Kevin Donovan Interview Transcript

The following is a transcript of my interview with Kevin Donovan. 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.

Bonica: Welcome to the forge Kevin.

Donovan: Thank you, thank you for inviting me to do this.

Bonica: You went to Syracuse University where you earned a Bachelor of Science in Information Studies in 1992. Why did you go to Syracuse and why Information Studies?

Donovan: Sure. Information studies because I in high school had taken some programming classes actually, and so I applied to Syracuse for management and they actually, based on some of the computer classes I had taken were starting a new program in information studies, which is really the management of information systems. And so they accepted me and then approached me about enrolling in this new shool as opposed to just going traditional management route.

Bonica: Okay.

Donovan: And at the time it just seemed like an exciting opportunity to be in on the ground floor. I think I was actually the first class that went through first class that went through four full years of that program at Syracuse University. So kind of a unique opportunity. In terms of why Syracuse, my family is originally from upstate New York.

Bonica: Okay.

Donovan: And I knew that I had to be ... At the time I was living in Massachusetts and I wanted to not be too close to home, but not too far from home. And I wanted a big school, and probably an active sports program to watch, not participate was intriguing to me too. Really, I think it was the combination of the location, the type of school I wanted, but then the unique opportunity to have a different program then I might have been thinking about.

Bonica: You graduated, this was not a health care specific field?

Donovan: No, not at all.

Bonica: When did you know you wanted to go into healthcare?

Donovan: I joke about this all the time and I tell people that I'm probably the only person you've ever met grew up wanting to be a hospital CEO.

Bonica: Really?

Donovan: Yes. And that's actually a true statement. At first I wanted to play for the Red Sox but I think out at a pretty early age that wasn't going to pan out.

Bonica: Yeah.

Donovan: But my father was a hospital CEO, the majority of my family works in healthcare either on the clinical side, or on the administrative side. I have an uncle who's a CFO, and many physicians, and social worker's, and nurses, and others, and I always knew the clinical route wasn't for me. And I guess I just assumed everyone worked in healthcare because that's kind of the way it was in my family.

Bonica: Of course, right.

Donovan: And yeah, I really did. I wanted to be a hospital CEO from an early age.

Bonica: Okay. You graduated and you went to work for trustees of health and hospitals in Boston as a computer support specialist and then Assistant Administrator. What was that and how did you windup working that first job?

Donovan: Sure, I graduated from college with that degree and started looking for jobs as we all do right, when we graduate from college, and I wanted to be in the healthcare field because I always knew I wanted to go back and get a Master's Degree in healthcare administration to pursue that goal of being a hospital CEO. But I wanted to work for a couple years and get some real life experience. I was looking for positions that matched my education from Syracuse in Information Studies and found this job for trustees at health and hospitals, which is the grant management arm, or at least at the time was the grant management arm of Boston City Hospital. It was for a healthcare organization, but it wasn't healthcare related type job. I mean it was [inaudible 00:03:11] job. And so really my first job there was to help people if they had problems with using Excel, or Word, and they were the very early versions, believe me, back in the early 90's of those programs.

Bonica: Right.

Donovan: And initially set up an email system and all those things that were really new and cutting edge at the time sadly enough.

Bonica: Yeah, I've heard of this email.

Donovan: Yeah, it's just an amazing thing. But anyways, it started out there and got my feet wet in the working world and learned what it was like to be a professional and get up everyday and put on a tie and go to work.

Bonica: That's one of the things we try and teach our students down at the program too.

Donovan: Sure, yes.

Bonica: It's a thing ... It doesn't, you weren't born necessarily knowing.

Donovan: Right.

Bonica: You worked there for a couple years and pretty quickly you went to a Master's of Healthcare Administration Program at the George Washington University, and you graduated in 1997. How did this degree prepare you for a future as a healthcare administrator? And why an MHA as opposed to say an MBA?

Donovan: Right. Again, I always knew I wanted to be in healthcare management. And very clearly when I thought about getting my post graduate degree that I wanted to have more of a healthcare focus. I did look ... I looked at a number of programs. Not a huge amount, but a number of programs, and did some visits, and I looked at one MBA program actually at Notre Dame that, because they didn't have an MHA at the time. I don't know if they do now or not. But I was just interested potentially in the school. But when it came down to it, I really knew that this is what I want to do for my career. And if I was so focused, and I thought it made a lot of sense to get more focused education, then a broad education. And the George Washington Program was a good match for me.

Bonica: It's a top ranked school. The program is.

Donovan: It's a really good program, right. And actually interestingly enough, back to family ties. My father went through the MHA program at George Washington.

Bonica: Oh neat.

Donovan: As well, and my uncle went to Med School at George Washington, so I had a lot of ties there. When I was young, my father was in Grad School there. I actually lived in DC. I don't remember it, I was that young.

Bonica: Yeah.

Donovan: I just kind of thought it was a nice fit.

Bonica: You did your residency which is a third year part of that-

Donovan: Correct.

Bonica: At George Washington you do a year residency following your two years of didactic?

Donovan: Correct.

Bonica: Where was that?

Donovan: That was at North East Health Systems in Massachusetts.

Bonica: Okay.

Donovan: North East Health Systems was the combination of Beverly Hospital and Addison Gilbert Hospital in Gloucester, and you're right, so George Washington has a one year requirement for a residency. And honestly, I think it was the best thing probably, I've ever done in my career and my training. Because it's an opportunity as a relatively young inexperienced person to have access to the C Suite and the board and the things that you wouldn't normally get to see as a traditional new hire, or in an organization. It was great experience spent, it's a one year program, one year requirement. I spent about nine months in that role doing various things. But one of the things I started to do, was I did an RFP with the Vice President to select a practice management system for the employed physicians of North East Health Systems, which was a new program for them as well. It was the time in the 80's or 90's I should say, sorry I'm dating myself. That everyone was buying physician practices, and it was all about competition on the North Shore between different organizations, and they were acquiring all these groups and then they had to figure out what to do with them.

I did an RFP to pick a practice management system and it was interesting and they were hiring up at that time, and so we converted the last three months of my residency into an actual full time job that then I continued on when the residency was done.

Bonica: Neat. All right. And you did a series of practice manager jobs continuing in the Boston area. And then eventually joining the Dartmouth Hitchcock system culminating with the Director of Ambulatory Services for the Children's Hospital at Dartmouth through 2007. I wanted to ask you, what do Practice Manager's do?

Donovan: Sure.

Bonica: It's a common term we hear about in healthcare.

Donovan: Right.

Bonica: What is that?

Donovan: I think it varies a little bit by group. I think of a Practice Manager a little bit like a CEO or COO of an organization. And that means you can be doing a number of things on any given day. Whether it be a formal and strategic planning, or as informal for practice managers backing up people who are out in the billing office, those types of things. It's a little bit like Jack of all trades, a little bit like a COO, making sure that everything happens smoothly and the patients are satisfied and getting the services that they need. And making sure the bills go out the door, and money comes in the door, and all those types of things. And me having started at a hospital base, hospital owned physician practices, and worked there a couple years, I transitioned to a private practice. Went to a private practice on purpose, because I wanted to see how "The real world" worked.

Bonica: Okay.

Donovan: Back to my earlier point about hospital owned practices in the day, we were making it up a little bit, and we didn't have all the experience. And I think this has been well documented in some of the literature. But we didn't have all the experience and we tried to put a hospital mentality onto physician groups. I saw some of the challenges of that when I was in Massachusetts and that's why I left to go run a private practice, so I could see what it was really like to be lean and efficient, and get things done in the best manner. That was a really good experience for me, and I think as I think back on my career, a defining moment in terms of some of the challenges and opportunities and things that I did as a Practice Manager.

Bonica: And you finished up as the Director of Ambulatory Services for the CHildren's Hospital at Dartmouth. What was that job?

