what I need from you." What I've found is more often than not
if you just tell other leaders what is expected of them they're going to do it.
After assessing for instance some of the, during the joint commission surveys
they had found some deficiencies.
Again, going out looking for
leaders that are competent in particular areas, putting them in place and then
being very specific is the joint commission standards for this particular area.
I need you to make sure that every single one of these are met, not only met,
but go above and beyond the required standards.
Mark: Have Goodall filled its joint commission?
Patsy: It did fill joint commission but it did
have-
Mark: Significant findings.
Patsy: Some findings, correct. That was prior to
the CEO coming on board. When she came on board, she began to put some great
leaders as well as processes in place.
Mark: We also oversaw four construction projects
during your tenure as the VP of operations. Was this a new skill set for you
had you done that before?
Patsy: I had never done that before.
Mark: What did you do and what was that experience
like?
Patsy: Again, we began to expand it to different
geographic areas such as Waterboro Maine and Kennebunk Maine, and in order to
grow we needed to have a facility that housed all the services that we were
going to offer in those communities. Again, we're fortunate to have somebody
that came to work for us that had a background in construction management. He
reported directly to me and we began the process of saying working with an
architect, working with engineers that helped us to work through the size of
the building, what we would have in the new building and then talking to us
from an operational perspective to pose questions to us to say, "Well talk
to me about how you work? Where do you register your patients? How many of
those patients are pre-registered? How many books do you need for
registration?"
Then they would help us say,
"Okay, you have laboratory draws that you do every morning, that's your
heavy time during the morning because people are fasting. How many draw
stations do you need?" As they would pose these questions we began to
develop the model of the facility that we wanted to build, and so was form
around function and it was a fabulous sight.
I really enjoyed it because I
got to not only work through the process of developing a new building, but then
I got into the design aspect which was what colors are you going to choose?
What are the chairs going to look like? To me, quite frankly that was a lot of
fun so I enjoyed that a lot.
Mark: Sure. This is a good example of the kind of
different skill set that's required, I think as you move up. You started out in
the lab, you were trained as a medical technologist, and very knowledgeable
about that field and so on. As you moved up you're moving into overseeing stuff
that you aren't a expert.
Patsy: Exactly.
Mark: What was that experience like as you pencil
this construction thing, as you got another example. I think a lot of managers,
that's a grueling process for a lot of managers. What was it like for you to as
you moved out of the areas, out of the laboratory and into the get your picture
management, how did your management style? How did your leadership style
change?
Patsy: Well, in large part I had to realize that,
particularly in the first one in two projects that I didn't have the background
to feel confident that everything I was doing was right. My leadership
definitely had to change and that I had to have faith in the person who
reported to me.
I also needed to make sure that
I was following up and asking some questions that might seem naive to perhaps
to some people, but you had to be humble and just get out there and ask those
questions because the folks who knew how to do building projects, all they
wanted to do was have a completed project that was done well. They were leading
us all along the way, but I had to have faith in the process and the person who
was reporting to me that I wasn't leaving anything out. A little nerve-wracking
but nonetheless a positive learning experience all the way around.
Mark: This would be true, I assume, for things
like I mean you went into oversee and you had the pharmacy report doing all
this, same kind of approach.
Patsy: Yes and No. The difference what I found in
some of the clinical areas was that I had such an intense background about
process in the laboratory, just as an example. The physician would go in and order
a lab test, the lab test gets put into the computer and then the phlebotomist
goes draws the blood and then the blood comes back to the laboratory and you
run the analysis on it and now you report it back. When I got to the pharmacy
and the same with the respiratory and other departments like that, I learned
that, "Okay, well the doc isn't necessarily ordering a blood test but he
is ordering a medication that medication order has to be put into the computer.
It needs to get down to the pharmacy." Now the pharmacist is pulling that
medication and then getting that back to the floor.
There were so many similar
processes that I could easily relate to and help along versus constructional is
totally new and different. Totally new and different.
Mark: Have you found that to be true for other
departments if you've picked up? If some would have, would lend themselves to
the kind of process management that you had learned right from college. Some
probably don't lend themselves work that way through construction.
Patsy: Yeah, health information. Construction but
even something like health information management, which is medical records.
Really from the background that I had, you really don't go into the medical
record at all. You really don't have much of a need to and so understanding
those processes and from a regulatory perspective what should be in the medical
record, which shouldn't be liability issues. It's very different, a lot to
learn but the same leadership experiences in terms of making sure you have the
right person in place, and then having faith in that they're going to work with
you and fulfill all of the regulatory requirements that are needed.
Mark: Sure. How do you know when you have the
right person in place and how do you know you don't?
Patsy: Oh, boy.
