Patsy Aprile Interview Transcript

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

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

Mark:    Welcome to the Forge, Patsy.

Patsy:    Thank you. Glad to be here.

Mark:    The University of New Hampshire is only about a 20-minute drive from Maine or the Maine border, so I'm pleased to finally have a guest from the Maine health care community on the podcast. Although you are in Maine it seems like your early career roots were actually in New Hampshire.

Patsy:    That's correct, yeah.

Mark:    You attended Colby-Sawyer College and earned a bachelor's degree in medical technology. Why did you go to Colby-Sawyer and how did you choose medical technology?

Patsy:    Actually, Colby-Sawyer my best friend in high school, her mom had gone there, and so she took us for a ride to Colby-Sawyer and at the end of the day I had applied to some private schools as well as public schools that I actually got more financial aid from the private school. That's how I came to have my education at Colby-Sawyer.

Mark:    Okay, why medical technology? Did you know you wanted to do something in healthcare when you went there?

Patsy:    Yeah, I know I wanted to do health care but at the time I had thought well, I'm not sure I want to be a nurse. This was a course that was offered at Colby-Sawyer and so I moved ahead with it.

Mark:    What is medical technology for folks who ...?

Patsy:    Medical technology is laboratory science, so it's the study of the chemistry of the body.

Mark:    You thought you wanted to do clinical science-

Patsy:    Correct.

Mark:    After you graduated what was your first job out of college?

Patsy:    My first job out of college was in the laboratory at Salem Hospital in Salem Mass, and when I worked there I was a generalist in all areas of the laboratory so I did blood bank, hematology, chemistry, microbiology and it was a fantastic job. I loved it.

Mark:    All right, when did you make the transition into leadership? When did you move out from that? Did you stay as a technician for a while? When did you ...?

Patsy:    I did. I worked in the laboratory for 19 years.

Mark:    At Salem?

Patsy:    No, I had moved at that point to New Hampshire and I was working at the Elliott hospital, and again I was a generalist and then there was a position open in the laboratory as a supervisor of Hematology. I applied for the position and I got it. Then after having that position for a while then I moved up to the ranks of laboratory manager, and then laboratory director. That kind of was my progression in the laboratory.

Mark:    This is all at the Elliot?

Patsy:    Yes, it was.

Mark:    Did you have any mentors that were encouraging you to move along in that in the laboratory realm and moving up as a leader?

Patsy:    Yup, when I was in the laboratory there was a gentleman who had been the director of the laboratory at the Elliot Hospital for over 30 years, and once I got the supervisor position he couldn't have been any more supportive of me as an emerging leader. He mentored me primarily in terms of finances as it related to the laboratory and what upper management would be looking for and thought in terms of reports and the up and downs of the reports, as well as the profit and loss statement. He was a great mentor to me, very, very supportive.

Mark:    It looks like in 2005 you moved on to be the executive director of clinical services at Catholic Medical Center.

Patsy:    I did.

Mark:    Tell us a little bit about that position and how did that come about.

Patsy:    All right. This was during the time when the two hospitals in the city of Manchester merged together, and so the Elliot Hospital and Catholic Medical Center merged together and after three years they actually de-merged. When they de-merged there was actually two positions one was the director of laboratory services at the Elliot Hospital that I was fortunate enough to have been offered the position. At the same time a Catholic Medical Center they came to me and said, "I'm going to offer you some progressive leadership here, and if you stay with us I'll make you the executive director of clinical services, so not only will you able to see the laboratory but we'll give you other areas," and to me that was such a great opportunity that I decided to move to Catholic Medical Center and take that position.

Mark:    Oh neat. What were you responsible for as the executive director of clinical services?

Patsy:    I always saw several of the outpatient areas including of course the laboratory but also the pharmacy, the wound center, the eye center, clinical nutrition, food services. Later, I also oversaw the start of a new program, which was the gastric bypass program.

Mark:    I think I misspoke, you actually took that job in 2002.

Patsy:    That's correct.

Mark:    Then you left in 2005 to go to Goodall. The position you took at Goodall was vice president of operations. That's correct. Tell us a little bit about that position.

Patsy:    Sure.

Mark:    Actually, first, what was Goodall Hospital? How big was it? Beds, employees.

Patsy:    Goodall Hospital had a little over 900 employees, I think it was 940 employees. It was a small hospital in terms of inpatient, it's an average daily census was only about 23, 25 at the time. I had a very good sized outpatient service line, and during the years that I was there it actually grew and moved into other geographic areas.

Mark:    Goodall was in Sanford, Maine. You left New Hampshire, left Manchester area moved east and north up to Maine. Now, as vice president of operations tell us a little bit about that job, what was that?

Patsy:    Sure, so that job was actually in large part and expansion of what I was doing at Catholic Medical Center. I oversaw, a lot of the same departments but then I also had additional new one, so I oversaw the pharmacy the laboratory, but then I also had the Health Information Department, the admissions department, some on the physician practices.

                I also had human resources and as that, that was a wonderful learning opportunity for me because not only was I able to help with all of what you think of in terms of human resources, which is the hiring and the disciplining and the orientation, but also I learned an awful lot about benefits and compensation. That was a great learning opportunity for me. I actually went on to actually also be the compliance officer for the organizations.

Mark:    What is that?

Patsy:    Compliance officer in essence is a mandated position by the centers for Medicare and Medicaid, and they're essentially looking for every organization that accepts funding from the government to make sure that all of their billing practices are handled in an ethical manner.