Donovan: Sure. That's really running the professional practice of CHAD, of the Children's Hospital at Dartmouth. Anyone who sees kids at Dartmouth Hitchcock is a member of the Children's Hospital at Dartmouth, which is a group within DH. And whether that be general Pediatrics or Pediatric Neurosurgery, or those types of things, they've really created a culture that's different within CHAD from the rest of the organization, and that people really feel like its something that they belong to and in that role it did a number of things. Probably one of the bigger things I did was I brought all of the Pediatric providers to gather into one contiguous space in a new outpatient ambulatory space. Prior to that general Pediatrics was in one building. The Pediatric General Surgeons were with the Adult Channel Surgeons. Pediatric Ophthalmologists with the Adult Ophthalmologist and so what we did was built a new floor, a new wing, where we brought all the Pediatric specialties together in one family friendly space, so that we can all practice together as a group practice and so that the kids could have the type of environment that they really require, which is different then what we as adults need. That was a pretty exciting project for me, and I think that job was about five years or so, and really enjoyed it. It also had an academic component to it.

Bonica: Okay.

Donovan: And I was the Administrator for the Dartmouth Medical School Department of Pediatrics. In terms of supporting all the research activities that the principle investigators and the faculty did, did all that support work as well and ran the clerkship, and residency programs, and some pretty interesting stuff, totally different then what I had done before.

Bonica: You were in the ACHE Fellow designation in 2007, how did you come to be involve in ACHE, the American College of Healthcare Executives?

Donovan: Sure, I've always believe in giving back to my profession, and also being involved in my profession. So you're right, I became a fellow of the American College of Healthcare Executives in 2007, and I did that because my career at the time where I had taken a detour from my original goal of being a hospital CEO to getting involved in physician practice management, I made a decision that ... A purposeful decision that I want to get back to my original goal, which was to be the CEO of a community hospital. And so I started to think of ways to get back on that track if you would and one of them was to get involved more with the ACHE, American College of Healthcare Executives, where previously I had been very involved with the Medical Group Management Association.

Bonica: Okay.

Donovan: And the American College of Medical Practice Executives. I actually became a fellow of the American College of Medical Practice Executives, I think in 2000, and you know, moved through the ranks there and had been the president of the New Hampshire MGMA, and had been on the board of the regional MGMA, and those types of things, and had been very involved. But then as I said, I really wanted to get back to hospital management, I made that choice to get more involved with ACHE, as opposed to ACMPE. And I'd been a member of ACHE for a while, but really then took seriously the fellow designation and then becoming involved in the group.

Bonica: In 2007, you joined the Elliot Health System as the Vice President for Physician Services. And as we were talking before we started the Podcast, I recently interviewed Bridgette Stuart who is currently in that role and listeners who are interested can check out that interview for a more in depth discussion of the position. But in brief what was the position, and how did it lead to your promotion in 2008 to be the Senior Vice President for Clinical Operations?

Donovan: Sure, so I did listen to your Podcast with Bridgette, so I could hear what she could say about her predecessor, but she said only kind things, so I appreciate that. But yeah, I took, again back in 2007 or so when I was really thinking, okay I want to get out of Physician Practice Management, not necessarily out of it, but I want to get back towards that original goal. I had went around and networked with people who had made similar jumps or people who had ... were working in the hospital field. And through some connections and those types of things, got hooked up with the Elliot Health System at the time, that was hiring a new position, which was the Vice President for Physician Services. And I went there and took that position and it was really to run their employed physician groups. But also the Cancer Center that was part of the organization, and to be a member of the Senior Leadership Team. It gave me insight and input into more then just the physician provider side of things, but into the whole health system operations.

And the time that I went there, one of the big goals of Doug Dean, the CEO was that they had about 60,000 people who had a Primary Care Provider in one of the employed physician groups. And his goal was to get to the magic number, not quite sure why it's magic, but of 100,000 lives-

Bonica: Okay.

Donovan: So they wanted 100,000 people who had a primary care provider in their network, and at the time the specialty group was also pretty small. It was Neonatology, and some of the hospital based specialists. And the goal really was to build a multi-specialty groups. Time that I spent at the Elliot, much of my time was spent building the network through new hires, acquisitions, attracting physicians to come work at the Elliot who might be admitting to other organizations, those types of things. So really an exciting time to build that group network and did a lot of work on that, and now Bridgette has the fun of making sure it operationally works of what I kind of patched all together. And I know that's a challenge for her probably. But a really exciting time and great organization as well.

Bonica: And 100,000 covered lives in Manchester area, Manchester the city has about 100,000 people, so that's a pretty aggressive target.

Donovan: It was pretty aggressive, so Manchester for people who know, Catholic Medical Center, Dartmouth Hitchcock, and the Elliot were all co-existing at the time. Not always smoothly co-existing, but co-existing at the time, and so we were all actively looking for as much market share as we could get. If you look at the big population around Manchester, we thought it was about a quarter million people, and we were looking to get at least 100,000 of those 250,000 people.

Bonica: You transitioned to be the Senior Vice President for Clinical Operations, but what was that role and how it is different than your prior role.

Donovan: Sure. So I was the VP for Physicians Services, I had all the employed physicians, provider groups, the Cancer Center as I mentioned, and at the time when I first went there, there was also a Vice President for, I forget the term, maybe Hospital Clinical Services, or something like that. It was Pharmacy, and Laboratory, and Radiology, and Respiratory, and all the Outpatient Hospital Departments. The Pain Center and all those types of things. And that individual left, and so rather than replacing that individual, they just gave me all of his departments as well, and promoted me to the Senior Vice President role.

Bonica: Okay, very nice.

Donovan: For me, great opportunity.

Bonica: Yeah.

Donovan: Back to that path, great opportunity to say, "Hey those are traditional hospital departments that I know that I can do a good job helping to support, and so I'll take them on." And so, really in that role, I mean it was a huge role for me at a relatively young age. And I really am grateful to some of my mentors and people who supported me in moving into that role, and I got ... I mean I had all of Clinical Operations pretty much except for Inpatient Nursing. There was a Chief Nursing Officer who did hospital Inpatient Nursing, ER, OR, those types of things. But anything else that really saw patients in that system reported up through me.

Bonica: Oh, what about Finance or HR, things like that?

Donovan: Yeah, no.

Bonica: Was that under you as well?

Donovan: That was carved out. Finance and HR, and IT actually at the time all reported up through the CFO in that organization.

Bonica: Okay. Just to get a scope of that that is.

Donovan: Sure.

Bonica: What would you say was your most valuable lessons you learned while you were the VP for Clinical Operations? How did that prepare you for your next role as CEO?

Donovan: Yeah, I think that as I've progressed through my career and moved up the ranks if you would. It's always been interesting to me how much more autonomy you have as you move along that path of CEO and how, for lack of a better term, how scary that autonomy or that responsibility is.

Bonica: Okay.

Donovan: And I have to tell you moving from an academic medical center environment where I was a Director to a Community Hospital, but a big Community Hospital, but still a Community Hospital where I was now a Vice President, it amazed me at how much more authority and latitude I had to make decisions. But it also amazed me how much pressure was associated with that. When you're a Practice Manager or Director and you often are implementing decisions made by other people and it maybe easy to element about oh, I don't know if I agree with this. It gets a little different when then you're the person they're all looking at that you have to make the decision. And so I've always been struck by that. And so I was amazed when I went to the Elliot about how much responsibility I had and about how exciting that was, and what a great opportunity it was. And especially in that organization, which is very dynamic and makes decisions quickly, and implements things quickly. It was just a great experience.

Bonica: That's a theme I've heard actually a couple of times from CEO's.

Donovan: Okay.

Bonica: It's different when you're sitting at the desk where the buck stops.

Donovan: Right.

Bonica: Yeah.

Donovan: That is for sure.

Bonica: Let me come back to that in a little bit.

Donovan: Yes.

Bonica: You were Vice President for Clinical Operations, kind of a COO role, right?

Donovan: Mm-hmm (affirmative)-

Bonica: Is this a common path for Administrators to follow into the CEO role?

Donovan: I think it may have been in the past, I'm not sure it will continue to be in the future. I mean I think about most of my counterparts. I mean there are people who came up through the ranks whether they started out in the clinical side of things, or they started out in management. But it's interesting, it's more clinical personnel move into leadership roles within hospital management what the future will bring. And I, in some ways, I think maybe my path, which has been more traditional might be a little bit more like a dinosaur path, I don't know.

Bonica: Okay.

