Episode 312- Healthcare Gets Better When Leaders Invest In People. with Quint Studer

Healthcare keeps getting labeled “more complex,” but that line can become a trap. When leaders accept it as truth, they stop simplifying, stop teaching, and stop making clear decisions. I sat down with Quint Studer to talk about what’s actually breaking healthcare operations and hospital finances right now and what we can do that’s practical, not performative.

Quint connects the dots between Medicare Advantage denials, the ballooning cost of fighting those denials, and the painful reality of physician enterprise losses. We talk about why independent private practice has become financially unsustainable for many doctors, why employment is now the default, and why health systems need to manage medical groups as a core part of the enterprise, not a side business with its own scoreboard. Along the way, we dig into vertical silos, matrix confusion, and the leadership blind spot that shows up when people manage isolated expense lines without understanding cause and effect.

Then we shift to the human engine of performance: experience, culture, and skill building. Quint makes a strong case that healthcare is underinvesting in leadership development and workforce training, even while spending heavily on new buildings and technology. He lays out a more effective approach he calls precision development, and he challenges us to treat physicians and other high performers with the kind of support other industries provide, not just a paycheck and a productivity target. If you care about healthcare leadership, patient experience, physician burnout, and building a culture that holds up under pressure, this conversation will give you plenty to wrestle with.

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Transcript

Welcome And Mission

SPEAKER_01 0:00

Welcome to this episode of the Healthcare Bridge, where we explore the vital connections shaping our healthcare landscape. Hosted by Nathan Kaufman, Managing Director of Kaufman Strategic Advisors, the Healthcare Bridge is dedicated to improving healthcare delivery by strengthening the strategic and financial performance of healthcare providers. As part of the Common Bridge family, our focus is on fostering insightful, nonpartisan conversations that drive meaningful change in the healthcare industry. We invite you to join us as we build bridges toward a healthier future. The show is available on Substack, YouTube, and your favorite podcast platforms. Search for the Common Bridge and stay connected.

Meeting Quinn Studer

SPEAKER_02 0:36

This is Nate Kaufman with the Healthcare Bridge, part of the Common Bridge family of podcasts. Our goal is to have an unscripted, brutally honest conversation with key thought leaders in healthcare. And I'm excited today to have Quinn Studer as our guest. Now, a little background about Quint. Maybe 30, 35 years ago, I was asked to present at this retreat for a hospital, Baptist Hospital, Pensacola. And I got up with my little transparencies and I put all these silly things down about strategy and marketing. And everybody listened and they clapped. And after that, the CEO, Al Stubblefield, I believe was his name, gets up and introduces his new executive vice president of operations, Quint Studer. And unlike me, who was this stiff at the podium, Quint is walking around the audience telling stories about heroes in healthcare and how lives were being saved and people were crying. And I'm thinking, who the heck is this guy? And what is he doing? Well, Quint has become probably the key thought leader on healthcare leadership, talent development, and performance. In addition, he's an entrepreneur, an author, and a philanthropist. Welcome Quint to our podcast.

SPEAKER_03 1:50

Nate, um, I still remember that. I remember exactly where it was, and it was in um Alabama. And um we're so lucky because when I got there, because to meet you, can you know since then you've always been to me one of my thought leaders. In fact, I tell people, I take your post and I send them to CEOs on a regular basis to read. Because sometimes CEOs are just so busy where they're hearing things from one perspective. And sometimes they sometimes even me don't like to hear things that I might not agree with or might challenge me a little bit. So you and of course your your good friend, Jamie Orlikoff. I mean, we sort of were a little bit of a threesome, and um I love you. I love everything about what you do and have done and continue to make a difference.

SPEAKER_02 2:37

I appreciate that. But for our audience, why don't you give us a little background, your origin story, how you got into this and uh where you are today?

Purpose, Doability, And A Nurse

SPEAKER_03 2:45

Yeah, well, I got into it. Um and I can go way too long, but I'm gonna bring up one topic that I think is really interesting. Um, I was a special ed vocational ed teacher for 10 years. So I worked with special need adults helping them to learn job skills. You might say, well, what does that have to do with this? Well, what it has to do with this is breaking complex things into doable steps. And I think that's the nature of teaching. Because in healthcare, I just got off the call with a big system today, and I had to hear this, nothing's ever been more complex. And I say I've been hearing this for like 40 years. Um nothing's never been worse. I've been hearing this for 40 years. Um, you know, the perfect storm. Well, I've been hearing this for 30 years since George Clooney's movie. So I think it is important to, as a leader, to be able to take things that are complex and break it down to doable steps. I was speaking at an HCA conference recently, and they say Quentin's the master of doability. So that was really important to me. When I got into healthcare, um, I just got into it by accident. You know, I spoke at George Washington University the other day. I said, what about your career? So my career is pretty lopsided. I'm a recovering alcoholic. So I ended up working in the treatment field because I'm a recovering alcoholic 44 years ago or 43 years ago. But that again connected me to purpose, worthwhile work, and making a difference and saving lives. Then I got lost, Nate. I truly got lost. I got working in an acute care facility, and it seemed like we weren't talking about purpose, worthwhile work, and making differences. We were talking about FTEs. We were talking about acuity index. We were, you know, people weren't people, they were FTEs. I get all that. But we just were so busy dealing with the metrics, I think we forgot the people. