Robert Mach Interview Transcript

The following is a transcript of my interview with Robert Mach. 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, Robert.

Robert: Happy to be here.

Mark:    It is true that once you're a Marine, you're always a Marine?

Robert: That's a true statement. I truly believe that.

Mark:    So you enlisted in the Marine Corp in 1987 and you served until 1992. What drew you to Marines and what did you do while you were in the service?

Robert: I think I got interested in the Marines in high school. I really associated with their sense of esprit d'corp which means always faithful. That really drew me into getting interested in that. When I went into the Marine Corps, I wanted to be a tank driver and they had no opening. So my dad always said do something in the Marines that you can come out and get a job so I said air traffic control sounds good. That's how I got involved in that.

Mark:    So not healthcare.

Robert: Not healthcare. Not at all. No, the furthest thing from my mind probably back as an 18 year old kid.

Mark:    So what do you do as an air traffic controller in the Marine Corps?

Robert: So I was stationed in Beaufort, South Carolina, the majority of my time. Went to school in Memphis, Tennessee at the Aircraft Naval Air Traffic Control base there. We can control airplanes. I was up in the tower talking to airplanes, landing them. It was a great job in the Marine Corps. I loved it. Really loved it.

Mark:    What did you learn in your time in the Marines that when you look back has influenced your future career?

Robert: I think the thing that the Marine Corp taught me was leadership to be really honest with you. I will tell anyone to this day that I learned more about leadership in the Marine Corp than any book can teach you or any class I took over my educational career. It teaches you how to be a leader.

Mark:    Can you give an example of something you learned or an experience you had?

Robert: I think they do a good of, listen, starting you out at a lower rank and teaching you progressively, giving you more and more responsibility, to where you are on a platform where you can stand up and give direction and be helpful and mentor younger Marines. I think they give you that platform and I think they do a really good job at it.

Mark:    So you left in 1992. What did you do in between there? In 1997, you started work at Bradley Memorial. What did you do between '92 and '97? What were you up to?

Robert: Yeah, so in 1992 when I got out of the Marine Corp, I worked a lot of different jobs. Construction for awhile. I worked at a company called ITS, cleaning airplanes down in Fort Lauderdale, Florida. Moved all over the country doing odd jobs here and there. I ended up having the GI bill after my time in the Marines. So I knew I wanted to continue my education. My wife's family needed some help, so we ended up moving back up to Vermont where I actually in 1995, I was sitting down reading the paper. Opened the paper and saw the X-ray school there, a hospital based program had just graduated a class and they were looking for applicants for their next class. I was like well, X-ray sounds like a good career. Let's head that way. So, that's what I did.

                So '97 I graduated X-ray school. It was a two year program and after that we ended up moving down to Cleveland, Tennessee where Bradley Memorial is.

Mark:    So you actually did your training, was it at Rutland Regional?

Robert: It was a Rutland. It was a hospital based program. Back then, you don't see too many hospital based X-ray programs anymore. There are still a few out there but very few. The advantage that I found was going through a hospital based program, you still get the education component to take your registry and become an X-ray tech, but you get a lot more clinical experience than a traditional hospital or a traditional college based program. Because at the hospital, you're always at the hospital. You were there taking X-rays all day long. You would have, out of an 8 hour day, you would have eight hours of classes, six hours of taking X-rays.

Mark:    So you're pretty competent by the time you come out of that?

Robert: Yeah I think so. That's, in my career as an X-ray director, I would tell you that's what I've found. People coming out of a hospital based program are more ready to work right away. Where people coming out of a college based program, require some additional training.

Mark:    So that was your first experience in healthcare? Just this kind of hey that sounds interesting. Let me give that a try.

Robert: Yeah, really strange right? I mean a strange congruence of events. It just happened. I picked up the paper that day, which lead to my healthcare career.

Mark:    Wow. So like you were saying, you then got a job at Bradley Memorial Hospital as a radiology team leader.

Robert: I did.

Mark:    Did you start out as a team leader or did you go down as a tech first?

Robert: No. As you're starting out in your healthcare career, you take the first job that is open to you. I started work at midnights. That was the job they had open. I took a job working midnights with one other tech who matter fact was in the army. Yeah he taught me a great deal. Here again, when the second shift team leader job came open, I raised my hand and I got that job.

Mark:    So going to Cleveland, Tennessee, that was the first job that was available?

Robert: Yeah. We had some family that lived down there. It was funny, my last year of school, maybe six months left in my radiology program we had taken a vacation down there. Staying with some family and I just kind of made some trips to some hospitals down there and asked to talk to some people and said hey I'm graduating in six months. I might be interested in coming down here and Bradley called and said hey yeah we'd like you to come down. That's how we moved down to Tennessee.

Mark:    Okay. So you spent three years down in Cleveland and then you left Tennessee and moved back to Rutland, Vermont.

Robert: So strange. Was down in Cleveland for three years and still had plenty of friends up in the Rutland area. People I had trained with. People who mentored me within X-ray and they called me one day and said hey, what would you think about moving back to Rutland? We're looking for a CT tech. I said well I don't know. Let me talk to my wife about it. So yeah, so we decided to move back up to Rutland. Here again, they just kind of called out of the blue saying hey. You were a great student, we'd love to have you back.

Mark:    So you moved back as a CT tech but by the time you finished at Rutland though, you were the Assistant Radiology Director?