Donovan: But I also look at all the people you're training today and you know, those people, the students that I've had interactions with, the very sharp ... I call them kids, but very sharp folks. And I think that yeah, you come into an organization, you just get your feet wet, and you volunteer to do stuff, and I think that people can move up in that path. Maybe the exact path through Clinical Operations isn't how everyone will do it, but by taking on progressive more responsibilities, you'll find yourself in a position of more authority.

Bonica: In 2010, you left the Elliot and you took on the role as President and Chief Executive Officer for the Mount Ascutney Hospital and Healthcetner where we are today.

Donovan: Right.

Bonica: Before we talk about the hospital itself, can you tell us a little bit about where Mount Ascutney is, and what makes it unique?

Donovan: Sure. Mount Ascutney Hospital is in the main campuses in Windsor, Vermont. Windsor is kind of center of the state of Vermont, but on the border with New Hampshire, so about ten miles or so from Claremont, New Hampshire. And then we have another location of Woodstock, Vermont where we have an Ambulatory Care Center where we provide a number of services and that's probably about 15 miles from here. Very different communities. Windsor is more of a blue collar working town, traditionally was a mill town, and had a lot of industry. Woodstock is much more of an affluent, almost second home, or definitely a second home kind of resort town if you would.

Bonica: Okay.

Donovan: And very different populations that we serve, but all that have that common bond of loving to live in Vermont, and the outdoors, and those types of things.

Bonica: Hospitals are often a major economic engine for smaller towns. Coming back to kind of the community as a ecology, how do you, as the CEO of the areas hospital interact with the business, non-profit, and government leaders in town?

Donovan: Sure. You're right, we are by far the largest employer in this town. I actually would love if that weren't the case, because the demographics of our community would be a little different, but if we have probably around 500 employees, we are by far the largest employer. The other, Simon Pierce, which is glassblowing and a restaurant, and other types of things are in town, but maybe they employee 75 people or so. Very much our organization is looked at as a vibrant part of the fabric of the community and employs so many people, and then brings in so much money in terms of supporting families and people who are working, and then we support stores, and all those types of things. That it's important to be a good part of the community and civically minded.

I'm involved in a number of ways. I'm a member of rotary and I have been for probably the last six years or so. And was the President of Rotary I guess, a year and a half ago. And very active in that organization. I sit on other groups. I sit on the board of something that's called the Windsor Improvement Committee, or WIC as we call it. And really the role of WIC is to bring business to town and to encourage business to succeed in Windsor.

Bonica: Okay.

Donovan: And so not healthcare business. That's not my role, my role there really is if someone is looking to start up a business, we try to help them to get access to capital and work in a way that they can create economic engines in this town that then support the community in a positive way. It's very important for me as the leader of the largest business in town to be involved in things, besides just running my hospital. And I enjoy that, I think it's one of the nice things about working in a Community Hospital, it's one of the nice things about working in a smaller community, as opposed to a major city. And yeah, so I take a lot of time to do that actually.

Bonica: This is a rural community as we were talking about. Hospitals require specialized, skilled employees. How do you find the skilled workers that you need ranging from the physicians, to the RAD Techs, and so forth?

Donovan: That's a real challenge here. I know the recruitment retention are a challenge everywhere. And having worked in larger cities, like Manchester and at major centers like Dartmouth Hitchcock, and being in Massachusetts for a while, you're always focused on recruitment and retention. But recruitment and retention here in a community like Windsor, it's a little bit of a different story, because first you have to find someone who has the idea they want to live the lifestyle that people live in Vermont, and that's important to them. That narrows down the candidate pool if you would. And then we, as an organization in a rural community, we're not an organization that can afford to pay top dollar for every specialty, or for every employee that we have. And we can't compete solely on compensation either. It becomes a real challenge looking for the right type of person who wants to live in this environment, who maybe money is not the driver for them, or I should say money will not be the driver for them. And that really above all appreciates that sense of community that we can provide and the fact that you can take care of your neighbors and friends, and colleagues, and that you really get to enjoy what it's like to live in small town America. And that's really what I feel like this is like.

It does become a challenge. I know that we have hired some people over the last couple of years who they have thought that, that's what they wanted, and they've moved from major cities, or they've moved from Massachusetts, and then they come up and they might stay a year or two, and then they find out, you know, I guess I really do need a movie theater closer than 40 minutes away, 30 minutes away. And sometimes those people leave, and that can be upsetting to local community. And I know that right now, and all communities are struggling with this, but we're struggling with the fact that physicians don't come to town and hang up a shingle anymore and stay forever. We just had a physician retire who had been on the medical staff here for 40 some odd years, was an institution in the town, and there were some people who were upset because physicians come and go now every five or six years. It's become more of a job where they can be transitioned to new roles than it used to be. It's a real challenge that we're always working on, but the key is finding somebody who really knows what it's like to shovel snow at 6:00 in the morning so you can get to work. And somebody who really knows what it's like to live around here, which is great.

Then the other part of that is that we as an organization and employer, we need to know that we recruit people who are interested in work, life balance. That's why they come here, right? And if we're going to recruit someone because they're looking to ski, or pursue outside activities with their kids, we need to create a culture that supports that. And we worked really hard to do that in terms of supporting people to have more of a life than just work. And I think that goes back to what we talked about compensation before. I think some people are happy to take a job just for the money, and just work all day long, but people who come here they get a fair wage, but they also want to know that they have a life outside of work. We respect that as an employer, we try to find ways to support that.

Bonica: What is the general organizational structure of Mount Ascutney Hospital and Healthcenter? Who are your direct reports?

Donovan: Sure. Pretty traditional organization chart. Chief Nursing Officer, Chief Medical Officer, which was actually a new position I created about five years ago, that had not been here. Chief Operating Officer, who really runs support services, things like Dietary, and Environmental Services, but then also runs the Physician Practices.

Bonica: Okay.

Donovan: Back to my experience coming through the system. It's just a unique individual said, "Yeah, I'll take it, I'll take anything on." So has a real unique background. Also, I guess Chief Financial Officer, the Director of Quality and IT as combined role here, which I think is pretty unique. But we happen to have a very skilled person who is a nurse by training, but during the whole transition to Electronic Medical Records over the last ten years or so, really moved into that realm. And also has a quality background as well. We have a combined role equality in IT, which is unique and we're very fortunate to have that individual. And then HR reports to me as well as development, so fundraising.

Bonica: Oh fundraising, okay.

Donovan: Yes.

Bonica: All right. Based on your website, the hospital and the healthcenter have six subordinate organizations. First and foremost is the hospital, then you've go an employed physician provider network, inpatient, acute rehab program, skilled nursing facility, assisted living facility, and a grant foundation. Let's talk a little bit about the hospital first. Mount Ascutney is a critical access hospital. I've talked about that with a number of guests. But for people who haven't listened to those prior Podcasts. Can you briefly tell me what that means? And why is it important?

Donovan: Right. Critical Access Hospitals were created, I think in the mid to late 90's. I think the craze around here of people turning into Critical Access Hospitals, they're organizations, which are critically important to their local communities and typically the designations are made by geography. Typically, it's if you're 35 miles or through mountainous terrain, but states have the opportunity to designate certain organizations as critical to their communities and needed providers, and that's how we became a Critical Access Hospital in the 90's. And basically what it means is that we are, we need to be a certain size. We can't be over 25 beds of Med Surge, now we can have another ten beds in a distinct unit. We'll talk a little bit about that. We do have our Inpatient Acute Rehabilitation Programs as well, but we need to be 25 Med Surge beds, we need to have an average length of stay of four days or less.

Bonica: Okay.

Donovan: And that means that we get cost based reimbursement for Medicare. And it used to 101% of allowable costs, it's now 99% of allowable costs. Which is an interesting thing for people who haven't worked in Critical Access Hospitals before, I think they think ... In a PPS Hospital you might think they can spend what they want and get reimbursed for their costs. No, its allowable costs and then it's even a certain percentage of your costs.

Bonica: Okay.

Donovan: It's still going to be pretty challenging to run in that kind of environment.

Bonica: What's the share of the hospitals patients that are Medicare and Medicaid?