Mark:    How did your position as vice president of operations, how did you fit into the overall leadership structure? You're pretty close to the topic at point.

Patsy:    Sure.

Mark:    Who did you report to and-

Patsy:    In that role, I reported directly to the CEO. Below the CEO there were a few other vice presidents, so there was a vice president of elder care services, there was the chief financial officer, and then there was also the chief nursing officer, as well as myself. That's, again, we were pretty much all at the same level reporting directly to the CEO, but having different lines of responsibility.

Mark:    Okay, Goodall was kind of struggling at the time when you arrived on several fronts, and one of those was the noncompliance issues. Compliance issue that you talked about. How did you address that issue and the other issues that were going on at the time as a senior leader?

Patsy:    Well what I've come to learn is that, if you have the proper structure in place below you with people that are competent to do the jobs that are required, as well as simply being forthright in saying, "This is what I need from you." What I've found is more often than not if you just tell other leaders what is expected of them they're going to do it. After assessing for instance some of the, during the joint commission surveys they had found some deficiencies.

                Again, going out looking for leaders that are competent in particular areas, putting them in place and then being very specific is the joint commission standards for this particular area. I need you to make sure that every single one of these are met, not only met, but go above and beyond the required standards.

Mark:    Have Goodall filled its joint commission?

Patsy:    It did fill joint commission but it did have-

Mark:    Significant findings.

Patsy:    Some findings, correct. That was prior to the CEO coming on board. When she came on board, she began to put some great leaders as well as processes in place.

Mark:    We also oversaw four construction projects during your tenure as the VP of operations. Was this a new skill set for you had you done that before?

Patsy:    I had never done that before.

Mark:    What did you do and what was that experience like?

Patsy:    Again, we began to expand it to different geographic areas such as Waterboro Maine and Kennebunk Maine, and in order to grow we needed to have a facility that housed all the services that we were going to offer in those communities. Again, we're fortunate to have somebody that came to work for us that had a background in construction management. He reported directly to me and we began the process of saying working with an architect, working with engineers that helped us to work through the size of the building, what we would have in the new building and then talking to us from an operational perspective to pose questions to us to say, "Well talk to me about how you work? Where do you register your patients? How many of those patients are pre-registered? How many books do you need for registration?"

                Then they would help us say, "Okay, you have laboratory draws that you do every morning, that's your heavy time during the morning because people are fasting. How many draw stations do you need?" As they would pose these questions we began to develop the model of the facility that we wanted to build, and so was form around function and it was a fabulous sight.

                I really enjoyed it because I got to not only work through the process of developing a new building, but then I got into the design aspect which was what colors are you going to choose? What are the chairs going to look like? To me, quite frankly that was a lot of fun so I enjoyed that a lot.

Mark:    Sure. This is a good example of the kind of different skill set that's required, I think as you move up. You started out in the lab, you were trained as a medical technologist, and very knowledgeable about that field and so on. As you moved up you're moving into overseeing stuff that you aren't a expert.

Patsy:    Exactly.

Mark:    What was that experience like as you pencil this construction thing, as you got another example. I think a lot of managers, that's a grueling process for a lot of managers. What was it like for you to as you moved out of the areas, out of the laboratory and into the get your picture management, how did your management style? How did your leadership style change?

Patsy:    Well, in large part I had to realize that, particularly in the first one in two projects that I didn't have the background to feel confident that everything I was doing was right. My leadership definitely had to change and that I had to have faith in the person who reported to me.

                I also needed to make sure that I was following up and asking some questions that might seem naive to perhaps to some people, but you had to be humble and just get out there and ask those questions because the folks who knew how to do building projects, all they wanted to do was have a completed project that was done well. They were leading us all along the way, but I had to have faith in the process and the person who was reporting to me that I wasn't leaving anything out. A little nerve-wracking but nonetheless a positive learning experience all the way around.

Mark:    This would be true, I assume, for things like I mean you went into oversee and you had the pharmacy report doing all this, same kind of approach.

Patsy:    Yes and No. The difference what I found in some of the clinical areas was that I had such an intense background about process in the laboratory, just as an example. The physician would go in and order a lab test, the lab test gets put into the computer and then the phlebotomist goes draws the blood and then the blood comes back to the laboratory and you run the analysis on it and now you report it back. When I got to the pharmacy and the same with the respiratory and other departments like that, I learned that, "Okay, well the doc isn't necessarily ordering a blood test but he is ordering a medication that medication order has to be put into the computer. It needs to get down to the pharmacy." Now the pharmacist is pulling that medication and then getting that back to the floor.

                There were so many similar processes that I could easily relate to and help along versus constructional is totally new and different. Totally new and different.

Mark:    Have you found that to be true for other departments if you've picked up? If some would have, would lend themselves to the kind of process management that you had learned right from college. Some probably don't lend themselves work that way through construction.

Patsy:    Yeah, health information. Construction but even something like health information management, which is medical records. Really from the background that I had, you really don't go into the medical record at all. You really don't have much of a need to and so understanding those processes and from a regulatory perspective what should be in the medical record, which shouldn't be liability issues. It's very different, a lot to learn but the same leadership experiences in terms of making sure you have the right person in place, and then having faith in that they're going to work with you and fulfill all of the regulatory requirements that are needed.