Robert: I was. Here again, it comes back to raising your hand when people are looking for people. So I went back as a CT tech. Worked that for a year, maybe a year and a half I would guess. The X-ray director at that time had left and Rutland had hired a lab person to run X-ray. She had no X-ray experience, so they were looking for an assistant director to sort of help her out with the rules of the road of radiology I guess I would say. Within healthcare we always say you speak your own language. A lab person did not speak X-ray language. So they needed someone to help her out and here again, I raised my hand, and got the assistant director position there.

Mark:    So these two facilities were fairly large facilities. Is that correct?

Robert: That's a true statement. Bradley was probably 220 beds. Rutland I think is about 170 beds.

Mark:    So busy places?

Robert: Very busy.

Mark:    Good places to get experience?

Robert: That's really the key to it.

Mark:    So tell us a little bit about your role as the assistant director at Rutland? What were the kind of responsibilities you were engaged in on a day to day basis?

Robert: Well as the assistant director I was really there to lead the staff. The X-ray staff. They kind of separated roles at Rutland. They had administrative staff within Rutland, which were the secretaries, the transcriptionists, the file room clerks. They reported to one manager. Then all the X-ray techs reported to me. So they sort of separated that role out. I was also in charge of how to formulate budgets. Capital budgets. Time keeping. A lot of roles but really managing the X-ray staff of the radiology was my main responsibility.

Mark:    What kind of leadership challenges do you think you face in the radiology department that might be a little different than say other parts of the hospital? What's unique about managing radiology?

Robert: That's interesting. I believe that people are people. People want to be treated with respect and dignity. No matter what part of the organization they are in. The little quirk with radiology is, I think of radiology people as the artists of the healthcare continuum right? So you are faced with challenging cases. You then have to go take images of somebody's broken bone or something and I know I need to get three views of this particular body part. Now how am I going to do that when somebody is on a backboard, got a broken arm and a broken leg but I still have to get these views. So it's kind of about thinking outside the box a lot. Going I know I need to do this, how do I get there? So I think radiology people as kind of the artists of a healthcare organization, which comes with its own set of challenges because they are free thinkers.

Mark:    So it attracts a certain kind of person after all?

Robert: Yeah, absolutely. I mean radiology people get to play with a lot of fancy toys, which is fun. I always think of people, they are free thinkers, which has its own challenges in getting all of them to march in the same direction.

Mark:    Okay. So during your time at Rutland, you also completed your bachelor's degree in healthcare administration. This kind of goes with the flow of your formal education is a bit non traditional. You went straight from high school into the Marine Corps. You did your certificate and then you finished off your bachelor's degree. It's a pattern I've seen with a lot of folks who make some of the choices that you made like going into the military directly from high school. Why did you decide at that point to earn a degree? Why did you decide hey I want to do healthcare administration as my degree?

Robert: Well I think it's just a natural progression of getting older, looking down the road and saying what do I want to do with my life? Coming out of the Marines, listen, I was an older than average learner. I think I got out of there when I was 23 and a couple years in there so it was really just about I really liked working in healthcare. It's about taking care of people and here again, back as an 18 year old kid never in my wildest dreams but going to X-ray school, dealing with patients, trying to help them. I found it was my calling.

Mark:    So this is the point where you really said, this is what I want to do.

Robert: This is what I want to do. Back when I decided to go to X-ray school with something to do. It wasn't hey I'm going to do this for the rest of my life maybe but it was something. Once you get in the field, I said boy helping people is maybe what I was meant to do. So I decided, listen, as the assistant director at Rutland, I think this is what I want my career to be and how do I then move up the ranks? And that comes with education. So it was time to go back to school and start learning.

Mark:    Did you have a mentor at this point? Anybody kind of helping you look through like okay, I think I want to commit to a future in healthcare, what do I need to do?

Robert: I will tell you, not in the healthcare field so much but I would tell you my wife pushed me to do this. So if you want to call my wife a mentor, I'm okay with that. She was thinking big picture for me at times. Instead of saying you were meant for more than just being an X-ray tech. You have this in you. I can see the fire in you. I would tell you she's the one that really pushed me to continue with my education.

Mark:    Good for her. Good for you.

Robert: It's a nice story.

Mark:    It really is a nice story. It's good to have a partner that sees something in you. That's awesome. So you stayed till 2003 when you actually moved over to Littleton and Littleton Regional Healthcare to be the director of diagnostic imaging services. That's where we are today and where you are today. What made you decide to make the jump to Littleton at the point?

Robert: Well there was some changes happening at Rutland. I thought in '03, I had been in Rutland for three years, I was ready to take my next step in my career path and I thought I was ready for a radiology directors job. The lab manager slash radiology manager was still at Rutland. Was doing a great job but she wasn't going anywhere anytime fast. I had a discussion with the Vice President there and said what are plans here? He said plans aren't going to change. Listen, I appreciate that. At least he was honest with me. I said okay well I need to start making some decisions about my future. He was supportive of that. I just happened to see this job in one of the trade magazines. So I applied and I got an interview. I fell in love with the place.

Mark:    So for listeners who are not familiar with New Hampshire, can you give us a quick sketch of Littleton? Where it is? What the community is like? And why did you fall in love with it?

Robert: Sure. So Littleton is in northern New Hampshire, north of the Notch. If you know anything about New Hampshire, New Hampshire is kind of separated into the north and south by a mountainous region called the Notch. North of the Notch, the population dwindles. It's not as built up as Southern New Hampshire, which has some cities. It's very rural. Littleton has been voted for several years one of the top ten best towns in the United States. We fell in love with it from a standpoint, it's a great place to raise kids. All my kids were younger, in elementary school at the time. When we came and visited on our first interview, my wife and I, we fell in love with it. The school systems were fabulous and I was given some autonomy to run the radiology department the way that I wanted it.