Donovan: Yeah, I talked about our demographics a little bit before and the fact that a lot of industries left this area, and we really rely on governmental payers here. In the last month that I saw, we were 58% Medicare, and 14% Medicaid. And then we're about 3% no pay, or self pay.

Bonica: Yeah.

Donovan: So three out of four people that we take care of have no ability to pay us, or they're governmental payers, which pay us less than our costs. The Medicaid program in this state pays us about .50 cents on the dollar, so when you look at it we only have one quarter, one out four people that have private commercial insurance that we take care of. It makes that ability to cost shift very tough for us. And that's our community so that's who we live to take care of, that's who we live to serve, and that's who we do a great job doing that. But it doesn't necessitate based upon our payer mix that we're a pretty lean organization and take cost control and being efficient very seriously or else we wouldn't be able to keep the lights on.

Bonica: You operate, you mention distance and geography as being one of the determinants of a critical access hospital. You operate pretty close to one of the largest hospitals in the region.

Donovan: Right.

Bonica: Dartmouth Hitchcock.

Donovan: Sure.

Bonica: Which I was just up visiting with Karen Clements the other day. Why does Mount Ascutney need to be a bedded hospital and why not just drive over to Dartmouth Hitchcock?

Donovan: Sure, I always say to people Dartmouth Hitchcock is both a blessing and a curse. It's to be on the negative side of things, it's a curse because you're right, someone can say, "Well, why would I need to see a Cardiologist in Windsor, when I can see one of the top 50 Cardiologists in the country 30 minutes from here?" And that is a challenge for any organization and for ours. Now it's a blessing, because it also means that we can focus on the things that we want to focus on, do them well, and then partner with Dartmouth Hitchcock for the things that we can't provide. And so, we as an organization for many years now, long before my tenure here, but definitely within my tenure here, we have really thought about how can we make the most of our geography and that relationship with Dartmouth Hitchcock or the proximity? And how can we focus on certain things that we can do better then them, and then rely on them for the things that they can do well. And what are some examples of that?

Probably the first among those is Primary Care. We know that people want to be seen locally. We know that in a community setting like this that we can be more nimble and we can get to know our patients better, and those types of things. We can really create a patient centered medical home that's excellent and that people want to go to. And that's something that's a little bit harder to do in an academic environment where they have the requirements of teaching, and where they have much more bureaucracy, and layers, and requirements then we do here in the community setting. Other examples of that is really Post Acute Care. We know that Dartmouth Hitchcock there are many things that they can do that we just couldn't, we wouldn't have the resources to compete with them for a better term, or to provide a similar service. What we focused on is Post Acute Care. People who may have been at Dartmouth Hitchcock for care, and now aren't ready to go home, but still need to be in an Inpatient setting.

There's two types of populations we take care of. One is what we call the swing population, so these are people who had a three day qualifying stay at Dartmouth Hitchcock typically who then might still need a couple more days. Maybe they had a hip fracture, those types of things. And they come down here, and they spend another couple of days with us, maybe a week rehabbing and getting ready to go to that home environment.

Bonica: And you said a three day qualifying stay, what does that mean for listeners?

Donovan: For Medicare, to be on a swing benefit for Medicare you need to be in an Acute Care setting, hospital setting for three days before you can qualify to go to a Post Acute provider to get an inpatient facility type services.

Bonica: Okay. Then Medicare would then pay for it?

Donovan: Medicare would then pay for it. Yes, Medicare would be happy for us to take them and not pay for them.

Bonica: Right.

Donovan: Yeah, it's a payment requirement thank you.

Bonica: Okay.

Donovan: The other population we take care of Post Acute Care is the Inpatient Acute Rehabilitation, and I know we'll talk a little bit about that.

Bonica: Yeah.

Donovan: That's a very important program for us.

Bonica: Okay. You actually worked with Dartmouth Hitchcock to establish a formal affiliation between Mount Ascutney and Dartmouth Hitchcock. What was the impetus for this move?

Donovan: Sure, again, I think the history has been partnership. But the impetus for the most recent move has been a strategic plan that we put together in 2011. I guess it was in the fall of 2011 we put together a traditional strategic planning process with our strategic planning committee of the board. And we hadn't revised our strategic plan for a number of years. And we took a critical look at what we wanted to be in the future, and what we could be, and address the issues like you're asking me. How do you exist with the major academic medical center in your backyard. We identified seven critical areas that we wanted to focus on, and many of those would be familiar to your listeners in terms of people, service, quality, finance, growth, or programs. We also added onto that though was governance, because we needed some work in terms of our board and our governance practices, and then community awareness. And whether that be from a marketing public relations side, or from a development side, they're both parts of that. We created those, we looked at those seven critical issues and said, "All right, where do we want to go in the future? And is it related to growth and programs, rather than thinking about competition what we thought about, what the question was, was should we find a like minded organization with similar principles to partner with in the future?"

We made that a goal to answer that question in 2011. We went through a process to think about what could our structure be in the future and the result of that, the culmination of that was a new relationship with Dartmouth Hitchcock about a year and a half ago where we are not a formal affiliate of Dartmouth Hitchcock Health.

Bonica: Okay.

Donovan: And now we've revised our strategic plan. We just did it this past fall and now the critical issue around growth and programs doesn't say should we partner with another organization, it says essentially now that we have partnered, how do we make good on all the promises of affiliation and all the benefits of that? It's really where we're looking to go in the future.

Bonica: What kind of benefits is Mount Ascutney getting from the new relationship that you have with Dartmouth?

Donovan: Sure. There's a lot. And I would be lying if I said it isn't a rocky, kind of a transition here. I mean one of the things that we did, we were the second hospital ever to sign up to be an affiliate of Dartmouth Hitchcock Health. That means we were in on the ground floor. And we knew that when you were in on the ground floor like that you're making it up as you go along a little bit. And Dartmouth Hitchcock, and I have a great relationship with those folks and always have, they were very honest with us. Okay, this is new for us to have smaller hospitals that are part of the system. They hadn't had that before. We're making it up as we go along, but there's lots of benefits that we're implementing on every day. The first one that's probably the easiest for the community to see and probably the best example for the community to get benefit is for partnership with clinical programs.

And there's a multitude of examples here. But probably a good one is General Surgery. We had two ... A couple years ago we had two full time General Surgeons, Valley Regional, which is a little ways from here. I had a couple of General Surgeons, New London Hospital had a couple of General Surgeons and so, the General Surgeons at those three organizations shared call, because they didn't want to be on call every other night. So they shared in the larger call pool but it meant when you were on call, you were covering three hospitals in a 40 mile radius. Which means your life could be pretty interesting at times. What we saw was that a number of those surgeons, most of those surgeons actually were looking to retire, and as we were looking at new grads coming out of training, nobody wanted to sign up for that job anymore. It goes back to what we talked about for recruiting challenges before. No one wanted to sign up with that type of position.

Now with Dartmouth Hitchcock what we've created the program where their surgeons come down and do their clinics and their surgery here on our patients. So we lease them for lack of a better term a couple days a week or really five days a week, and we have a consistent General Surgery presence by people who are Dartmouth Hitchcock General Surgeon, and they rotate. Someone like Dr. Brent White, who is on our staff. He works here three days a week and he works in Lebanon two days a week. He gets the best of both worlds because he gets that academic environment two days, but he also gets that community presence the other three days. It allows us to attract recruit people who we couldn't, and this goes back to what we were talking about before. We couldn't recruit them on our own because a guy like Brent White who wanted that tied to an academic center, we couldn't give that to him without them. It allows us to have a stable pool of applicants, it allows us to have high quality physicians here that probably we couldn't get on our own. And that's just a General Surgery example, but essentially if you look at any specialty practice we have now, they're pretty much all Dartmouth Hitchcock physicians who come down here.

Bonica: Okay. All right, that makes sense.

Donovan: Yeah.

Bonica: I know, having family members like you who are physicians, that's a big concern. Maintaining their skills is a big concern.

Donovan: Right.