Mark: Let's say, information management, you walk
in, early on, you have experience now. You probably have a better sense. Early
on, how are you trying to figure out my supervisor? I'm not saying what that
person was or just how do you know?
Patsy: You actually know from a few different
areas. The first place you know is, when you have your regulatory reviews, so
the joint commission comes in if there's big warning signs, they're going to
find that during their inspection and it's going to come out in their report.
That's one area that is like a slam dunk. There are some red flags there. Those
are experts coming in-
Mark: Exactly.
Patsy: ... and looking at your area.
Mark: Exactly.
Patsy: The other area is that you get hints from
sometimes hint, sometimes just over it. I need to talk to you from staff
members or other leaders who feel like, for instance, perhaps somebody needs to
meet with the leader of HIM, and it's just not getting back to them. No matter
who you are if you're a leader and for an organization you're expected to work
well with others, and they generally need you, they need their help got other
person's help in getting the job done.
You hear it either from another
leader off from the staff, and the magnitude and the volume of concerns that
are voiced are the two key, two things for you to take action.
Mark: Talking about growth. Goodall was in a
growth mode, it sounds like. Yet, in I guess around 2010 or so, you started
looking at Goodall starting looking at merger talks. That seems
counterintuitive to me, why would they be growing and then at the same time
thinking, maybe we should merge.
Patsy: Yeah, because a couple of things happened.
First of all, our reimbursement change. I'll just give the example of
orthopedic surgery. The reimbursement for orthopedic surgery again, just as an
example, what the centers for Medicare and Medicaid were paying us went down.
You have a decrease in reimbursement at the same time, we had a huge increase
in bad debt and charity care.
You have this triple effect of
bad debt charity care and then decrease reimbursement. That's probably the
biggest thing. The other thing that was concerning for Sanford was that, we
were in a building that was aging. It was over 85 years old and it was so
important that we retain services in Sanford, the local economy needed it, the
patients in the area needed it.
Yet, looking forward we knew
that reimbursement was going down, charity care going up, and we were in a
designation that we should have been what's referred to as a critical access
hospital because of our average daily census. If we had that designation we
would have had about five to $6 million more in reimbursement per year, and it
would have totally changed our financial profit and loss statement.
We were too close to the next
closest hospital. We were denied that designation. With all the other competing
forces, we said, "Well, we know we need to retain services here. Let's
work with Maine health." It's in our geographic service area it has a
phenomenal reputation, and what can we do to maintain the jobs that are in this
community, and that's why we worked with Maine health.
Mark: Can we back up just a second and talk about
what is a critical access hospital? I've had a couple of other folks on but
just folks who haven't listened to those other podcasts. If you could just very
briefly explain what is that and what does that designation do? You much may
have gone better reimbursements, how does that work?
Patsy: Critical access hospital is defined as a
hospital that has an average daily census of less than 26, and is located
greater than 25 miles from the next closest hospital. As if you fulfill both of
those then you can request a designation from the government as a critical
access hospital, and as such you get increased reimbursement from the
government for services rendered.
Mark: That's where the five or six million
additional.
Patsy: Exactly.
Mark: That would have made the difference to keep
you afloat-
Patsy: Night and day.
Mark: ... in the hospital.
Patsy: Night and day.
Mark: What about the capital improvement you would
have done you think, would have been enough?
Patsy: You know what it wouldn't have been enough
in the short term but in the long term if we could have waited out several
years than we would have been able to have a, we'd be able to add to our capital
funds. We certainly had a good endowment, so yeah.
Mark: In 2011, the CEO of the hospital left and
you were promoted to CEO by the board.
Patsy: Correct.
Mark: In a newspaper article that I read from the
time it said that, you have said your primary focus would be to continue the
merger discussions with Maine health. I'm guessing you probably knew that the
CEO title was probably not a permanent fair.
Patsy: It's true.
Mark: How did your focus change when you became
CEO? How did your day to day responsibilities change? What you thought about on
a daily basis change?
Patsy: Again, I did know that I would be in the
merger process for about a two year period of time, and the two hospitals that
we're merging. We had a parent organization Maine health and the two
organizations where Southern Maine Medical Center in Biddeford and Goodall
Hospital in Sanford, Maine. The CEO at Southern Maine Medical Center had been
the CEO, I had been in the organization for over 35 years, and the CEO for over
25 years.
He was extremely respectful,
extremely supportive, and it just made perfect sense. That has emerged
organization. He would be the CEO. My job in the interim role was to bring the
merger forward, do everything in my power to make sure it came in a efficient
smooth manner. During that two-year period of time the number of community
forms that happened throughout the Sanford Springvale area was just phenomenal.