Mark:    Which is important.

Robert: Absolutely. When I met with the CEO, one thing that really sold me on this place, is he said listen it's your department. You run it the way you want to. The only thing I ask is that you don't let me get hit over the head without knowing it's coming. Sold me right there.

Mark:    Now was that Mr. West?

Robert: No, that was actually Chip Holmes who was the CEO at that time. He's now with QHR up in Maine but when he said that, I said that's what I'm looking for. Let me run the boat. Let me do what I know is right and you won't be sorry. That's all you can ask for. Give me an opportunity. He gave me that opportunity.

Mark:    Great. So give us a quick comparison between Rutland Regional and Littleton Regional. Beds, service lines, satellite clinics, and so forth. How does and follow onto that how does Littleton's location affect the operation of the hospital?

Robert: Sure, so Rutland is much larger than Littleton. Rutland was, like I said, I think 170 beds. Littleton is a critical access hospital, which by terms means it's a 25 bed hospital, in patient unit. We actually have quite a robust outpatient service here at Littleton. We actually do less exams than Rutland did but busy for our community at least. We're a smaller community than Rutland but here again we have a thriving organization here.

Mark:    You have a fairly robust set of services. We walked around the hospital earlier and we were looking at all the outpatient activity that you have here. First question here is does Littleton employ its providers? What is the relationship between the providers that are working here and the hospital?

Robert: Right. So we do employ a fair amount of our providers but we also have providers we don't employ. I think something that our current CEO, Mr. West, has been very open to is when we're recruiting a provider or a sub specialty, we're open to anything that that provider might want. So do they want to be an employee of the hospital? Do they want to be out on their own? Or would they like some mismatch of that agreement. We're open to anything and I think that's just about recruitment, getting the right specialties in here for our area, and partnering with physicians, so it's a win win for the hospital organization and the physician. So yeah, we do employ quite a bit of them. We do have physicians that we don't employ but I think overall we have a great partnership with our employed physicians and our non-employed physicians.

Mark:    What is the trend that you see in terms of the relationship between physicians and hospitals? Employment or non employment?

Robert: Yeah, I think more and more physicians are asking to be employed by organizations. I think physicians go to school because they want to treat patients and help people. They are not necessarily business managers and they don't want the headaches of running a practice, having to deal with billing, management, that kind of stuff. The regulations are more and more and more burdensome. What I've found in talking to physicians is they didn't go to school to be a manager. They went to school to treat patients and they would much rather have somebody else do the management of the practice for them as long as they can see patients. I think that's the trend in healthcare now is more and more employed physicians.

Mark:    What is the most robust practices you have here?

Robert: I would tell you our most practice is orthopedics. We have a very strong orthopedic service line up here. They do amazing work. We attract a lot of patients all over New Hampshire and Vermont who come here specifically for orthopedic care. Yeah, it's a really robust service line for us. We also have, at least within the North Country here, urology. We attract a lot of patients because of urology here. We have several [inaudible 00:17:36] in neurology. We are one of the only hospitals up here in the North Country that offers neurology. I think we've taken a look at saying, if we can get the specialists here and get people under a hospital and see what a nice facility we have, maybe they'll come back. We've done a really I think good job at recruiting specialists that are right for our organization and area.

Mark:    We had talked earlier while we were walking around that you actually have OB, which is something that a lot of smaller hospitals have decided that they don't want to continue doing. But you guys have made that decision to continue to have an OB practice here.

Robert: Totally. The more and more small community hospitals just can't afford OB practice. It loses money for an organization. We've taken the tact here to keep our OB departments open and actually expand them because we truly believe that women in the family make their healthcare decisions for their family. If we can get them in the door to see what a beautiful facility we have and what great care we're going to give them, hopefully they are going to make the decision to bring their family back and receive care here. Even though, listen, it loses money for us as well, we've made that decision that it's an important enough service to continue on and hopefully those families come back for more care with our organization.

Mark:    So you came here initially as the director of diagnostic imaging services and you continued in that role and actually you were telling me you are actually technically still in that role.

Robert: Yes, sir.

Mark:    But it seems, as we say in the army, that someone started out adding rocks to your rucksack by which I mean you progressively added additional responsibilities over the next 10 years. I'm looking at kind of the list of things. You started out as the director of diagnostic imaging services in 2005. You also became the director of cardio pulmonary services in 2009. You became the physician practice manager for the radiology practice in '10. Physician practice manager for pain management in '11. You added the practice management for pulmonology and sleep medicine and in '13 you became the practice manager and liaison for orthopedic. So how did all that happen?

Robert: I kept raising my hand.

Mark:    Okay. So that seems like a theme in your career?

Robert: Yeah, well within healthcare nowadays, you know our margins are so small. It's about doing more with less and that's just the realization of it. I think somebody, some of my superiors and mentors saw something within me that said hey, Rob can do more. They asked, I would say yes. Absolutely. Give me more. I want to learn.

Mark:    Was that something that you had? You were, I assume, fairly comfortable at that point with imaging services? You came in, you were the director of imaging services but you hadn't worked cardio pulmonary.

Robert: True statement. Knew nothing about it. But here again it's about leading people. It's about having good people underneath you who you can trust and know that they are going to do the right thing and lead them in the right direction and mentor them. So I give a lot of my success to the people underneath me. I have good people that work for me. You got to have the right people in place who you can trust and know they are going to do the right thing too. So really it's about just giving them some direction.

                As I took on more and more roles and I kept raising my hand, yeah I'll do that. Yeah I'll do that. I have some really great people who work for me. I wouldn't be where I am at today if I didn't have those people because it's just about giving them a little bit of direction and saying hey here's where we are going. Let's all go in the same direction. Let's roll the boat the same way. Or let's all get on the bus and head in the same direction. It wasn't a hard leap for me because really it's about managing people. Did I need to know everything I needed to know about cardiology? I've learned a ton since I took over but it's really about having good people underneath you that just need a little direction and here again, I give them the autonomy like I was given to say hey. Do the right thing. If you do the right thing for the patient, you're probably not going to be wrong. So go at it. Do your job.

Mark:    Is that an important part of your leadership style is embrace of autonomy?

Robert: I think so. If you have the right people working for you, there is a trust that comes with that. That's built up over time but absolutely. I totally believe that part of a good leader is giving some autonomy to your people to do the right thing. It doesn't mean that people don't make mistakes. People do make mistakes. We're all human but then that's part of the mentoring aspect is you bring them in and say hey. This is not maybe the way I would have done that. Let's learn from it. Here's what I would have done. Maybe that's still not the right thing but lets both learn from this issue.

Mark:    I think it's normal in a career, whether it's in healthcare or other fields, whereas a manager you start moving up. Eventually you're going to move out of an area where you have high levels of technical competence. You're going to have to start engaging with fields that you are not an expert in and you will never be an expert in if you want to keep moving up in management. So what advice would you give to people who are ready to make that jump? You talked about giving people autonomy and so forth but what did you do? So the day one you were handed cardiopulmonary or you became the physician practice manager. How did you start approaching that saying I'm never going to be the expert. So how did you deal with that?

Robert: So anytime I've ever taken over a different service line, up till today even if I'm given another challenge, I go meet with that whole team. I'll meet with the manager first or the director, kind of give them my outlook on life and healthcare but I also meet with their whole team. I have departments that have 40 people in them and I pull them all together and I have my talk with them and my talk kind of goes something like that. I'm a strong believer in integrity. Integrity to me means you do the right thing and you do the right thing even when nobody is looking. The other thing is I tell them I will always be honest with them. No matter what. As part of that commitment that I'm making to my employees to be honest, they also have to realize that I'm in a position I'm going to know some things that they can't know. They have to be able to take the words I may know but I can't tell you. Or that's an area where we can't go.

                So that's kind of my talk to my employees, every single one of my employees is that I truly believe in integrity and I will always be honest with you. If I think you can start from that point as a leader, a lot of things come easy because the book is open. So from that standpoint, if you can make that commitment between two people or me and my team of individuals, it's a good starting spot.

Mark:    Okay. So in 2005 you were not the expert in cardiopulmonary and so forth. How do you start, we're talking about leadership so how do you set the direction for an organization where you're not the expert in the field?

Robert: I think you rely on your people and I think you go and spend time with your people. Definitely not an expert by no means with cardiopulmonary or any of the service lines that I have right now but you go spend time with your people. I spend hours and hours and hours and days upon days upon days just sitting in cardiac labs observing and seeing what they did on a daily basis.

                I think part of the thing that made me successful in my role of today is that I came from a clinical background. So for lack of a better term, I have some street cred.

Mark:    Which a lot of administrators do not have. Like myself.

Robert: They don't. I don't think necessarily you have to but I think you do need to keep an open mind and say listen I don't know everything. I'm never going to know as much as you and that's okay. I'm here to help you. It's about subservient leadership. I'm here to help you. You come to me when you have a problem. You come to me when you need some direction. We can talk about anything whether it's work related or in your personal life. You need some help. That's what I'm here for. I think it's about getting to know your people. Getting to know what they do. Knowing that you're never going to be the expert. But you know what? In the end, we all put our pants on the same way. What are we here for? We are here to take care of patients. If we can start from the perspective to say, we're here to take great care of patients, we're really starting off on a good foot and things after that, they get easier.

Mark:    Obviously you've been successful because leadership kept recognizing that hey Robert is doing something right because he kept adding those rocks to your rucksack. But as you add these kinds of additional responsibilities, you can't spend the same kind of time with each individual organization right? This is something that managers as they rise in responsibility, it's great to get boots on the ground whenever you can but as you have a larger scope, there is more ground to put your boots on. How did you make the adjustment to that?

Robert: That's the hardest thing to be honest with you. When you move up in an organization, the hardest thing to learn is you can't be every place at once. You can't spend as much time as you would like to because there is just the overwhelming amount of work you have to do and you have to spend time with everybody. Listen, personally as I think about it, do I miss spending some time in radiology because that's my comfort zone? Absolutely I do if I'm going to be honest about it. Absolutely I do. But hopefully, I'm helping other people and other departments and my other employees. Something I do on a daily basis, I did it today before you came in, every day I go around on every single one of my departments. Get my cup of coffee and then I'm off on the streets.

                That means I round up everyone of my departments, meeting with the individuals that are in that department on the day and my manager saying hey what's going on today? Is there anything I can help you with? Get into a conversation, 10, 15 minutes. It lets him know you're there for him. Then you move to the next department. So even though I've lost some time as somebody takes on more and more responsibility, you lose the ability to spend four hours in a department. You're just spending that time differently with different people.

                So it's something I truly believe in, is every morning, 9 am. I'm out on the streets rounding up my people.

Mark:    One of the things you've said a couple of times is it's important to have the right people. How do you know that you've got the right people? So you take over a new organization, how do you know you have the right people?

Robert: It takes time.