Bonica: So if you come to a place where you don't get to practice and do the full range of skills, your skills atrophy and so being able to go back to Dartmouth they probably have more variety in their schedule, I imagine that allows them to-

Donovan: Most definitely. I mean one of the things that's very hot topic these days and I'm sure you guys have been talking about it. But it is low volume surgery. And with volume comes quality and there are a number of organizations. There's Dartmouth Hitchcock, John's Hopkins, and the University of Michigan this past summer who made a pledge that they will not allow providers to do low volume surgery. That means they're putting in place minimum volume standards for their surgeons. They're proceduralists to meet quality goals. In an organization like this where we're small a General Surgeon, he or she probably couldn't meet those volume requirements just in this institution.

Bonica: Right.

Donovan: If you're really at the whim, walks in through the ER door on any given day, but now with the partnership with Dartmouth Hitchcock and those folks being able to work up there, and down here, they know that they can get the volume they need, but they also know they can still work in that community location. It's also great from a patient perspective. I mean think about it, if you're going to have something done, do you want someone who has done one in the last two years, or do you want someone who is doing them all the time?

Bonica: Absolutely.

Donovan: It's a real benefit I think for our patients and this community to have people who are the best trained and doing a lot of the appropriate things.

Bonica: You have an employed physician network, what does that mean?

Donovan: Yeah, essentially what that means is that almost the entire medical staff here is employed. And where we talked before about my experience in Manchester and we created a group medical on purpose. Here it really grew up out of necessity. If you think back to our payer mix, 75% government or no pay, it is hard to find physicians who can make a go in Private Practice anymore. The only physicians or medical groups that we have on staff here that are private anymore are Dermatology and Radiology. Every other specialty, all of Primary Care are all either employed by us, or leased by us from Dartmouth Hitchcock. So that really means that we have the financial responsibility to make those practices sustainable and it's part of the overall mission. But it does mean that we need to be very selective back to some of the earlier discussion. Selective about what we do, whether it makes sense clinically, whether it makes sense financially, and all those types of things. But it does mean also that all those provider groups are administratively integrated with us. There's a lot of benefits to that such as one common electronic medical record across all of our specialists, across all of our locations throughout the organizations. There's a real benefit to that. But that benefit comes with additional administrative complexities as well.

Bonica: Sure. Okay. Karen Clements who I interviewed from Dartmouth Hitchcock mentioned, one of the things she said that was special about Ascutney was your robust Inpatient Acute Rehabilitation Program. What is Inpatient Acute Rehabilitation and is this here in the hospital, or is it a separate facility?

Donovan: It's here in the hospital. Here at our main campus in Windsor, kind of a unique facility in that the physician practices, provider practices, the hospital, the outpatient therapy areas, the inpatient acute rehabilitation program are all in one big building that's all contiguous. It actually makes a very nice environment from the continuity of care because providers and staff can move around pretty easily. In a larger city that wouldn't be possible but in a smaller community like this, we can make that work. The inpatient acute rehabilitation facility is attached to this building, the main hospital building. It is a separate distinct part unit, a ten bed, Inpatient Acute Unit. Inpatient Acute Rehabilitation, it's really, it's a multi disciplinary intensive rehabilitative process or focus on getting people back to health. These are people that require quite intensive care so they need to meet a minimum standard of three hours of individual therapy per day. That means three hours of working one on one either with a Speech Therapist, Occupational Therapist, or Physical Therapist, to come back from probably some of the most challenging illnesses that you could think about. Things like major trauma. Things like traumatic brain injury, things like major strokes, those are the types of patients that we take care of in that program.

By Medicare payment standards again, very limited scope of a diagnosis that can be provided, that can be taken care of in that setting. And very restrictive, so we have to be very careful about who we take to make sure that one, that they're appropriate from a clinical perspective, and can I really do that therapy, and will they really benefit from it? And then two, do they meet those CMF criteria so that we can actually bill for it, get paid for it, and so the patient can have coverage for it? And it's an incredibly great program here. I mean it really probably is the jewel of our organization where things like Primary Care, and General Surgery, and we take care of people from Windsor and Woodstock for our Inpatient Acute Rehabilitation Program. We take care of people I say all the time from the Canadian border to the Massachusetts border. And truthfully even beyond that. We really are the regional resource for this type of program. Dartmouth Hitchcock does not have an Inpatient Acute Rehabilitation Program.

Bonica: Okay.

Donovan: The reason they don't have one is because we're do good at it. And they probably about one of the only academic medical centers you ever run across that doesn't have their own Inpatient Acute Rehabilitation Program, and that's because we serve that need. We are one of, there are only two Inpatient Acute Rehabilitation Programs in the state of Vermont. The other UVM, UVM Medical Center. We are the only one in Vermont that is what's called CARF Accredited. The committee on accreditation of rehab facilities, we are the only CARF accredited facility within a 100 mile radius of Dartmouth Hitchcock, of Lebanon. We really are the go to resource for this. And I talked before about Canada to Massachusets, but we've served patients from all 50 states. We routinely have people every summer who are from abroad, who unfortunately end up in this country as tourists, maybe have some kind of traumatic accident and end up here. And so we have connections really across the globe. It's pretty interesting for a small organization in a rural community like this, yeah.

Bonica: You also have a Skilled Nursing Facility. What's the difference between Rehab, and Skilled Nursing?

Donovan: Yes, I should say we did have a Skilled Nursing Facility.

Bonica: Oh okay.

Donovan: We closed our nursing facility about a year or so ago.

Bonica: Okay.

Donovan: We did that purposefully through our strategic planning process, but an answer to your question when we did have it, the difference was that the Skilled Nursing Facility we used it as more of a long term care facility. These were really people who this was their home, and-

Bonica: This was a Nursing Home?

Donovan: It was a Nursing Home.

Bonica: Okay.

Donovan: Type environment.

Bonica: Okay.

Donovan: Originally when that Nursing Home was opened in the 70's, it opened at 66 beds. Somewhere in the 80's maybe, they moved it down to 50 beds, but those 50 beds were in semi private rooms, so shared rooms. Prior to my arrival they had moved it to 25 private rooms. So 25 Nursing Home residents in 25 rooms, but financially the numbers just didn't work. We were losing about 2 million dollars per year.

Bonica: Oh.

Donovan: Just on those 25 Nursing Home beds. We partnered, there's a Private Nursing Home in town and we partnered with them so that they could focus more on the residential care and we would continue to provide the geriatric medical coverage. We closed our 25 beds, which actually from a facility perspective a decision was also made because it allowed us to retrofit that space into a brand new renovated Inpatient Acute Rehabilitation Program for us.

Bonica: Oh okay.

Donovan: It was an economical decision from two parts. But I guess an answer to your question, it was really more of a long term care Nursing Home type setting.

Bonica: Okay. Now your website said you have an Assisted Living Facility. Is that still also [crosstalk 00:48:48]

Donovan: We do have an Assisted Living Facility.

Bonica: Okay.

Donovan: As well.

Bonica: How does that fit into your overall strategy?

Donovan: Sure, so we have a 48 bed Assisted Living Facility on Main Street. Not on this campus. Three historic homes, we call it Historic Homes Rosemead. These are three very historic, huge mansion type homes that were in disrepair, had been run down. And so we bought them, we rehabbed them, and we turned them into Assisted Living. And there's three levels of care in there from very independent, to much less independent, and people can move along that continuum between the three homes, and it fits into our mission in many ways. I mean it fits into the mission that this is an ability of being the biggest organization in town, of helping support the town or renovating those three down trodden facilities right on Main Street, which were great buildings but had no use. It also helps from our mission of providing services to this community, and our mission is actually is to improve the lives of those we serve. We've purposefully made that much broader than just to provide healthcare or hospital services.

And it fits into the, now that these are seniors who have active, vibrant lives, living close to Main Street, they can walk around to restaurants and shops, and stores, and they can get easy transportation here to the hospitals to their Primary Care Provider. We send our providers down there to do home type visits, and the integration just really works from taking care of people in our community. And ensuring that the community is strong and people are healthy. It's been a really nice partnership that has been ongoing and I mean the challenges of that industry of Assisted Living can be tough at times as well, but again, we're helping people who are community members and helping them lead active healthy lives.

Bonica: And then finally, you have a Grant Foundation. What is the function of the Grant Foundation?