Mark:    Sure. How do you know when you have the right person in place and how do you know you don't?

Patsy:    Oh, boy.

Mark:    Let's say, information management, you walk in, early on, you have experience now. You probably have a better sense. Early on, how are you trying to figure out my supervisor? I'm not saying what that person was or just how do you know?

Patsy:    You actually know from a few different areas. The first place you know is, when you have your regulatory reviews, so the joint commission comes in if there's big warning signs, they're going to find that during their inspection and it's going to come out in their report. That's one area that is like a slam dunk. There are some red flags there. Those are experts coming in-

Mark:    Exactly.

Patsy:    ... and looking at your area.

Mark:    Exactly.

Patsy:    The other area is that you get hints from sometimes hint, sometimes just over it. I need to talk to you from staff members or other leaders who feel like, for instance, perhaps somebody needs to meet with the leader of HIM, and it's just not getting back to them. No matter who you are if you're a leader and for an organization you're expected to work well with others, and they generally need you, they need their help got other person's help in getting the job done.

                You hear it either from another leader off from the staff, and the magnitude and the volume of concerns that are voiced are the two key, two things for you to take action.

Mark:    Talking about growth. Goodall was in a growth mode, it sounds like. Yet, in I guess around 2010 or so, you started looking at Goodall starting looking at merger talks. That seems counterintuitive to me, why would they be growing and then at the same time thinking, maybe we should merge.

Patsy:    Yeah, because a couple of things happened. First of all, our reimbursement change. I'll just give the example of orthopedic surgery. The reimbursement for orthopedic surgery again, just as an example, what the centers for Medicare and Medicaid were paying us went down. You have a decrease in reimbursement at the same time, we had a huge increase in bad debt and charity care.

                You have this triple effect of bad debt charity care and then decrease reimbursement. That's probably the biggest thing. The other thing that was concerning for Sanford was that, we were in a building that was aging. It was over 85 years old and it was so important that we retain services in Sanford, the local economy needed it, the patients in the area needed it.

                Yet, looking forward we knew that reimbursement was going down, charity care going up, and we were in a designation that we should have been what's referred to as a critical access hospital because of our average daily census. If we had that designation we would have had about five to $6 million more in reimbursement per year, and it would have totally changed our financial profit and loss statement.

                We were too close to the next closest hospital. We were denied that designation. With all the other competing forces, we said, "Well, we know we need to retain services here. Let's work with Maine health." It's in our geographic service area it has a phenomenal reputation, and what can we do to maintain the jobs that are in this community, and that's why we worked with Maine health.

Mark:    Can we back up just a second and talk about what is a critical access hospital? I've had a couple of other folks on but just folks who haven't listened to those other podcasts. If you could just very briefly explain what is that and what does that designation do? You much may have gone better reimbursements, how does that work?

Patsy:    Critical access hospital is defined as a hospital that has an average daily census of less than 26, and is located greater than 25 miles from the next closest hospital. As if you fulfill both of those then you can request a designation from the government as a critical access hospital, and as such you get increased reimbursement from the government for services rendered.

Mark:    That's where the five or six million additional.

Patsy:    Exactly.

Mark:    That would have made the difference to keep you afloat-

Patsy:    Night and day.

Mark:    ... in the hospital.

Patsy:    Night and day.

Mark:    What about the capital improvement you would have done you think, would have been enough?

Patsy:    You know what it wouldn't have been enough in the short term but in the long term if we could have waited out several years than we would have been able to have a, we'd be able to add to our capital funds. We certainly had a good endowment, so yeah.

Mark:    In 2011, the CEO of the hospital left and you were promoted to CEO by the board.

Patsy:    Correct.

Mark:    In a newspaper article that I read from the time it said that, you have said your primary focus would be to continue the merger discussions with Maine health. I'm guessing you probably knew that the CEO title was probably not a permanent fair.

Patsy:    It's true.

Mark:    How did your focus change when you became CEO? How did your day to day responsibilities change? What you thought about on a daily basis change?

Patsy:    Again, I did know that I would be in the merger process for about a two year period of time, and the two hospitals that we're merging. We had a parent organization Maine health and the two organizations where Southern Maine Medical Center in Biddeford and Goodall Hospital in Sanford, Maine. The CEO at Southern Maine Medical Center had been the CEO, I had been in the organization for over 35 years, and the CEO for over 25 years.

                He was extremely respectful, extremely supportive, and it just made perfect sense. That has emerged organization. He would be the CEO. My job in the interim role was to bring the merger forward, do everything in my power to make sure it came in a efficient smooth manner. During that two-year period of time the number of community forms that happened throughout the Sanford Springvale area was just phenomenal.

                My role changed greatly in terms of communication and getting out and talking to the community. I also began to have many staff forms, so every few months I would have forms with a content, one set of content that it was about an hour long, but I'd have about 11 of the same forms in three days, over and over and over again with the same message. Communication is so key in order for it to go smoothly, in order for any merger to go smoothly you have to communicate and communicate often and well, and I think I did that. That was the primary goal and actually [crosstalk 00:22:54].

Mark:    Your focus really shifted from an internal operations focus to a external communications, merger.

Patsy:    Exactly, yeah.

Mark:    I must have been a big learning process. What were the biggest things you learned in that time frame?