Mark:    What are you looking for?

Robert: It takes time. I am a strong believer in integrity and honesty. That's what I'm really looking for. I think there is a ground swell within the recruitment worlds to say, hire for your culture. I can teach you the technical aspects of it but hire the right person for your culture. So how do I know if I have the right person? It takes time. It takes time observing them and seeing how they are treating their employees. See how they are dealing with their administration. Do they have a sense of integrity? Are they always being honest? Are they giving me a load of crap when they come in and talk to me? So it does take time. And listen there are people who you find are not right. You need to move them out of leadership roles. Maybe they are just not a good leader. Maybe they are a great employee but they are just not a good leader. Not everybody can be a great leader and that's okay. The world needs Indians as well as chiefs, right? But I think that's about having an honest conversation with somebody.

Mark:    That's got to be a hard conversation to have.

Robert: It can be a hard conversation but I think as long as you come at it from a mutual respect point and you're being honest with the person, I think that's important. So not everybody is a great leader. That's okay but I think just finding the right leader within an organization, it takes time getting comfortable and trusting that person so you can say hey, here is the job at hand. Go do it. You have confidence and you trust that person that they are going to get the job done.

Mark:    So in 2013, you were promoted to be the executive director for operations at Littleton. What is the scope of this position? What activities do you oversee with that?

Robert: I really oversee all the ancillary services. I still oversee X-ray. Cardiac. The additional responsibilities, physical therapy, facilities management, housekeeping, pharmacy, food nutrition, and there are probably a couple I'm leaving off. So really all the ancillary departments excluding nursing because they are run by the chief nursing officer that really make this organization. That's kind of the scope of my work now. A lot more employees. I manage, overall, probably in the range of 120 employees to 150 employees. We have generally in our organization about 450 to 500 employees.

Mark:    So how does your role now mesh with the other senior leaders in your organization? You mentioned a chief nurse. How do you all fit together?

Robert: We have a really great senior leadership team here at Littleton. So my boss, Warren West who is the CEO, is over several senior managers. So there is a CNO. There is the executive director of operations. There is a CFO, chief financial officer. We have the director of community outreach relations on the senior management team. The director of HR is on the senior management team and then there is a senior executive director of physician practices on the senior management team. So we all have our little piece of the puzzle that we do. CNO oversees nursing of course. I oversee the ancillary departments. The CFO oversees all the finance of the department, of the financial department, so patient financial services, the finance department, health, information technology and then the executive director of physician practices overseas all the physician practices.

                So we meet several times a week just to kind of hear again. We get our directions from the CEO. We walk out of the room in lockstep, push that down to the organization.

Mark:    Are you all equals? Is this a team of equals kind of? Direct reports?

Robert: Yes. I would say yes, we are a team of equals. No one is more important than another. That comes back to we all put our pants on the same way. We have different levels of responsibility within the organization but within our senior management group, there is a free flowing set of ideas that come out. We are expected to speak our mind within our meetings and give our take on certain situations or whatever the topic of the day is. Within that meeting or that group, we are free to say whatever we want. But when we walk out of the room, we are one team. Whether we just had a good argument over something, we come up with a decision and when we walk out of that room we're all supportive of that decision. So yeah we have a really great group of senior managers here.

Mark:    Nice. So you are no longer the physician practice manager for those physician practices?

Robert: True statements. So when I took the position back in 2013, they actually split the chief operating officer position into two because the chief operating officer came several years ago, we actually only employed a couple physicians back then but in our previous discussion, the trend is for more and more physicians to want to be employed by the hospital. So they decided to split the chief operating officer into two positions, which was the operations and the physician practice side.

                Although I do still, it's hard to give up things, I still deal with the orthopedic practice. So, that's still under my auspices. All the other physician practices are under the director of physician practices.

Mark:    But you picked up things like logistics and nutrition care?

Robert: I did. I did. Yeah.

Mark:    Let's talk again a little bit more about leadership. How has your leadership style changed over the years as a result of your experiences in particular to accommodate the additional scope?

Robert: How has my leadership changed over the years? I think it's funny. I think some of that comes with age. I think when I came out of the Marine Corps, listen this is the way you do it. Go do it, right?

Mark:    Very directive.

Robert: Very directive. I think over time you understand that you need to give your people, the people that report to me, some autonomy and some general guidance about my expectations and then let them go do their jobs. It's about I've become much more of a servant leader, right? That it's not a top down approach. It's a bottom up approach. As you look at a triangle, I should be at the bottom. I should be trying to help everybody else perform to their max potential, right? So it's really more about instead of back when I was younger and in the Marines, more directive, now it's more about listening and what can I help you with? I can tell you that's the biggest change that I've had my leadership career is becoming more of a servant leader and listening and trying to prop my folks up to do the best job they can. Instead of me directing down. They should be directing down to me and saying I need this to my job better and me listening and saying, yeah let's make that happen. Or giving them a reason to say well we can't do that now and this is why. Whether there are financial constraints or whatever, but I think I've become a much better listener over my career.

Mark:    You've mentioned servant leadership a couple of times. That's a book, Servant Leadership.

Robert: Yes it is.

Mark:    I assume you've read it. You're a fan of it then?

Robert: I am. I am.

Mark:    Can you summarize sort of what this philosophy is?

Robert: I think just the philosophy is that as a leader, you are there to help your people. I mean achieve their maximum potential. Within the healthcare world, what's our number one job? We're here to take outstanding care of patients, right? I should be there to help my people achieve that every single time, every day, every hour, every minute, every second. So my job as a leader within our organization is to help my people achieve that goal of taking great care of patients.