Donovan: Sure. That one's a little bit different. That is a separate 501C3, that is actually held under the hospital license, but under the hospital organization. But that, I think echos back to that mission that we just talked about. It goes back to improve the lives of those we serve. We see ourselves as needing to do much more than just provide traditional medical services within the four walls of a hospital. We do things like we run the Community Giving Room. That means that's people who don't have clothing, and they need to get clothing, so they go to our building down close to Main Street, to the Windsor Connection Resource Center, and they go to our Giving Room and they get clothing for their family. We provide free computers where people can get online and get access to the internet if they don't have computers in their house. We bring in Social Services Agencies from all over the place to come into the particular building, the Connection Resource Center and provide services to clients that might not be able to travel to get to them. We do a lot of things like that traditionally might be a little bit unique for a healthcare organization. We provide the school nurses. We help with afterschool programs. We engage in ways that are just a million different ways that we engage the local community to help improve their lives, which we do through a number of ways.

But one major way we do it is we seek grants to help support these types of activities. And whether it be smoking cessation, or whether it be when we do a ton of work in the schools with kids on substance abuse, and not smoking, and not abusing alcohol and drugs, and doing afterschool programs with them again so that they have a place that they can go rather then go hang out and get into some risky behavior. We are always seeking grants and cobbling together kind of ways to improve the community through that grant foundation. Right now, probably maybe half a million to 3/4 of a million dollars of grants that run through that, a couple of years ago we were all the way up to about a million dollars a year, which is ... I mean there's a 50 million dollar a year organization. I mean, that's a big number for us.

Bonica: That is, yeah.

Donovan: And we really make those resources go long way as well.

Bonica: You're the CEO of Mount Ascutney, what do you do for the hospital and the healthcenter? What is the day in the life of Kevin Donovan like?

Donovan: Sure. I don't know how exciting it is, but I do a little bit of everything. We talked before about being practice manager and about doing a little bit of everything. I mean part of the reason I was always attracted to healthcare and part of the reason I want to get back into the Community Hospital setting is because I do feel like one day I can do a little strategic planning, the next day I can do a little finance, the next day I can do a little operations, the next day I'll do a little marketing. I love the fact that I get to touch a lot of different things. I did see interestingly recently a survey that said 42% of any CEO's time is spent dealing with Human Resource issues.

Bonica: Okay.

Donovan: I would probably say it seems more like 70% of the time. And I think that's really because the job of a CEO in many ways is to interact with people whether they're internal customers, external customers. What's a given day like for me? Very seldom is there a day that I stay, spend all my time within the four walls of this institution. Typically, my day might start with maybe a meeting at Dartmouth Hitchcock or some kind of discussion with other community hospitals in the area where we're talking about partnership opportunities. Might make my way back here to the organization to have some internal meetings, I'm joking, but back to maybe about marketing meeting, or advertising, then might do a little recruitment. But then, head out to a rotary meeting, or to a community meeting thinking about how to engage people in town. Very different types of things that I do. Part of the reason I love it is because it is so different. I do feel like sometimes I'm running around like crazy. But I feel very fortunate to have the job I have because it's enjoyable, and I get to do a lot of different cool things.

Bonica: We were talking earlier a bit about achieving that level of autonomy.

Donovan: Yeah.

Bonica: What surprised you most when you became CEO?

Donovan: I think back to that conversation we had, the fact that by virtue of sitting in this seat, I think people expect a certain, or I k know people expect a certain level of performance and knowledge on a wide variety of issues. Back to that progressive autonomy and progressive responsibility that we discussed. I can remember being here very early, maybe my first week or so, sitting right in this office where you and I are sitting, and having to make a decision at this table with three other people. And often times decision aren't black and white and it was like okay, then they're all looking at you like well, what's the decision? And there's that comfort of being a Director or Vice President, or whatever where you feel like I can feel free to say, "Well I don't think that's going to work." But when the rubber meets the road, as CEO you got to make those decisions. And that's really freeing, and it's really gratifying, and it's also really scary at times. I think you get more comfortable with that as you are used to being in the roles. I've been a CEO for about five and a half years now. And I'm more comfortable with it. That being said, I don't think you don't completely ever get comfortable with it. But yeah. I think that's probably the biggest thing I remember.

The other thing I joke about this sometimes too, is it used to be I would write a memo and send it out to my colleagues and say, "Hey, give me some edits on this." And I'd get all kinds of edits and now sometimes I send it out and say, "Hey give me some edits on this," and you get back, "Looks good." It's like all of a sudden I'm a brilliant writer, because I'm a CEO. I joke with people about that.

Bonica: Okay.

Donovan: And I think we've developed a really good team here where we, sure I'm the CEO, but I mean we're all equals, we're all trying to do the same thing. We're all trying to provide good service to our community. And so, if someone can tell me how to do something better, or give me some guidance, I'm always looking for that. I think we've got a good environment here like that, but it does take some time to build trust within your team that they know that, that's an appropriate thing to do.

Bonica: Okay. You're actually an employee of Dartmouth Hitchcock now?

Donovan: Right.

Bonica: Was that part of the change that, when you did the affiliation?

Donovan: So to be ... Yes, part of the affiliation, the CEO of the affiliate organizations have to be employees of Mary Hitchcock Memorial Hospital. That's part of it. I am much like the physician staff we talked about before, I am leased, for lack of a better term, to Mount Ascutney Hospital as the CEO.

Bonica: Okay.

Donovan: I am responsible to the board of trustees of the Mount Ascutney Hospital as my primary supervisor employer, and so I always say I like that because I know who can fire me and I know who my master is, right?

Bonica: Right.

Donovan: And so my master is the local community to do what's right for the local community. But yes, I am a Dartmouth Hitchcock employee and that's a model that they put in place a number of years ago. They, and again, it's like medical staff thing, where the thought is you can attract people who might take a Dartmouth Hitchcock job, leased out in the local communities, because there's a draw to that, that you might not be able to get somebody in the local community on the organization's own doing that.

Bonica: And you serve a quarter of your time to supporting corporate level responsibilities at Dartmouth Hitchcock. What does that mean?

Donovan: I do. That's a good question. What does that mean? No. I often ask myself that. What that means is that I help support Dartmouth Hitchcock as they pursue other affiliations as they maximize the affiliate relationship. So remember I said we were in, kind of on the ground floor. There are a number of other affiliates since we've come on board. There are a number of other pending affiliate organizations that are out there. And so part of my role for that quarter time is helping Dartmouth Hitchcock understand what it's like when you sit out here in a community hospital, because they're used to sitting in an academic medical center, and thinking about the world from that perspective. So helping educate them on what it's like to sit over here in the community and think about services, also help them integrate.

And so prioritize. If we're going to integrate from a financial perspective, which is one of the goals that we're going to do. Where do we start? Do we start on doing the master investment program together? Are there opportunities to combine and buy out pension plans? It's really help them think about and implement where to focus the resources across the system. And so help coordinate some of those resources, so in that quarter of my time I don't think just about Mount Ascutney, but I think about the other affiliate organizations as well. And how can we all partner to get some benefit for all of us?

For me, it's a great opportunity because it allows me to again, just take on a new role, and do things that might be a little bit different then a traditional job, or traditional CEO role, and gives me some experience in both New Hampshire and Vermont, and experience in other organizations, and networking that just might not be there otherwise.

Bonica: It's great. You mentioned the board.

Donovan: Yes.

Bonica: And so, Mount Ascutney has it's own board?

Donovan: Yes, we do.

Bonica: I was going to ask you about that given the affiliation arrangement. You report to the board, can you tell me a little bit about how people come to be on the board, what is the function of the board, how is it constituted?

Donovan: Sure. Great questions. I talked before about our strategic plan 2011, I talked about some governance work. We have a lot of work to do on improving our governance processes as well. A number of years ago, and we've worked really hard on that. We have a governance sub committee of the board. And we want to make sure that we are best practice and progressive and doing all the right things. The board is a 15 member board. We are, I guess, back up, so we are a 501C3, not for profit, independent, maybe not independent, but Community Hospital. We have seated reserve powers to Dartmouth Hitchcock Health. What that means is that we are our own organization and our board makes decision and our board is entrusted with the resources of this organization to provide services to our community. But we've seated these reserve powers to Dartmouth Hitchcock and that they have certain powers that they can say, "Okay, I know the local board approved that, but we, from the systems perspective don't think that makes sense." What's a real life example of that? Well if we did something crazy, and we said we're going to start a Radiation Oncology Program and buy a Linear Accelerator, Dartmouth Hitchcock would be like, "Yeah, no you're not."