My role changed greatly in terms
of communication and getting out and talking to the community. I also began to
have many staff forms, so every few months I would have forms with a content,
one set of content that it was about an hour long, but I'd have about 11 of the
same forms in three days, over and over and over again with the same message.
Communication is so key in order for it to go smoothly, in order for any merger
to go smoothly you have to communicate and communicate often and well, and I
think I did that. That was the primary goal and actually [crosstalk 00:22:54].
Mark: Your focus really shifted from an internal
operations focus to a external communications, merger.
Patsy: Exactly, yeah.
Mark: I must have been a big learning process.
What were the biggest things you learned in that time frame?
Patsy: I think that thing that I learned the most
is that when you are even though you're going through a merger and I know what
the end state will be, as the CEO for that two-year period of time the number
of sleepless nights was phenomenal, because as I mentioned a few times during
this discussion, keeping services health care services in Sanford for the
community was a key, and making sure that it was done and done well really as a
CEO, it's on your shoulders. It's such an honor and such a privilege. Unless
you take pay very close attention, it could go amiss. I would say what
surprised me the most was the number of sleepless nights.
Mark: How far away is Sanford from ... we're in
Biddeford today. How far is Sanford from here?
Patsy: It's about 24 miles.
Mark: Is there inpatient capacity? You were saying
you wanted to keep services in Sanford, so what services did you decide as an
organization would remain there?
Patsy: What we actually are going to answer a
little bit differently, we've stopped in patient services in Sanford. We have
the capacity here and Biddeford, but we actually retained just about everything
else. We have all of the diagnostic imaging the MRI, CT, a full service emergency
department. We have specialty practices such as OB orthopedics.
We have a pain management
center, we do colonoscopies out there, ambulatory surgery. We have a pain
management center, so we actually pretty much everything-
Mark: It's pretty robust.
Patsy: Right, that we were doing before, rehab
services, other than inpatient.
Mark: Okay, so OB services would be outpatient
well-baby kind of stuff.
Patsy: Exactly.
Mark: But deliveries are done here.
Patsy: Exactly.
Mark: Can you talk a bit about your relationship
with the board.
Patsy: Sure.
Mark: What does a board do for a hospital? Then
this must have been kind of a unique time to be a member of the board as you
they were working through these as you were working with them through that
process. Tell us a little bit about what does the board do normally and what
was it like in this very kind of crucial time for their organization?
Patsy: The board of trustees is essentially the
oversight of the organization. We have 20 members of our board of trustees. We
are made up of 40% physicians and the rest laypeople, and they oversee all of
the- they're a fiduciary responsibility to make sure that we're handling our
dollars appropriately. They oversee capital expenditures, but most importantly
they oversee the quality of care of the organization.
Mark: Is that today? You're talking about or when
you were at Sanford?
Patsy: Both.
Mark: Okay, so there would have been separate
boards at that time.
Patsy: Sure. Actually, we went to a very unique
process in that we each had a board of trustees of about 20 members each and we
decided that we wanted to have one board of trustees. No, let me state that
differently. That we wanted to have, we each would ... until we merged we would
have separate boards of trustees, we would maintain that, but we would have the
same board of trustees members. What we did was we each organization went out
to its board of trustees and said, "Okay, we are going to have a holding
company," and that holding company will be made up of 20 trustees.
Those same 20 trustees will be
the trustees of Southern Maine Medical Center and the trustees of Goodall
hospital. We'll have three separate sets of minutes and so we went out to the
board and said, "Who would like to stay and who would like to move
on?" Actually, we were very fortunate just through self-selection and we
wanted it to be equal representation, which was very different because Southern
Maine Medical Center was about double the size of Goodall.
We decided through the guidance
of Maine health to have it be most functional, that we should have equal
representation. We took 10 members from the Goodall board and 10 members from
the Southern Maine Medical Center board to make a new 20 member board of
trustees.
Mark: Who was the board organized? Are there
committees or functions that in either individual members of the board or
groups of subgroups who's responsible for?
Patsy: Yeah, so the board of trustees, each trustee
is requested to be on at least one committee. We have a board of trustees
meeting, they meet once a month but we also have committee meetings. We have a
finance committee meeting, oversees obviously all of the finances as it relates
to the organization. We have a governance committee that looks at our
governance structure and our bylaws, and then we have a compensation committee
that oversees the compensation of the executives. Then lastly, we have a
quality committee of the board that looks at all of our quality scores, all of our
quality indicators, and discusses improvements for quality.
Mark: During that merger process what were they
doing? What were the board members doing in terms of what kind of decisions
were brought to the board, what kind of decisions were left to their respective
CEOs? I might be reaching back a bit.