                So it's not me dictating down to them. It's me being at the bottom helping them. They should be driving things down to me that I can help them with. That's how I see servant leadership.

Mark:    Can you give an example of a leader that you work with who kind of demonstrated that to you? Maybe helped you see, I need to be more like him or her?

Robert: I think when I came here, part of the thing that I told you that attracted me to the job was Mr. Holmes who was the CEO at that time. The thing that really sold me was he said listen, the radiology department is your department. You go run it. Just don't let me get hit over the head. I trust you. That's all I needed to hear. Listen, somebody was going to give me the opportunity and they were going to trust me to do the job. Listen, there ain't nothing better than that. I've tried to portray that to my managers now to say listen, I trust you. Here is the direction we're going. Get the job done. Hand's off. You come to me when you need issues or you need something solved, but I trust you to do the job that I'm laying for you. Go get it done.

Mark:    Can you give me an example of a difficult leadership lesson that you might have had to learn the hard way? What did you learn from it?

Robert: This was back when I was only the radiology director. I might have been in charge of cardio pulmonary at that time. There was a situation where I was down having lunch one day and there was a code blue pediatric call within the X-ray department. Now a code blue is basically cardiac arrest within the hospital and it was in my department. So I flipped out right away. I'm like oh my god. What's going on up in X-ray? So I ran from the lunch room to the X-ray department, totally out of breath. I run in the room ready to help and there they are, doing a CPR on a mannequin. I lost it. I totally flipped out. I used a lot of profanity words because here again my adrenaline was pumping and I had no idea they were going to do a mock code blue drill within my department. What did I learn from that?

                One, keep your cool. Have some tact. I had always prided myself on having tact and coming across professional. That day I lost it because my thought was how can you do this within one of my departments with one, letting me know and two can control the chaos that was going to happen within my department. That was where my head was at. Retrospectively, I could say that I understood what they were trying to do was you have to go code blue drills right so you know everyone is going to show up, they know where the rooms are at. I shouldn't have flew off the handle at this one particular person who was running the code blue drill. I subsequently apologized because I saw the errors in my way and actually I will tell you after that conversation of me going to her and saying man, I'm really sorry about flying off the handle on you. I said some inappropriate things, totally apologized. I was out of line. We actually became very good friends after that. I think it actually helped our relationship because I was willing to admit that I had made a mistake.

                I think that's huge because as a human being, as much as we think we're perfect and everything we do is great, we do make mistakes. So it kind of taught me a lesson that one don't fly off the handle and admit when you make a mistake because usually on the end, good things come of that. Me and this person it broke down some barriers that were within our relationship and we actually had a much better relationship after I actually went and apologized and said hey I was in the wrong.

Mark:    Nice. Good, good.

Robert: Lesson learned.

Mark:    Yeah. Can you give me an example of a leadership challenge that you are particularly proud of having met?

Robert: A challenge of proud of. There is a lot I'm proud of. I think my current position today, I'm not one to take the credit for things. So that's kind of hard for me but I am proud of the work that all of my people do. I think they are extremely hard working, from the environmental staff to the pharmacists to some of the physicians I have. We really do great work here. I don't take the credit for that. They get the credit for that because they are the ones doing the work on the front lines. I'm only here to help them out in times of need and to give them a little bit of direction but besides that they are the ones doing the hard work. To sit there and say there is something that I'm proud of, I'm proud of my people because they do amazing things on a daily basis that they didn't even realize sometimes. That's part of our job too is to say, you were amazing today because something just out of the blue for them that they wouldn't even think about.

                As far as somebody going out and one of my facilities guys, going out and giving a jumpstart to a dead car in the middle of winter when it's 30 below up here. That's amazing. To not even think about it. Oh yeah I'll come give you a jump. From simply, helping a patient get up the hallway. So they do amazing things everyday and that's what I'm proud of is that my people do amazing things on a daily basis and it's just common hat for them.

Mark:    That's cool. You mentioned organizational culture and hiring for your culture. What is organizational culture and why is it important?

Robert: I think each organization has a culture that they want to portray within their four walls. I think our organizational culture here at Littleton is around helping, around having some integrity, and treating each patient and our CEO says this, treating each patient like they were your mother here and how would you want your mother to be treated. If you can keep that in your head and do what you would want for your mother, we're in a pretty good spot.

                I think it's about being open and honest with people. I think that's what we try to portray as our culture here. We try to hire people who are honest and open, willing to change at times and here again, treat each patient like they were your mother and would you want the best care for your mom? Absolutely. So that person in that bed is somebody's mother or somebody's father. Treat them just like they were your own mother and father and we're going to be in a pretty good spot.

Mark:    How do you think leaders go about shaping organizational culture? What does it take to get the kind of culture you want?

Robert: I think you've got to live it. You've got to live it. It can't just be a set of words we say. It can't just be us pumping out the mission and vision statement right? As a leader you have to live that. You have to live your culture. You have to go out there and be willing to show it. I round on patients every day.

Mark:    Which means you actually go and talk to them to patients.

Robert: I do. Absolutely. Every day, I try in whatever department I'm in, if there is a patient sitting there whether it's in the lab waiting to get blood drawn, in the X-ray department getting an X-ray or I'm down on the nursing floor and somebody is laying in a bed watching TV. I may just walk in and say hey, how are we treating you today? Is everything going okay? Is there anything we can help you with? Any questions? So as a leader and something I expect of our leaders is that you live that culture. It just can't be a set of words that you're spewing out there. It's not do as I say, it's do as I do. We as leaders aren't willing to live that, how do we expect our employees to live that.