Patsy:    I think that thing that I learned the most is that when you are even though you're going through a merger and I know what the end state will be, as the CEO for that two-year period of time the number of sleepless nights was phenomenal, because as I mentioned a few times during this discussion, keeping services health care services in Sanford for the community was a key, and making sure that it was done and done well really as a CEO, it's on your shoulders. It's such an honor and such a privilege. Unless you take pay very close attention, it could go amiss. I would say what surprised me the most was the number of sleepless nights.

Mark:    How far away is Sanford from ... we're in Biddeford today. How far is Sanford from here?

Patsy:    It's about 24 miles.

Mark:    Is there inpatient capacity? You were saying you wanted to keep services in Sanford, so what services did you decide as an organization would remain there?

Patsy:    What we actually are going to answer a little bit differently, we've stopped in patient services in Sanford. We have the capacity here and Biddeford, but we actually retained just about everything else. We have all of the diagnostic imaging the MRI, CT, a full service emergency department. We have specialty practices such as OB orthopedics.

                We have a pain management center, we do colonoscopies out there, ambulatory surgery. We have a pain management center, so we actually pretty much everything-

Mark:    It's pretty robust.

Patsy:    Right, that we were doing before, rehab services, other than inpatient.

Mark:    Okay, so OB services would be outpatient well-baby kind of stuff.

Patsy:    Exactly.

Mark:    But deliveries are done here.

Patsy:    Exactly.

Mark:    Can you talk a bit about your relationship with the board.

Patsy:    Sure.

Mark:    What does a board do for a hospital? Then this must have been kind of a unique time to be a member of the board as you they were working through these as you were working with them through that process. Tell us a little bit about what does the board do normally and what was it like in this very kind of crucial time for their organization?

Patsy:    The board of trustees is essentially the oversight of the organization. We have 20 members of our board of trustees. We are made up of 40% physicians and the rest laypeople, and they oversee all of the- they're a fiduciary responsibility to make sure that we're handling our dollars appropriately. They oversee capital expenditures, but most importantly they oversee the quality of care of the organization.

Mark:    Is that today? You're talking about or when you were at Sanford?

Patsy:    Both.

Mark:    Okay, so there would have been separate boards at that time.

Patsy:    Sure. Actually, we went to a very unique process in that we each had a board of trustees of about 20 members each and we decided that we wanted to have one board of trustees. No, let me state that differently. That we wanted to have, we each would ... until we merged we would have separate boards of trustees, we would maintain that, but we would have the same board of trustees members. What we did was we each organization went out to its board of trustees and said, "Okay, we are going to have a holding company," and that holding company will be made up of 20 trustees.

                Those same 20 trustees will be the trustees of Southern Maine Medical Center and the trustees of Goodall hospital. We'll have three separate sets of minutes and so we went out to the board and said, "Who would like to stay and who would like to move on?" Actually, we were very fortunate just through self-selection and we wanted it to be equal representation, which was very different because Southern Maine Medical Center was about double the size of Goodall.

                We decided through the guidance of Maine health to have it be most functional, that we should have equal representation. We took 10 members from the Goodall board and 10 members from the Southern Maine Medical Center board to make a new 20 member board of trustees.

Mark:    Who was the board organized? Are there committees or functions that in either individual members of the board or groups of subgroups who's responsible for?

Patsy:    Yeah, so the board of trustees, each trustee is requested to be on at least one committee. We have a board of trustees meeting, they meet once a month but we also have committee meetings. We have a finance committee meeting, oversees obviously all of the finances as it relates to the organization. We have a governance committee that looks at our governance structure and our bylaws, and then we have a compensation committee that oversees the compensation of the executives. Then lastly, we have a quality committee of the board that looks at all of our quality scores, all of our quality indicators, and discusses improvements for quality.

Mark:    During that merger process what were they doing? What were the board members doing in terms of what kind of decisions were brought to the board, what kind of decisions were left to their respective CEOs? I might be reaching back a bit.

Patsy:    During the merger process, the board really had its ... The primary responsibility at the time was due diligence. In other words if the two entities were going to merge together. They wanted to make sure that the quality scores were such that each other would not damage each other, and in fact we each had great quality scores so that one was pretty easy to get past. We needed to understand the financial challenges of each organization and whatever those challenges were to request a plan to be put in place, to overcome those challenges. And then from a governance perspective, the governance committee had some great work to do in terms of again looking at our organization bylaws and updating them for this new Southern Maine healthcare that was being formed.

Mark:    As the leader on the Goodall side, what were the main concerns of the people from Goodall, from the staff, are kind of going into it? How did you, you said you had a lot of meetings with them, what were their concerns and how did you work with them?

Patsy:    The primary concern was that, it might got to have a job.

Mark:    Sure, that's it.

Patsy:    Am I going to getting a job, that was by far the number one question the, number two question was if I'm going to have a job is it the same job and what site will it be at. Some of the decisions that needed to be made took time and a lot of thought, and so the struggle was not being able to answer the questions. It wasn't for lack of not wanting to answer it but the answers weren't there yet. We had to work through thoughtful processes.

                I have to say that overall though, we were very fortunate because very, very few jobs were lost. Most people self-selected for instance, director of rehab, director of pharmacy. There were several positions that people said, "Well, there's two of us, we only need one. I'll go look for a job elsewhere." That just happened over and over again. Like I say, we really our goal was to have no layoffs and so because it was a two-year process, it worked out that we were actually able to do that.

Mark:    Give a lot of time for people.

Patsy:    Exactly.