Patsy: During the merger process, the board really
had its ... The primary responsibility at the time was due diligence. In other
words if the two entities were going to merge together. They wanted to make
sure that the quality scores were such that each other would not damage each
other, and in fact we each had great quality scores so that one was pretty easy
to get past. We needed to understand the financial challenges of each
organization and whatever those challenges were to request a plan to be put in
place, to overcome those challenges. And then from a governance perspective,
the governance committee had some great work to do in terms of again looking at
our organization bylaws and updating them for this new Southern Maine
healthcare that was being formed.
Mark: As the leader on the Goodall side, what were
the main concerns of the people from Goodall, from the staff, are kind of going
into it? How did you, you said you had a lot of meetings with them, what were
their concerns and how did you work with them?
Patsy: The primary concern was that, it might got
to have a job.
Mark: Sure, that's it.
Patsy: Am I going to getting a job, that was by far
the number one question the, number two question was if I'm going to have a job
is it the same job and what site will it be at. Some of the decisions that
needed to be made took time and a lot of thought, and so the struggle was not
being able to answer the questions. It wasn't for lack of not wanting to answer
it but the answers weren't there yet. We had to work through thoughtful
processes.
I have to say that overall
though, we were very fortunate because very, very few jobs were lost. Most
people self-selected for instance, director of rehab, director of pharmacy.
There were several positions that people said, "Well, there's two of us,
we only need one. I'll go look for a job elsewhere." That just happened
over and over again. Like I say, we really our goal was to have no layoffs and
so because it was a two-year process, it worked out that we were actually able
to do that.
Mark: Give a lot of time for people.
Patsy: Exactly.
Mark: See where the redundancies were themselves.
Patsy: Exactly, yeah.
Mark: What about culture? It sounds like both of
the organizations were performing well, so it doesn't sound like there was a
problem at even place but every organization is different. Even high performing
organizations that have different cultures. What was it about? What was that
like?
Patsy: I have to say that because we're now a
melded organization and culture takes at least three to five years to get
there, we've only been merged for two years. The changing culture is evolving
and the culture for Southern Maine healthcare our tagline is, excellence
always. Everything we do, excellence always. To us, to have high quality scores
is really important. We want to have high patient safety, all of that. We do
very well in those areas but we want to do better and exceed. Again, this is a
culture that's evolving and I think it was difficult for both sides.
It's just because like you say
culture is so important and one was smaller one was bigger and again-
Mark: Maybe more intimacy in the Sanford. You
could know everybody and wrapping arms around little more.
Patsy: Exactly, yeah.
Mark: It's a little bigger.
Patsy: Exactly.
Mark: Those folks we're having to come join into a
larger organization where maybe not as intimate.
Patsy: Honestly, from the, other than the inpatient
piece a lot has really stayed as is the Sanford camp.
Mark: I see, okay. The culture is still there.
Patsy: Exactly. Exactly.
Mark: Following the merger you were appointed as
the senior vice president and chief operating officer for Southern Maine
healthcare, the physician that you currently hold. Let me ask this. What is the
relationship between Southern Maine health care and Maine health? How does
being part of Maine health help Southern Maine healthcare?
Patsy: Maine health is our parent organization.
Maine health actually has several hospitals below it, Maine Medical Center is
one pen bay, Lincoln healthcare. There's several and where another one of the
hospitals. What Maine health does for us is that they provide us depth in terms
of working with the big peers, such as Anthem, Cigna, they can go out to the
payers and say, "Okay, I want to work on reimbursement and you don't have
all these hospitals underneath us," and so they essentially afford us
buying power that we didn't have in the past.
They also have a slate of legal
counsel, and being able to tap into attorneys quite frankly on a daily basis,
some that specialize in compliance. Others that specialize in human resources,
some in pension that you can reach out to these different attorneys is a
benefit that quite frankly we didn't have in the past.
Though, one thing that's
different is now having a parent organization is that Maine health has its own
board of trustees. Now, we want our board approves whether it'd be big
financial purchases, let's say, we're going to build a new medical office
building the board of trustees at Maine health, now has to approve that also.
We do have another layer and from a timing perspective, it takes a little bit longer
but again we have the depth and breadth of Maine health which is a huge benefit
overall.
Mark: One more question about the board, I forgot
to ask you earlier when you mentioned 40% of the membership of the board are
physicians, and then the rest are lay members of the community. Why the high
level of high concentration of physician members?
Patsy: Again, it's a governance philosophy here at
Southern Maine healthcare, you generally don't see that percentage of
physicians on a board of trustees. The reason why we have that as part of our
culture is that, as we go to the board, and we talk about and requests such
things such as capital expenditures. For different equipment that we might need
to purchase, physicians have a very keen eye on what should and should not be
purchased and they help prioritize.