                So here again, I do that on a daily basis and I let my staff see that. If they see me doing it, they sure the heck can do it too.

Mark:    So we talked a little bit about mentorship earlier. You said you had a great partnership with your wife and she's been very encouraging to you. Do you have any mentors since you've been here at Littleton or prior to coming through?

Robert: Yeah, I would tell you I look at Mr. West who is the CEO of this organization as a really great mentor. He's pushed me forward in my career. He's challenged me appropriately on things. He has driven me to a level, to the position that I'm at now. Even though he'll tell you, oh my god, I can't believe I hired him for the job, I think he really, really, you know, him and I have a great relationship and if he's not teasing me I know he's really mad at me.

                So he's pushed me to take on more and more responsibility within the organization and he really believes in servant leadership and treating patients as if they were your mother or father. I think part of being a good mentor too is being honest with people, even if you got something bad to say. Or I didn't do something right. He'll come to me and say hey, this is not the way I would have handle this or listen, you didn't do that right. That's part of being a mentor is being able to have that honest communication with somebody to say yeah, this didn't go quite as you might have wanted. Or you screwed up. Listen, we all screw up right? And somebody has to be willing to tell you, you screwed up.

                So from a mentorship standpoint, he's mentored me quite a bit and I roll that down to my people because we need to be able to tell our leaders, hey we screwed up. Here's how we fixed it. Going forward, this is what I would do. I had one of those conversations today. So yeah. But that's about being honest.

Mark:    Those are hard conversations to have.

Robert: They are hard conversations but they are necessary conversations.

Mark:    How do you get into that?

Robert: They are necessary conversations. Here again, as you develop trust and a relationship with the people who report to you, listen we do operate. I do not and I don't believe our organization is not a heavy handed disciplinary organization, right? We understand people mess up. We are human beings. We are not infallible and we are not perfect. We make mistakes. You are not going to get fired for a mistake. But let's learn from your mistake. Let's have a discussion about it and then let's move forward so hopefully the mistake doesn't happen again. You know what? If you make the mistake again, we'll have another conversation about it and we'll try and fix it then. It's not about writing people up or terminating people because you make a mistake. It's about getting people to go where you want them to and doing the right thing.

                Here again, come back to the point. We're here to provide great patient care, right? If you start with that premise, which means something I learned in the Marine Corps. You probably know this as well being in the army. There are really two goals as a leader. There is mission accomplishment. And there is troop welfare, right in that order. They don't change, right? So what's our mission? Taking great care of patients. Right? The second one is you take care of your people. If you take care of your people, they are going to provide great people care, patient care. I always come back to those two things. It's mission accomplishment and it's troop welfare.

                So I totally believe I that concept. So I think if you take good care of your people, they will take great care of patients. So you have to be able to have honest conversations with people.

Mark:    Yeah, yeah. So let's shift gears a bit and talk about professional organizations, which is part of why we're having this conversation today and that is you are the New Hampshire regent for the American College of Healthcare Executives. What is that position and actually let me back that up. What is the American College of Healthcare Executives and how did you get involved in ACHE?

Robert: So the American College of Healthcare Executives is an organization that is there to promote healthcare executives really. It's about networking. It's about education. It's about career management. It's about making sure that healthcare executives and people with leadership roles within the healthcare realm, are doing the right thing, getting educated, staying on top of things, and doing a good job really. They have a set of ethical standards as most organizations do. They expect you to live by those ethics, which is really, ethics is about doing the right thing.

                I got involved as my previous boss kind of recruited me to get into the American College of Healthcare Executives. He was the New Hampshire regent at the time when he said hey I think this organization might be good for you. I know you're trying to move up your career ladder. I think this would be really interesting for you to get involved in. There are great educational and networking opportunities. So I became a member back in, I believe, 2010.

Mark:    Let me pause you for a second. That was Peter Wright who has previously been on the Forge.

Robert: Right. So Peter was my previous boss here. So he was the New Hampshire regent. So I got involved. I was doing my masters program at that time too. So when he was getting ready to exit his three year term as the regent, he recruited me to run for the New Hampshire regent, which I did. I was elected by the New Hampshire members and that's how I became the regent.

Mark:    So what does the regent do?

Robert: I think the regent is there for our New Hampshire members as a sounding board and a conduit to the National American College of Healthcare Executives. So they drive some policy education. What do we want the National Congress to be looking at for us? So I'm kind of that conduit. I reach out to the members. They email me. I get phone calls from them saying hey I'm really interested in this. Can you bring this back? Or how do I do this? Here again it's about mentoring some people. I get plenty of emails going hey. What do you think about this? Or what do you think about that? Or I'm thinking about going down this road to this career next.

Mark:    People are asking for career advice.

Robert: Yeah, career advice. How do I get to a senior management level? Which then I can point them to the podcast. But it's that kind of stuff. So the ACHE is really about networking, world class education, career management, and a set of ethics that kind of guide our principles on how healthcare executives should act and treat people.

Mark:    How has your personal experience with ACHE influenced your career and your career progression?

Robert: I would say it's made me get out of my shell and think about healthcare more globally. You know healthcare isn't just about what happens here in Littleton, New Hampshire. Healthcare is about what's happening in the state as well as what's happening nationally and to some respects what is happening globally with healthcare. So it's made me get out of that, hey what's happening in Littleton mode, to really what's happening in our state. There is a lot of issues in healthcare. Reimbursements are declining. A lot of us operate on very small margins if any margins at all. It's made me take a look at where is healthcare going in the future.