Bonica: Okay.

Donovan: And it's interesting because as we talk about this and we did a lot of discussion about this when we entered into the relationship. It's not like we make decisions in a vacuum and then we pass them up to Dartmouth Hitchcock and they check them yes or no. I mean it's really, it's the whole idea behind the affiliation is partnership and collaboration to improve services. At Dartmouth Hitchcock they have limited capacity. And you talked before about why not just send people up to Dartmouth Hitchcock, well because they have a limited number of resources and beds. What they're always looking to do is get people out, transfer them here, so that their beds, they can have availability to take sickest patients. And so back to those swing patients that we talked about before. And so any given day, there's probably, between our Inpatient Acute Program and our swing program, there are probably 27 patients here in beds that are one point in time or another had been at Dartmouth Hitchcock admitted and now have stepped down to Mount Ascutney. It's really all about partnership and so it's all about talking together about how to make it work. And yes, DHS reserve powers over us, but it's really collaborative in terms of how we execute those.

In terms of how we pick those 15 people, as part of your question. Five of the 15 by virtue of the affiliation are appointed by Dartmouth Hitchcock.

Bonica: Okay.

Donovan: And so these might be people who are physicians or administrative leaders at Dartmouth Hitchcock, or they might just be local people who Dartmouth Hitchcock has appointed to our board. A good example of this is, is there is someone who is on the Senior Leadership Team up at Dartmouth Hitchcock who has been a past town selectman here in Windsor. They appointed him to our board because he knows Dartmouth Hitchcock and he knows Windsor, so it's like what a perfect individual to fill that seat. The other ten members are people who are locally elected. Our local incoporators, or members of which we have 150 incorporators. Their primary role is to elect our locally elected ten board members. The role of the board is to govern, not manage the organization and the resources. And to make sure that we're meeting our mission and that the CEO and his or her executive team are doing the right things, and achieving good quality access and financial stability, and set patient satisfaction, and we take that charge very seriously. And to think about strategically where are we going in the future, not to think about micromanaging issues of okay, what's the employee benefit package going to be next year? But more to think globally about what are the healthcare needs of the community?

And you talked before about the grant foundation. Approving the community health needs assessment and then the implementation plan for how we're going to engage our community on things that we find in our community health needs assessment are important. On the last one it was mental, dental, and transportation. This one, it's about substance abuse, unfortunately, and mental, dental, and transportation again. And so how, ask global questions, like okay, so if behavioral health is an issue within our community, how are we thinking differently about meeting those people's needs? As opposed to getting into the weeds of how much is Dr. Jones paid and those types of things.

Bonica: Okay.

Donovan: That was a long winded answer.

Bonica: No that's a great answer, thank you. The big buzz in healthcare right now is population health.

Donovan: Yeah.

Bonica: How is Mount Ascutney Hospital contributing to the health of the community and engaging in population health?

Donovan: Sure. I think population is the buzz word, and I use it probably all the time too. But I think everything we've talked about today to me in many ways has a connection to population health. Whether it be Primary Care where we're really trying to keep people healthy and well, whether it be the Grant Foundation where we're really trying to engage people where the live and work as opposed to making them come to the healthcare facility or whether it be focusing on Post Acute Care where we're trying to take people out of an intensive environment and getting them back to living a good healthy, a life. I feel like all those things that we're doing are focused on population health. In terms of how someone might think traditionally what are we doing? I mean we're doing a lot of things.

We talked about patient center medical home where the highest designation NCQA medical home that we can be. We work very hard to make sure we have good quality programs and primary care. We are part of an ACO, an Accountable Care Organization on the state of Vermont. So Vermont's pretty unique in that it has an ACO that was created with all of the hospitals, so 14 hospitals came together and a number of physician groups and other providers created in ACO, and also Dartmouth Hitchcock as well. ACO One Care Vermont, and so we are an active participant in that. I'm on the board of One Care Vermont in my role, and so they're about ... And One Care Vermont has contracts, population health based risk contracts with Medicaid population, Medicare population, and Commercial Insured population. About 100,000 people, back to that magic 100,000 number interestingly enough. About 100,000 people in the state of Vermont are receiving their care through that population health vehicle of which we are an important part.

About 5,000, maybe 6,000 people who we take care of who have a primary care provider here are in one of those three populations, and they're care coordination, and their quality, and their finances are all part of that ACO. And so we've been focusing on being in on the ground floor of that too, knowing that partnership collaboration is key to the future of providing good, efficient, quality healthcare.

Bonica: The hospital recently received the American Hospital Association's Foster G. McGaw prize for excellence in community service. How is that connected to ... Is that connected to the Grant Foundation?

Donovan: It most definitely is. I mean that's the work that we do in the community and so we did win that award a couple of years ago, which I'm not sure the people in the community fully understand how big of an award that is. And how unique of an organization that we are. Because we have had a rich history of working collaboratively with our community, which is great. And we love to do that. But we won the Foster G. McGaw prize a number of years ago and it really identified us as the hospital that was best engaging its community on improving the health and wellness of its members. And I say to people to give them a little context, the year that we won the runner up was Mass General Hospital. And so, people always ... That generally tends to get people's attention.

Bonica: You got mine.

Donovan: Yes, exactly. And then I further the joke and say yes, I'm going to call the CEO of Mass General and give him a couple of pointers.

Bonica: They'd appreciate that I'm sure.

Donovan: I don't think he'd take my call. But anyways, it means that for a small organization, we do a lot. And they recently had, it was about a couple of months ago. We sent a couple of our board members to Chicago because they had the winners for the Foster G. McGaw prize all come together for the last ten years come together and talk about the new and innovative, exciting ways that we're serving our community so we can take best practices and roll them out across the broader field of healthcare. The organizations all in that room were all billion dollar, thousand bed hospital organizations. And then there's little old 35 bed Mount Ascutney Hospital right there. But you know, they learned as much from us as we learned from them and you know, again, I think it's the benefit of being in a small community where we see a need and we figure out how to stick some resources into that need, and you see people you know who have issues, and could use some help, and you figure out a way to help them out with it. Again, I think it's a little bit about what makes it special here. It's very connected to all that grant community type work that we do.

Bonica: Let's shift gears and talk specifically about leadership.

Donovan: Sure.

Bonica: What makes a good leader and specifically what kind of behaviors are characteristics?

Donovan: Yeah. I'm a big believer in servant leadership, or I'm a big believer in that there's nothing that's below me to do. I mean sure, I'm the CEO and that sounds good and believe me, I'm happy to be CEO. But that doesn't make me any different then anyone else and everyone here as I said before were just trying to do, achieve the same goal, the MA, which is to provide good patient care to people who live in our community. So, being in a small organization, I get much more involved in the day to day things, then someone who runs say, Dartmouth Hitchcock would at the CEO type level. And that's enjoyable to me. And I think that's just, it's about coming to work and getting done what needs to get done. And being humble about that. And really it's about building a good team. So as I think about my success, wherever I've been, I use Elliot as an example, I mean moving into that Senior Vice President of Clinical Operations role, that was achievable and doable for me, because I had really good department managers who really were dedicated and were really educated in their fields.

And so what was my role? My role was to help them get done what they needed to get done for the patients. My role wasn't to tell them what they needed to do in the lab or in radiology. My role was to help them think critically about what could be done better and how to get them the resources to produce a good outcome. And so I think that, that's really how I approach my role here too, is I'm a facilitator, and as I've moved through my career and most people see this, you become less of a doer and more of a facilitator as you progress. And so my role right now is facilitation, whether it's in the community or within this organization, and just to kind of produce a good outcome, whatever that be.

Bonica: What do you look for when hiring leaders and evaluating leaders?