They are very helpful in that
regard but I would say the number one reason to have that percentage of
providers on the board is because of their in-depth knowledge on quality, and
quality of care. Again, as we strive for excellence always, what physicians can
bring to the board of trustees is just phenomenal.
Mark: Okay, great. The Maine healthcare has 20
locations in six cities, is that correct?
Patsy: That's correct.
Mark: What would you consider your flagship
facilities? Then what are all the other locations and what's going on
generally?
Patsy: Biddeford and Sanford are clearly the two
flagships, cities that we're in, but we also have four we're located in four
different buildings in Kennebunk, and we're also in a few different buildings
in Saco. I would say those are our primary buildings that we're in and
geographic regions.
Mark: Do you have eldercare?
Patsy: We do.
Mark: What is that?
Patsy: Okay, eldercare. We actually have a 74 bed
nursing home in Sanford and those are dually license for skilled beds and nursing
home beds. Above and beyond that in Sanford we also have a 14 bed residential
care facility and we also have a 24 bed dementia care facility. Then offsite,
off of the hospital campus, we also have another 32 bed residential care
facility. We actually have quite a few elder care beds, they're all in Sanford.
When we go out to the community
in Sanford, what we hear over and over again is, "You're going to retain
our eldercare?" The aging community wants to be assured that their loved
ones will have a place to go locally as they age. It's a great service line to
have and it's a whole specialty all them in itself.
Mark: It is. It literally is a different
licensure.
Patsy: Whole separate cam model, exactly.
Mark: How does that fit into? It's a different
care model. Why should it be part of a acute care system?
Patsy: Sure. Well eldercare, when we think of
health care in terms of transitions of care. We are paying much closer
attention to the transition for instance of our patient from the emergency room
to our patient physician office. We want to make sure that that transition
happens well, and it doesn't fall through the cracks. What we find from an
eldercare perspective is that, as a patient ages and they might need to be seen
in acute care facility.
Many elder care need to
transition to an eldercare facility, so again, it's just another means for
transitioning the patient to the most appropriate level of care. We also have
patients that are having hip and knee surgeries, and need to have skills care
afterwards. To have skilled care is part of our model again, provides us a
place for our patients that are being discharged from inpatient care,
transitioning to a skilled level care.
Mark: Okay, so following the merger, again became
the senior vice president and chief operating officer for Southern Maine
healthcare. How is that position different than your previous position prior to
becoming CEO at Goodall? Is it roughly the same responsibilities or do you have
a broader scope?
Patsy: The scope is broader in terms of geographic
region which actually is a challenge, because as I mentioned we're in so many
different geographic regions, staff and the community want to know who you are
when you're in senior leadership. They want to be able to know your face and
they want to be able to know that you're actively involved in the community.
Just having the geographic scope
definitely provides a challenge, so that you need to ask yourself, where do I
need to be today and where do I need to be visible. To me, that's the greatest
challenge I have in this position.
Mark: How important is it to be visible and what
do you mean by that?
Patsy: Well from an employee engagement
perspective, so from an employee perspective it's extremely important to be
visible. Improved engagement scores for employees, so employee engagement
improved scores show that employees will stay with the organization longer, and
turnover is such a big issue for organizations that being visible is one way to
help ensure that our employees will be here for the long term. To me, it's
extremely important.
Mark: One of the things that you've implemented
since coming on board as the COO is a operational excellence program throughout
the Southern Maine Healthcare System. What is this program?
Patsy: All right, so operational excellence is
really our way of managing, it's a new way of managing the organization. It's
referred to as lean daily management, and it starts the day where we come into
a huddle and we look at key performance indicators every day, there's about 30
people that come into a room and we essentially look at today's census. What's
the number of patients that we anticipate discharging. What was our ED volume
yesterday. How many patients do we have as borders, which means that they are
looking for placement elsewhere.
Mark: Somebody psych or something like that.
Patsy: Exactly, yeah.
Mark: We've talked about that a few times.
Patsy: Yeah, how many are psych patients, how many
are not psych patients but this is not the right-
Mark: How the level of care?
Patsy: This is not the right level of care for them
and they need to be transitioned elsewhere. We start the day that way and then
we go on to what we refer to as a daily gamba walk, which is we go to the
different units and we essentially meet up with staff who present key
performance indicators to us.
Mark: Is this all 30 members of this team or just
a subset?
Patsy: We actually have nine walks a day and we
have two liters per day going to each one of those walks. We visit every
department of the hospital every single day.
Mark: You split out?
Patsy: We split up.
Mark: It's not whole-
Patsy: There's two people per walk and there's
about 12 walks, 12 places we stopped on each walk.
Mark: Do you alternate?
Patsy: Yeah, we actually sign up for this and
leadership the vice presidents have to do at least two walks a week. Managers
have to do at least three walks a month, and our directors have to do at least
four walks a month. We sign up for these walks and we do them every single day.