Mark:    Why should people get involved in ACHE, in particular young folks early in their career? Why should, for example, students in HMP, my program down at UNH be joining as students and trying to get involved?

Robert: I think first and foremost for your students, there is great networking opportunities there. So much of after they graduate and getting a job in the healthcare field is about knowing people. Listen, you're a great student. You are a 4.0 student but boy, you need an in someplace. We get hundreds and hundreds of resumes. So what is the differentiator there. Sometimes the differentiator is hey, I know this person. I can call this person and say hey, I just applied for this job. Put in a good word for me or can I put you down as a reference. Because inevitably, even though we get hundreds and hundreds of resumes, the healthcare world is a small community right? There is a lot of people just since I've been in the ACHE that I know now. I'm helping one of my members, she's applying for a job and she said hey, I don't know anybody here. Do you know somebody here? Absolutely I do. I'll call that person and let them know.

                There needs to be a differentiator within when you put in the resume or an application because just the volume is so much in healthcare nowadays. People are looking through resumes. What is the differentiator there to get you a job? Sometimes that just comes down to meeting people and networking with them and somebody saying hey, I remember that person. Yeah, she was really good. I looked at her presentation at the chapter board meeting. It was fantastic. She was really great. I think she might be good for this position.

                There is world class education at the ACHE. The seminars I've been to? Unbelievable. Usually a lot of the education comes from people within our field who have an expertise. The education is fabulous. It's real world. Not something you heard $20 years ago. It's about what's happening in an organization today and this is what we did to address this issue.

                Then they have career management services, which is really great. So if the students ever get a chance to go out to congress out in Chicago, they actually have executives sit down and do resume reviews with people. Say, oh you might want to change this or this resume is great. There is just a lot of things that I think the college offers, especially the students. I would tell you the number one thing would be networking though.

Mark:    Yeah and finding that first job first.

Robert: Listen, you've got to get in somewhere right? I know your goal and I'm sure my goal is, okay somebody graduates with a health degree, they shouldn't be working at McDonald's. Let's get them into the healthcare field because we need new leaders. You and I are not getting any younger. So we need up and comers who really want to do great things for people.

                So that's what I would say.

Mark:    Well so in closing let me ask you, what advice do you have for someone thinking about going into healthcare administration today whether they are coming straight into the field from a program like HMP where I teach or maybe they are trying to make a shift into the field like you did. What education should they pursue? What jobs?

Robert: The first thing I would say is it's not easy. It's not an easy field to be in. If you want something challenging but equally rewarding, it's a field for you. Listen, coming out of college, you're going to start on a lower rung. Keep raising your hand and saying yes. Yes, I'll take on that responsibility. Yes, I'd love to do that. The more you say yes, the more you move up. You know I would ask people, are they prepared to be servant leaders? Are they prepared to put their pants on the same way as everybody else? It's not about management from the top down. It's the inverse.

                Do they have the burning desire to help people? I think that's what I found. When I got into healthcare I would have never thought I would have had that but I found wow, this is really great. I can make a difference. Do they have that I want to make a difference attitude? Then start small. The first step is getting into an organization. So don't think you're going to come out of school and you're going to be the CEO. Start small. You have to get into some place that is willing to take a chance on you. Show them that you've got the where with all to do bigger and better things.

                So part of my thing is when I did my master's, I didn't do an MHA. I did an MBA.

Mark:    Why did you make that choice?

Robert: I thought, you know listen, if anything ever changes and the way healthcare was going back then. You know I better be prepared for other things just in case. You never know what's going to come around the corner. Right? So keep your mind open. There are a lot of jobs out there in healthcare. It's not just about hospitals. There's a ton of different jobs out there in healthcare. Keep your mind open.

Mark:    Let me follow up with one last question. It occurred to me as you were talking. You've worked at mid sized, large bedded facilities as well as a critical access hospital here. What's the benefit in terms of career development at being at each of those. We were talking before we started the interview that a lot of my students go to places like Mass General. Huge. Children's. Huge. These great big facilities. What would you sell a place like Littleton or a smaller facility. Maybe a community hospital. What would be the benefit of going there instead?

Robert: I think part of the draw that I've drawn to smaller community hospitals is one you get to know everybody. Two, hospitals or healthcare organizations, I think we talked about this earlier. It's do more with less. So I think the opportunities can almost be greater at a smaller hospital because they are always looking for someone else to do something else. So I go back to when I started my X-ray career. I went to a small 14 bed hospital to start with which, you know, right before Bradley I only worked there for a little bit but it was a small hospital.

                I learned how to do ultrasound and CAT scan because that was you had to do to survive. So at a small community hospital, it's all about doing, I hate to say doing more with less but it's about who can do more and wants that opportunity. Right? So sometimes I think the opportunities are actually greater if you can show that hey, I want to do more. Here again, I keep coming back to it. You just have to keep raising your hand saying yeah I'd love to take that one. Because the more you show and people get to know and trust you, the more they will put on your plate and you will move up in the organization.

                So, that's what I think about community hospitals. It's more of a family sense in a smaller organization. I'm a big believer in we take care of our family here. I think most of our leadership team believes that as well. That every member of our organization, the 450, 500 employees that we have, are a member of our Littleton Regional Healthcare family and we would go above and beyond for those people. I think by knowing those people personally, on a named basis, gives you more opportunity and makes you feel a sense of community and family.

Mark:    That's great. Thank you so much for taking the time to talk with me today.

Robert: Thank you. It's been my pleasure.