Mark:    See where the redundancies were themselves.

Patsy:    Exactly, yeah.

Mark:    What about culture? It sounds like both of the organizations were performing well, so it doesn't sound like there was a problem at even place but every organization is different. Even high performing organizations that have different cultures. What was it about? What was that like?

Patsy:    I have to say that because we're now a melded organization and culture takes at least three to five years to get there, we've only been merged for two years. The changing culture is evolving and the culture for Southern Maine healthcare our tagline is, excellence always. Everything we do, excellence always. To us, to have high quality scores is really important. We want to have high patient safety, all of that. We do very well in those areas but we want to do better and exceed. Again, this is a culture that's evolving and I think it was difficult for both sides.

                It's just because like you say culture is so important and one was smaller one was bigger and again-

Mark:    Maybe more intimacy in the Sanford. You could know everybody and wrapping arms around little more.

Patsy:    Exactly, yeah.

Mark:    It's a little bigger.

Patsy:    Exactly.

Mark:    Those folks we're having to come join into a larger organization where maybe not as intimate.

Patsy:    Honestly, from the, other than the inpatient piece a lot has really stayed as is the Sanford camp.

Mark:    I see, okay. The culture is still there.

Patsy:    Exactly. Exactly.

Mark:    Following the merger you were appointed as the senior vice president and chief operating officer for Southern Maine healthcare, the physician that you currently hold. Let me ask this. What is the relationship between Southern Maine health care and Maine health? How does being part of Maine health help Southern Maine healthcare?

Patsy:    Maine health is our parent organization. Maine health actually has several hospitals below it, Maine Medical Center is one pen bay, Lincoln healthcare. There's several and where another one of the hospitals. What Maine health does for us is that they provide us depth in terms of working with the big peers, such as Anthem, Cigna, they can go out to the payers and say, "Okay, I want to work on reimbursement and you don't have all these hospitals underneath us," and so they essentially afford us buying power that we didn't have in the past.

                They also have a slate of legal counsel, and being able to tap into attorneys quite frankly on a daily basis, some that specialize in compliance. Others that specialize in human resources, some in pension that you can reach out to these different attorneys is a benefit that quite frankly we didn't have in the past.

                Though, one thing that's different is now having a parent organization is that Maine health has its own board of trustees. Now, we want our board approves whether it'd be big financial purchases, let's say, we're going to build a new medical office building the board of trustees at Maine health, now has to approve that also. We do have another layer and from a timing perspective, it takes a little bit longer but again we have the depth and breadth of Maine health which is a huge benefit overall.

Mark:    One more question about the board, I forgot to ask you earlier when you mentioned 40% of the membership of the board are physicians, and then the rest are lay members of the community. Why the high level of high concentration of physician members?

Patsy:    Again, it's a governance philosophy here at Southern Maine healthcare, you generally don't see that percentage of physicians on a board of trustees. The reason why we have that as part of our culture is that, as we go to the board, and we talk about and requests such things such as capital expenditures. For different equipment that we might need to purchase, physicians have a very keen eye on what should and should not be purchased and they help prioritize.

                They are very helpful in that regard but I would say the number one reason to have that percentage of providers on the board is because of their in-depth knowledge on quality, and quality of care. Again, as we strive for excellence always, what physicians can bring to the board of trustees is just phenomenal.

Mark:    Okay, great. The Maine healthcare has 20 locations in six cities, is that correct?

Patsy:    That's correct.

Mark:    What would you consider your flagship facilities? Then what are all the other locations and what's going on generally?

Patsy:    Biddeford and Sanford are clearly the two flagships, cities that we're in, but we also have four we're located in four different buildings in Kennebunk, and we're also in a few different buildings in Saco. I would say those are our primary buildings that we're in and geographic regions.

Mark:    Do you have eldercare?

Patsy:    We do.

Mark:    What is that?

Patsy:    Okay, eldercare. We actually have a 74 bed nursing home in Sanford and those are dually license for skilled beds and nursing home beds. Above and beyond that in Sanford we also have a 14 bed residential care facility and we also have a 24 bed dementia care facility. Then offsite, off of the hospital campus, we also have another 32 bed residential care facility. We actually have quite a few elder care beds, they're all in Sanford.

                When we go out to the community in Sanford, what we hear over and over again is, "You're going to retain our eldercare?" The aging community wants to be assured that their loved ones will have a place to go locally as they age. It's a great service line to have and it's a whole specialty all them in itself.

Mark:    It is. It literally is a different licensure.

Patsy:    Whole separate cam model, exactly.

Mark:    How does that fit into? It's a different care model. Why should it be part of a acute care system?

Patsy:    Sure. Well eldercare, when we think of health care in terms of transitions of care. We are paying much closer attention to the transition for instance of our patient from the emergency room to our patient physician office. We want to make sure that that transition happens well, and it doesn't fall through the cracks. What we find from an eldercare perspective is that, as a patient ages and they might need to be seen in acute care facility.

                Many elder care need to transition to an eldercare facility, so again, it's just another means for transitioning the patient to the most appropriate level of care. We also have patients that are having hip and knee surgeries, and need to have skills care afterwards. To have skilled care is part of our model again, provides us a place for our patients that are being discharged from inpatient care, transitioning to a skilled level care.

Mark:    Okay, so following the merger, again became the senior vice president and chief operating officer for Southern Maine healthcare. How is that position different than your previous position prior to becoming CEO at Goodall? Is it roughly the same responsibilities or do you have a broader scope?