Mark: It's not you doing visiting a particular
specific area every time, it's different senior leaders visiting different
places, so you're always getting different nights.
Patsy: Exactly, so I might be for instance today I
did a walk in Biddeford, tomorrow I might do a walk in Kennebunk, the next day
and I might do a walk in Saco, so I make sure that I do a different walks, so I
have that visibility and get around.
Mark: What's the benefit of doing this?
Patsy: The benefit of doing this is one, visibility
but far beyond that the benefit is that when we visit the different units,
staff members come up with what we're referred to as key performance
indicators. They are monitoring issues in their departments that they feel as
staff members they can improve upon. For instance, how quiet is the floor for
other patient? Can the patient sleep at night? They actually might ask the
patients go in and say, "Was it quiet enough for you?" Then they
report on that the next day to us.
One unit looked at, it was an
outpatient unit, and they looked at the number of handicapped spots that were
available for their patients to park, because these were cardiac patients, and
what they were learning was that the patients there wasn't enough handicap
spots and they had to walk a long way. This was an issue for that particular,
and other unit looked at the number of no show patients and said to themselves,
"We have an awful high no show rate, why?" Again, now the other
patients can't take that time because it's blocked for this person who didn't
show up. As they begin to monitor themselves they begin to drill down and put
new processes in place to overcome the shortcomings.
Mark: You said these are measures that they
choose?
Patsy: The staff chooses them themselves.
Mark: You're provided them some sort of training
to come up with this.
Patsy: Yeah, it's a three-day training just for two
staff members on a particular unit. They go out in real time and go back to
their unit and train everybody else, and then within it's a three-day training
in with them on the fourth day we start right in. It took us a year and a half
to do all of the departments, but they're all done and we've been doing it for
a year and a half now and it's worked very, very well.
Mark: That's neat. You called The Lean Daily
Management and a Daily Gamba Walk. What about six sigmas sort of stuff? I know
you had a lab background, so that's got to appeal to your prior-
Patsy: This is all part of the same if you will
school of thought. This is what we have implemented, but we're actually using a
data cam model of how you manage daily.
Mark: What is Fedic?
Patsy: Fedicare is an organization that is well
known for its lean daily management tools, and they actually train
organizations throughout the United States to do this.
Mark: Let's shift gears now and talk specifically
about leadership. How would you define your leadership philosophy?
Patsy: My leadership philosophy is to be a mentor
and to be an educator and to be a communicator, because again I had mentioned
earlier that what I found in my career is that, if you just tell staff or
leaders what is expected of them they want to do the right thing. If you can
communicate with them, educate them, and then mentor them all along the way you
have a very successful leader at the end of the day. That's my leadership
philosophy.
Mark: All right, what are the characteristics and
behaviors of a good leader and how do you aspire to those yourself?
Patsy: I believe in leading by example and also of
giving yourself wholeheartedly to your work while you're at work, but there has
to be some work life balance because if there isn't, you can crash and burn. In
my earlier years, I used to give of myself at work and at home to work, and I
think a lot of leaders learned that lesson the hard way and with time I've
learned while I'm here I'm going to give a 150% but I have to have some balance
in order to be able to come back the next day.
Mark: I was going to ask you about work life
balance, so let me ask you that now. I've been reading Sheryl Sandberg's book
'Lean In' and health management policy the department I teach in about 80% of
our students are young women. Obviously, one of the issues that Sandberg raises
is this issue of work life balance. If you're married you have kids and you've
worked your way up into senior management. How did you make all that work?
You're saying some of it was you had to learn to do that.
Patsy: Yeah, exactly, but I would say that I'm very
fortunate and that I have a very supportive environment at home. There are
times when you have to work a lot of hours, but it's also not unusual to have
to work a lot of evenings. I'm someone who's at work at 6:30 in the morning and
once or twice a week it's not unusual not to get home till 9:00 or 10:00 at
night. My husband has always and my kids at the time, they're older now but
we're always supportive of me ra-ra mom.
Mark: That's awesome.
Patsy: I've been fortunate in that manner.
Mark: Can you give an example of a difficult
leadership lesson that you had to learn maybe the hard way?
Patsy: I would say a leadership lesson that I've
learned and I have to say it's been more than once, and that is when you
realize and recognize that there is somebody in a position that isn't doing the
job that they should be doing. If you leave them in that position too long, not
only do you do a disservice to that individual but at that same time you're
doing a disservice to the organization.
I, as an individual, always want
to give, I want to mentor and educate and help that whatever person it is that
isn't working out, I want to help them along to get there. My lesson learned
has been that there have been times and it's been more than once when I've left
somebody in the position too long, which you don't want to cut it off too soon
but-
Mark: That's not fair.