Donovan: Yeah, those are great questions. Hiring leaders for me it is really about attitude. I'm the kind of guy, we spend a lot of time at work, and so I like to have a good time at work. And we work really hard. And we've talked about the fact that you have to have work life balance, and we spend a lot of time at work and so it's' got to be an enjoyable place. I want to make sure that I'm hiring people who have a good attitude. I'm hiring people who don't have an inflated, I guess sense of self worth in many ways. You know, I don't want to hire someone that there are tasks or issues that are below them, or people who think that they're better than other people. I mean I think you know, I mean it's one of the things I do love about this organization being small is that everybody goes to lunch and you know, you see a table of physicians sitting with the maintenance guy, sitting with the housekeepers, sitting with anesthesia, I mean it's a just a sense of community. And there's not a click kind of view that you get in other places.

As I looked at higher leaders, I'm just looking for people that obviously have the skills and experience but really for me, it's more about attitude and it's about emotional intelligence, and it's about whether you can get along with others and facilitate and see multiple sides of an issue. I've always thought that, that's a particular strength of mine in that if I'm facilitating or negotiating with a couple people I have the ability to see both sides of the story, and try to understand where there's maybe a common mid point. So I'd be looking for those same skills as I look to recruit people.

In terms of evaluation you know, obviously it's very important to make sure that the skills, so if you're a Chief Financial Officer, you got to make sure you do the bond refinancing correctly, and all those skills are important. But again, I want to make sure that you have good report with your other senior leaders and that you have good repore with the employees, and that you have good repore with the medical staff, and as we evaluate every year and we take performance evaluations here very seriously. As we do that we evaluate not just your hard skills, like the finance skills for a CFO, but also your people skills, and do things like 360's and we spend a lot of time here working on trust. We do work with an institute called the Reyna Institute, which is a management group that really they focus on trust in the work place.

Bonica: Okay.

Donovan: We think about trust of character, trust of capability, and trust of communication. And so, we rate ourselves on those three dimensions of trust individually, and then we rate ourselves as a team. We've been doing that for about three or four years now, and we're always looking for constant improvement on that. And actually, I have a report to go to the board next Monday, but we just did that and our scores for the third year have improved in those three dimensions of trust. And so you know, what does that mean? It means that if we trust each other to communicate, we trust each other that we're capable, and we trust that we're of good character, we can better function as a team to achieve the desired outcome. And so, from an evaluation perspective we think more then just the ... I mean obviously we think about the technical skills. But we think also about the human interaction skill as well.

Bonica: Did you find mentors in your earlier jobs? So how did they influence your thinking about leadership and about your career.

Donovan: Yeah, I've always tried to learn a lot from different people I've worked for or people that I've worked around. And some of these lessons I've learned have been positive lessons, and some of those lessons have been negative lessons. I've always tried to keep and eye out for what are the behaviors that I want to emulate some day? Or emulate right away, but what would I want to emulate and what would I not want to emulate? And I've definitely seen some behaviors from people I've worked for in the past that I haven't been happy with as an employee, and so now I take a conscious effort to make sure that I don't exhibit those same behaviors, and then I've seen things such as humbleness and I think of an example of Jim Varnum, who is a CEO of Mary Hitchcock Memorial Hospital for a long time.

I remember seeing him once when I was working up there. There was an off site employee parking lot and Jim parked in the offsite employee parking lot and he was sitting on the bus with the rest of us. And he was sitting next to someone who I don't know, and I was kind of watching him and he was having a conversation with that person. And he said, "Oh who are you and where do you work?" And she said, I don't know, I can't remember. But and then she asked him, "Well who are you? And where do you work?" And he said, "Oh, I'm Jim, I work in Administration." And I just remember thinking, here he is, normal guy like the rest of us, riding the bus, and he's Jim from Administration. He's not, you know, I'm the CEO and kiss my feet kind of thing. And that's just a lesson that's just stuck in my mind and I'll never forget.

And so, I've learned a lot of lessons from people as it relates to things, I mean my residency at North East Health Systems. I mean part of the reason I stayed there in Physician Practice Management is because Bob Fanning at the time who is a CEO, told me Kevin, right now I know you want to be hospital CEO but the hospital CEO, the future really needs to think about running Physician Practices and Provider Groups, and that's going to be a big part of the future. And he guided me very well on that. And I've been very fortunate to have people who have been looking out for me and guiding me in the right direction.

Bonica: How do you develop the leaders in your organization, and what are your expectations from mentorship within the organization, and how do you model this?

Donovan: Sure. I think developing leadership is all about giving people opportunity. And I feel fortunate that I've been given a lot of opportunity in my career. When I was at Dartmouth Hitchcock, those five years as the Director of Ambulatory Services for CHAD, I did a lot of other special projects as well. Kind of like now the way that I spend a quarter of my time doing some special type projects for Dartmouth Hitchcock, back then I used to do a lot of special projects as well. I've always been a big believer in that if they say, if somebody wants to, who wants to help with that? You raise your hand and say, "I'll help with that." Even if you don't know what you're doing per se, because that's how you get experience. I am looking for leaders in this organization and other places where I've worked who have that same kind of attitude. We talked about attitude before but people who are willing to say, "Yeah, I'll try that." And be honest, I haven't really done it before, but I'm willing to give that a shot. And I think effort is hugely important. I mean skill and having done things before is important. But just working hard and really doing your best, I think is probably 90% of getting something done appropriately. And so I'm looking for people who are willing to try new things.

I'm always amazed and it's happened to me a number of times that I've given people opportunity to take on special projects, or to enroll in special leadership programs. And you hear from people things like well, will I get more money? Or well, and I'm always amazed at that, because I guess I've just always been of the mind that you say yes, you do a good job, and then the rest of that follows. So I'm looking for people with that right, can do attitude in this organization. And we've got some really good ones. And I think, jumping topics a little bit, I think that's the other benefit of the affiliation with Dartmouth Hitchcock, is that in a small organization sometimes, you can be a little limited by the roles you can take on, but now being part of a bigger hole, maybe there's some exciting ways for people to move back and forth between the various entities that are affiliated with Dartmouth Hitchcock and stay within system, and get new experiences.

I think from an employee development perspective that's a real good opportunity for us, that we might not have had before.

Bonica: Last question. What advice do you have for people who are just starting a career in Healthcare Administration? What should they be doing to be successful, what should they be reading, listening to, who should they be talking to, what organizations should they be joining?

Donovan: Sure. Back to that theme we just talked about, I would say yes to every experience. If there's an opportunity to do a project, volunteer at a community agency, volunteer at a hospital, take on a project, sit in on a committee, any of that I think there's value to be learned from that. From a learner today, I would tell them to do that. We talked about George Washington before, so I'm a mentor with in the George Washington program, so they assign all of their students a mentor out in the community, and so there's a student there that I'm assigned to now, who we talk on the phone every month or two. And I'll give her guidance on projects and those types of things. And say the same thing to her. I say, "Just volunteer for everything. You're on break go to you local community hospital and say, is there something that needs to be done?" I, in my life have worked in a lot of different places in terms of when I was younger and did that, volunteered in the stock room of hospitals, or I was a candy striper believe it or not as a kid. And I didn't wear the old candy stripe outfits, but volunteer, because I think that you just learn a lot from just interacting in that environment if you want to be successful.

I guess in some way you say yes to every experience, in terms of what groups, at American College of Healthcare Executives, the MGMA, the American Hospital Association. Those are the three organizations that I've probably got the most from in my career. That's not to say that they're the only, but I mean if you're more financially oriented, the Healthcare Financial Management Association, the HFMA, become a member of those professional groups and societies. I know the students from your program come every year to the annual conference we put on. And I just think that's a great opportunity. Back to my being a resident, I think going to that conference, interacting with people at that level, I mean I would think that's just a great experience. I would take advantage of all of that they could do. In terms of journals and those types of things, Modern Healthcare is one that I've been reading for a long time. And just kind of having an affinity towards, but there's a ton of them out there. Health Leaders, and I mean a number of them and pretty easy to get your hands on. I would just say voraciously read all that stuff. Even if you don't think it's potentially of interest to what you're doing now. Because there's probably some lessons to be learned or things that are going to pop up in six months that you can say, "Oh, wow, okay. This really is important."

Just take advantage of every opportunity I guess is the bottom line on that one.

Bonica: Thank you so much for your time today.

Donovan: Sure, thank you so much, appreciated it.

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