Patsy:    The scope is broader in terms of geographic region which actually is a challenge, because as I mentioned we're in so many different geographic regions, staff and the community want to know who you are when you're in senior leadership. They want to be able to know your face and they want to be able to know that you're actively involved in the community.

                Just having the geographic scope definitely provides a challenge, so that you need to ask yourself, where do I need to be today and where do I need to be visible. To me, that's the greatest challenge I have in this position.

Mark:    How important is it to be visible and what do you mean by that?

Patsy:    Well from an employee engagement perspective, so from an employee perspective it's extremely important to be visible. Improved engagement scores for employees, so employee engagement improved scores show that employees will stay with the organization longer, and turnover is such a big issue for organizations that being visible is one way to help ensure that our employees will be here for the long term. To me, it's extremely important.

Mark:    One of the things that you've implemented since coming on board as the COO is a operational excellence program throughout the Southern Maine Healthcare System. What is this program?

Patsy:    All right, so operational excellence is really our way of managing, it's a new way of managing the organization. It's referred to as lean daily management, and it starts the day where we come into a huddle and we look at key performance indicators every day, there's about 30 people that come into a room and we essentially look at today's census. What's the number of patients that we anticipate discharging. What was our ED volume yesterday. How many patients do we have as borders, which means that they are looking for placement elsewhere.

Mark:    Somebody psych or something like that.

Patsy:    Exactly, yeah.

Mark:    We've talked about that a few times.

Patsy:    Yeah, how many are psych patients, how many are not psych patients but this is not the right-

Mark:    How the level of care?

Patsy:    This is not the right level of care for them and they need to be transitioned elsewhere. We start the day that way and then we go on to what we refer to as a daily gamba walk, which is we go to the different units and we essentially meet up with staff who present key performance indicators to us.

Mark:    Is this all 30 members of this team or just a subset?

Patsy:    We actually have nine walks a day and we have two liters per day going to each one of those walks. We visit every department of the hospital every single day.

Mark:    You split out?

Patsy:    We split up.

Mark:    It's not whole-

Patsy:    There's two people per walk and there's about 12 walks, 12 places we stopped on each walk.

Mark:    Do you alternate?

Patsy:    Yeah, we actually sign up for this and leadership the vice presidents have to do at least two walks a week. Managers have to do at least three walks a month, and our directors have to do at least four walks a month. We sign up for these walks and we do them every single day.

Mark:    It's not you doing visiting a particular specific area every time, it's different senior leaders visiting different places, so you're always getting different nights.

Patsy:    Exactly, so I might be for instance today I did a walk in Biddeford, tomorrow I might do a walk in Kennebunk, the next day and I might do a walk in Saco, so I make sure that I do a different walks, so I have that visibility and get around.

Mark:    What's the benefit of doing this?

Patsy:    The benefit of doing this is one, visibility but far beyond that the benefit is that when we visit the different units, staff members come up with what we're referred to as key performance indicators. They are monitoring issues in their departments that they feel as staff members they can improve upon. For instance, how quiet is the floor for other patient? Can the patient sleep at night? They actually might ask the patients go in and say, "Was it quiet enough for you?" Then they report on that the next day to us.

                One unit looked at, it was an outpatient unit, and they looked at the number of handicapped spots that were available for their patients to park, because these were cardiac patients, and what they were learning was that the patients there wasn't enough handicap spots and they had to walk a long way. This was an issue for that particular, and other unit looked at the number of no show patients and said to themselves, "We have an awful high no show rate, why?" Again, now the other patients can't take that time because it's blocked for this person who didn't show up. As they begin to monitor themselves they begin to drill down and put new processes in place to overcome the shortcomings.

Mark:    You said these are measures that they choose?

Patsy:    The staff chooses them themselves.

Mark:    You're provided them some sort of training to come up with this.

Patsy:    Yeah, it's a three-day training just for two staff members on a particular unit. They go out in real time and go back to their unit and train everybody else, and then within it's a three-day training in with them on the fourth day we start right in. It took us a year and a half to do all of the departments, but they're all done and we've been doing it for a year and a half now and it's worked very, very well.

Mark:    That's neat. You called The Lean Daily Management and a Daily Gamba Walk. What about six sigmas sort of stuff? I know you had a lab background, so that's got to appeal to your prior-

Patsy:    This is all part of the same if you will school of thought. This is what we have implemented, but we're actually using a data cam model of how you manage daily.

Mark:    What is Fedic?

Patsy:    Fedicare is an organization that is well known for its lean daily management tools, and they actually train organizations throughout the United States to do this.

Mark:    Let's shift gears now and talk specifically about leadership. How would you define your leadership philosophy?

Patsy:    My leadership philosophy is to be a mentor and to be an educator and to be a communicator, because again I had mentioned earlier that what I found in my career is that, if you just tell staff or leaders what is expected of them they want to do the right thing. If you can communicate with them, educate them, and then mentor them all along the way you have a very successful leader at the end of the day. That's my leadership philosophy.

Mark:    All right, what are the characteristics and behaviors of a good leader and how do you aspire to those yourself?

Patsy:    I believe in leading by example and also of giving yourself wholeheartedly to your work while you're at work, but there has to be some work life balance because if there isn't, you can crash and burn. In my earlier years, I used to give of myself at work and at home to work, and I think a lot of leaders learned that lesson the hard way and with time I've learned while I'm here I'm going to give a 150% but I have to have some balance in order to be able to come back the next day.