Patsy: ... keeping it on too long it's not doing
anybody any good.
Mark: What do you look for when you're hiring
leaders? You're a leader of leaders, you're probably the people that you are
most often hiring or if I'm going to be managers and supervisors, but you're
not hiring a lot of front line people most likely. What are you looking for
when you're hiring leaders and evaluating them?
Patsy: Oh, I've come to definitely use behavior
based interviewing as a skill when interviewing others. When I do that, you ask
questions, this one probably not as much now, but who do you want to be doing
in five years from now? It's amazing what some people will do to answer that
question. "Oh well, I want to move away," or, "I think I'm going
to change careers," and easy lesson to learn is just ask that question
because people would be very truthful with you, and that's probably not the
person that you want to eye at. Above and beyond that really looking for fit in
terms of personality, leadership style.
When you asked behavior based
questions about somebody's personality in terms of what do you look like when
you're angry. If somebody comes out right and says to me, "I do have a
history of kind of throwing things and maybe slamming my hand." "Oh
great. I'm glad that person disclosed that but that says to me, that's probably
not the individual that I need in my organization.
Mark: What about evaluating leaders? You've got
your team. What are you looking for, say, "You're doing a good job."
Clearly the technical competence I would assume, what are the important things
that they are doing on a day to day basis that you're looking for?
Patsy: I'm looking for a leader to be forthright in
their challenges and in their ability to get a job done. In other words, if I'm
given somebody a task I want the task to be done and done in a timely manner
and what I have found a few times is that for one reason or another that leader
might come back to me and say, "Oh, I'm going to get that done
tomorrow." I want somebody to be really forthright and say to me, "I
can't get that done tomorrow. In fact, I need a week to get this done."
"That's not an issue and if it is, then I'd let that person know." I
would say when evaluating somebody I now look for, is that person being
forthright with me in their own ability and in their communication style with
me because it's a challenge in the role that I'm in.
My boss, the CEO, is oftentimes
looking for some really tight timelines and if I'm asking somebody and they're
not being forthright with me, then it's quite a challenge for me to be able to
get that job done. To me, that's one of the number one significant challenges
that I face when talking to a leader.
Mark: Any special challenges when evaluating
clinical leaders?
Patsy: Not particularly because, again, we have the
tools of the Joint Commission or whatever a particular accrediting organization
and almost every clinical area has a medical director that oversees it
clinically. Again, from a clinical perspective there's always someone else
that's going to either buffer or help get us to where we need to be clinically.
Mark: We've talked a little bit about
organizational culture when we were talking about the merger, but what do you
think it's important and how do you go about trying to shape organizational
culture? What aspects of organizational culture are particularly important to
you?
Patsy: Again, our tagline is excellence always and
with that, we want to live it every day that we come to work and so that begins
at orientation. When we hire new employees, we essentially go through a
PowerPoint that talks about this is what's expected of you from a behavior
perspective. These are our values and each day when you interact with your
coworkers, we want you to interact in an appropriate manner to be respectful of
your coworkers to work well with other people.
From a culture perspective it
actually starts the minute the employee gets in the door. Then, for the
employees that have been here for some time on an annual basis, we actually
have our employees during the evaluation process, we actually have them sign
the values, the organizational values to say, "This is a reminder,"
and then again as always if somebody is deviating from expected behavior then
we counsel them.
Mark: You mentioned you had a mentor early in your
career when you were working in a lab. Have you had other folks helping you out
along the way?
Patsy: I have, yeah.
Mark: What do they do for you and how did they
help you?
Patsy: I have to say, there's a woman named Darlene
Stromstad, she was a CEO at Goodall Hospital. She not only was a great leader
just in terms of setting the stage for, in this role this is what's expected
from a community perspective, but she would role model that. Darlene was one
that was part of the Chamber of Commerce. She would lead event, she was the Go
Red Chairperson for the American Heart Association.
She was a great role model but
also one who actually set the expectation. She went to the management team and
would say, "Listen, as managers and directors here at this organization
you are expected to do at least three community activities per year. It could
be a parade, it could be helping at the YMCA. You are expected to do that and
live those values if you will." Above and beyond that though she was a
member of the American College of Healthcare Executives. She was the region for
the state of Maine several years ago but then she actually became a governor
for the American College of Healthcare Executives, and she pretty much lived
and breathed their values which was to mentor others.
She was not only a great role
model as a CEO but also as a community citizen and then role modeling the
values of the American College of Healthcare Executives.
Mark: You watch what she did, you've tried to
emulate that.
Patsy: Exactly, yeah.
Mark: How do you go about developing leaders from
within your organization? How important is it to develop leaders internally as
opposed to say reach out and bring in external leaders?
Patsy: Yeah, and again in case they move on or God
forbid something happened to them, we want to have a leader who could step in
in their place. Our directors do look for somebody in their department and they
mentor them as future leaders.
We also from a department of
education perspective here at Southern Maine Healthcare have ongoing leadership
classes that we ask all of our leaders to take, and each year the classes are
different and they change. Last year, we had some that the titles were having
difficult discussions with your employees. Another one was how to do behavior
based interviewing, and another one was constructive criticism. Those are just
examples of some of the leadership training that folks here at Southern Maine
Healthcare have to go through.
Mark: We talked a minute ago about work life
balance and so forth, and I was talking about Sheryl Sandberg. Can you tell me
a little about your experience being a woman in the various leadership roles
and now as an executive, do you believe your experience would have been
different? Had you had the same positions as a man? If so, how have you dealt
with that? Has it changed over your career?
Patsy: Well oddly enough, I have to say that it's
not something that I think about, it just isn't. In my role as a leader, I've
been very fortunate that I have to say most of my experiences have been really
quite positive. I just figure if you exude positive ness it comes back at you.
The man female thing just does not come up and hasn't come up much in my career
at all.
Mark: Let me jump not a talk. You mentioned your
former CEO and mentor who was very involved in ACHE and you are actually the
ACHE regent for Maine. We've had a number of guests on the podcast who are ACHE
members, can you briefly talk about ACHE and how did you become involved in it?
Patsy: ACHE is the American College of Healthcare
Executives, its primary focus is on educating leaders. Once you become a
member, after three years, you can actually sit for a certification exam to
become a fellow of the American College of Healthcare Executives. It actually
pushes you to a whole new level from a senior leadership ... Oh, I should just
say from a healthcare leadership perspective throughout the United States. It's
an honor and a privilege to be able to have that designation.
Mark: You are of the regent. What does the regent
do in general and specifically what are you doing as the regent in Maine?
Patsy: Sure, so the regent for the state of Maine I
essentially represent the American College of Healthcare Executives at the
local level, and so whatever is going on nationally I actually let the folks in
Maine know about what's going on nationally. I'm also based on being the
regent, I'm also on the local chapter of the American College of Healthcare
Executives.
It just so happens that the
local chapter here is referred to as the Northern New England Healthcare
Executives. What we do is essentially host educational sessions. We also
provide networking opportunities. Then lastly, I sent correspondence to
members, let them know about scholarships that might be available, all tuition
waivers that type of thing.
Mark: I worked with again with the undergraduate
program in health management, and we're always trying to convince these young
folks that they should join. What would you tell my undergrads, why they should
join now rather than waiting till they're advanced in their career?
Patsy: Sure. The American College of Healthcare
Executives just offers so much. The lesson learned here is the sooner you can
gain the benefits from the American College, the sooner the better. Educational
opportunities, networking opportunities, resume building opportunities, but
also the college has a very comprehensive ethical standards policy. As you
become a healthcare leader, you can refer to those ethical standards and
actually they set the groundwork for all of the work that you do as a
healthcare leader.
Then lastly, mentoring is a big
part of the values of the American College of Healthcare Executive. As you meet
members of the college, you can reach out to them for mentoring purposes. In
fact, it isn't encouraged. There's a great benefit.
Mark: In conclusion, what advice would you have
for students who are considering a career in culture administration? What
training, jobs, experience should they be seeking out?
Patsy: Healthcare management, it's actually tough
work and in large part the reason why it's tough work is because most
healthcare facilities are open 24 hours a day, seven days a week, 365 days a
year but it also is extremely rewarding. The reason why it's so rewarding is
that you see patients at their most vulnerable times in life.
You see patients during the joy
of birth, but you also see them during the sadness of death. Quality has become
such a focus in healthcare and every organization wants to provide the highest
quality at every point along the patient's visit. Whether you're an
undergraduate or a graduate student being in healthcare management it's clearly
a very, very rewarding field to go into.
From a training perspective,
again as long as you have an undergraduate degree and you work towards I would
always say in if you go into healthcare you should probably move on to have a
graduate degree.
Mark: MHA or MPH or, what do you recommend?
Patsy: It could be, generally it's one of three
master of public health policy and MBA, or master of healthcare.
Mark: Masterful of healthcare administration.
Patsy: Master of healthcare administration
generally it's one of those three and not necessarily in any particular order,
to be honest with you. Clearly to get into a director's role now, and actually
even offices and practices were looking generally for someone with a master's
degree. I would say, "Keep going. Don't stop in the quest because it's a
great field to go into."
Mark: Great. Well, thank you so much for your time
today. I appreciate all the great information you shared.
Patsy: You're welcome. Thank you very much.
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