Mark:    I was going to ask you about work life balance, so let me ask you that now. I've been reading Sheryl Sandberg's book 'Lean In' and health management policy the department I teach in about 80% of our students are young women. Obviously, one of the issues that Sandberg raises is this issue of work life balance. If you're married you have kids and you've worked your way up into senior management. How did you make all that work? You're saying some of it was you had to learn to do that.

Patsy:    Yeah, exactly, but I would say that I'm very fortunate and that I have a very supportive environment at home. There are times when you have to work a lot of hours, but it's also not unusual to have to work a lot of evenings. I'm someone who's at work at 6:30 in the morning and once or twice a week it's not unusual not to get home till 9:00 or 10:00 at night. My husband has always and my kids at the time, they're older now but we're always supportive of me ra-ra mom.

Mark:    That's awesome.

Patsy:    I've been fortunate in that manner.

Mark:    Can you give an example of a difficult leadership lesson that you had to learn maybe the hard way?

Patsy:    I would say a leadership lesson that I've learned and I have to say it's been more than once, and that is when you realize and recognize that there is somebody in a position that isn't doing the job that they should be doing. If you leave them in that position too long, not only do you do a disservice to that individual but at that same time you're doing a disservice to the organization.

                I, as an individual, always want to give, I want to mentor and educate and help that whatever person it is that isn't working out, I want to help them along to get there. My lesson learned has been that there have been times and it's been more than once when I've left somebody in the position too long, which you don't want to cut it off too soon but-

Mark:    That's not fair.

Patsy:    ... keeping it on too long it's not doing anybody any good.

Mark:    What do you look for when you're hiring leaders? You're a leader of leaders, you're probably the people that you are most often hiring or if I'm going to be managers and supervisors, but you're not hiring a lot of front line people most likely. What are you looking for when you're hiring leaders and evaluating them?

Patsy:    Oh, I've come to definitely use behavior based interviewing as a skill when interviewing others. When I do that, you ask questions, this one probably not as much now, but who do you want to be doing in five years from now? It's amazing what some people will do to answer that question. "Oh well, I want to move away," or, "I think I'm going to change careers," and easy lesson to learn is just ask that question because people would be very truthful with you, and that's probably not the person that you want to eye at. Above and beyond that really looking for fit in terms of personality, leadership style.

                When you asked behavior based questions about somebody's personality in terms of what do you look like when you're angry. If somebody comes out right and says to me, "I do have a history of kind of throwing things and maybe slamming my hand." "Oh great. I'm glad that person disclosed that but that says to me, that's probably not the individual that I need in my organization.

Mark:    What about evaluating leaders? You've got your team. What are you looking for, say, "You're doing a good job." Clearly the technical competence I would assume, what are the important things that they are doing on a day to day basis that you're looking for?

Patsy:    I'm looking for a leader to be forthright in their challenges and in their ability to get a job done. In other words, if I'm given somebody a task I want the task to be done and done in a timely manner and what I have found a few times is that for one reason or another that leader might come back to me and say, "Oh, I'm going to get that done tomorrow." I want somebody to be really forthright and say to me, "I can't get that done tomorrow. In fact, I need a week to get this done." "That's not an issue and if it is, then I'd let that person know." I would say when evaluating somebody I now look for, is that person being forthright with me in their own ability and in their communication style with me because it's a challenge in the role that I'm in.

                My boss, the CEO, is oftentimes looking for some really tight timelines and if I'm asking somebody and they're not being forthright with me, then it's quite a challenge for me to be able to get that job done. To me, that's one of the number one significant challenges that I face when talking to a leader.

Mark:    Any special challenges when evaluating clinical leaders?

Patsy:    Not particularly because, again, we have the tools of the Joint Commission or whatever a particular accrediting organization and almost every clinical area has a medical director that oversees it clinically. Again, from a clinical perspective there's always someone else that's going to either buffer or help get us to where we need to be clinically.

Mark:    We've talked a little bit about organizational culture when we were talking about the merger, but what do you think it's important and how do you go about trying to shape organizational culture? What aspects of organizational culture are particularly important to you?

Patsy:    Again, our tagline is excellence always and with that, we want to live it every day that we come to work and so that begins at orientation. When we hire new employees, we essentially go through a PowerPoint that talks about this is what's expected of you from a behavior perspective. These are our values and each day when you interact with your coworkers, we want you to interact in an appropriate manner to be respectful of your coworkers to work well with other people.

                From a culture perspective it actually starts the minute the employee gets in the door. Then, for the employees that have been here for some time on an annual basis, we actually have our employees during the evaluation process, we actually have them sign the values, the organizational values to say, "This is a reminder," and then again as always if somebody is deviating from expected behavior then we counsel them.

Mark:    You mentioned you had a mentor early in your career when you were working in a lab. Have you had other folks helping you out along the way?

Patsy:    I have, yeah.

Mark:    What do they do for you and how did they help you?

Patsy:    I have to say, there's a woman named Darlene Stromstad, she was a CEO at Goodall Hospital. She not only was a great leader just in terms of setting the stage for, in this role this is what's expected from a community perspective, but she would role model that. Darlene was one that was part of the Chamber of Commerce. She would lead event, she was the Go Red Chairperson for the American Heart Association.

                She was a great role model but also one who actually set the expectation. She went to the management team and would say, "Listen, as managers and directors here at this organization you are expected to do at least three community activities per year. It could be a parade, it could be helping at the YMCA. You are expected to do that and live those values if you will." Above and beyond that though she was a member of the American College of Healthcare Executives. She was the region for the state of Maine several years ago but then she actually became a governor for the American College of Healthcare Executives, and she pretty much lived and breathed their values which was to mentor others.

                She was not only a great role model as a CEO but also as a community citizen and then role modeling the values of the American College of Healthcare Executives.

Mark:    You watch what she did, you've tried to emulate that.

Patsy:    Exactly, yeah.

Mark:    How do you go about developing leaders from within your organization? How important is it to develop leaders internally as opposed to say reach out and bring in external leaders?

Patsy:    Yeah, and again in case they move on or God forbid something happened to them, we want to have a leader who could step in in their place. Our directors do look for somebody in their department and they mentor them as future leaders.

                We also from a department of education perspective here at Southern Maine Healthcare have ongoing leadership classes that we ask all of our leaders to take, and each year the classes are different and they change. Last year, we had some that the titles were having difficult discussions with your employees. Another one was how to do behavior based interviewing, and another one was constructive criticism. Those are just examples of some of the leadership training that folks here at Southern Maine Healthcare have to go through.

Mark:    We talked a minute ago about work life balance and so forth, and I was talking about Sheryl Sandberg. Can you tell me a little about your experience being a woman in the various leadership roles and now as an executive, do you believe your experience would have been different? Had you had the same positions as a man? If so, how have you dealt with that? Has it changed over your career?

Patsy:    Well oddly enough, I have to say that it's not something that I think about, it just isn't. In my role as a leader, I've been very fortunate that I have to say most of my experiences have been really quite positive. I just figure if you exude positive ness it comes back at you. The man female thing just does not come up and hasn't come up much in my career at all.

Mark:    Let me jump not a talk. You mentioned your former CEO and mentor who was very involved in ACHE and you are actually the ACHE regent for Maine. We've had a number of guests on the podcast who are ACHE members, can you briefly talk about ACHE and how did you become involved in it?

Patsy:    ACHE is the American College of Healthcare Executives, its primary focus is on educating leaders. Once you become a member, after three years, you can actually sit for a certification exam to become a fellow of the American College of Healthcare Executives. It actually pushes you to a whole new level from a senior leadership ... Oh, I should just say from a healthcare leadership perspective throughout the United States. It's an honor and a privilege to be able to have that designation.

Mark:    You are of the regent. What does the regent do in general and specifically what are you doing as the regent in Maine?

Patsy:    Sure, so the regent for the state of Maine I essentially represent the American College of Healthcare Executives at the local level, and so whatever is going on nationally I actually let the folks in Maine know about what's going on nationally. I'm also based on being the regent, I'm also on the local chapter of the American College of Healthcare Executives.

                It just so happens that the local chapter here is referred to as the Northern New England Healthcare Executives. What we do is essentially host educational sessions. We also provide networking opportunities. Then lastly, I sent correspondence to members, let them know about scholarships that might be available, all tuition waivers that type of thing.

Mark:    I worked with again with the undergraduate program in health management, and we're always trying to convince these young folks that they should join. What would you tell my undergrads, why they should join now rather than waiting till they're advanced in their career?

Patsy:    Sure. The American College of Healthcare Executives just offers so much. The lesson learned here is the sooner you can gain the benefits from the American College, the sooner the better. Educational opportunities, networking opportunities, resume building opportunities, but also the college has a very comprehensive ethical standards policy. As you become a healthcare leader, you can refer to those ethical standards and actually they set the groundwork for all of the work that you do as a healthcare leader.

                Then lastly, mentoring is a big part of the values of the American College of Healthcare Executive. As you meet members of the college, you can reach out to them for mentoring purposes. In fact, it isn't encouraged. There's a great benefit.

Mark:    In conclusion, what advice would you have for students who are considering a career in culture administration? What training, jobs, experience should they be seeking out?

Patsy:    Healthcare management, it's actually tough work and in large part the reason why it's tough work is because most healthcare facilities are open 24 hours a day, seven days a week, 365 days a year but it also is extremely rewarding. The reason why it's so rewarding is that you see patients at their most vulnerable times in life.

                You see patients during the joy of birth, but you also see them during the sadness of death. Quality has become such a focus in healthcare and every organization wants to provide the highest quality at every point along the patient's visit. Whether you're an undergraduate or a graduate student being in healthcare management it's clearly a very, very rewarding field to go into.

                From a training perspective, again as long as you have an undergraduate degree and you work towards I would always say in if you go into healthcare you should probably move on to have a graduate degree.

Mark:    MHA or MPH or, what do you recommend?

Patsy:    It could be, generally it's one of three master of public health policy and MBA, or master of healthcare.

Mark:    Masterful of healthcare administration.

Patsy:    Master of healthcare administration generally it's one of those three and not necessarily in any particular order, to be honest with you. Clearly to get into a director's role now, and actually even offices and practices were looking generally for someone with a master's degree. I would say, "Keep going. Don't stop in the quest because it's a great field to go into."

Mark:    Great. Well, thank you so much for your time today. I appreciate all the great information you shared.

Patsy:    You're welcome. Thank you very much.

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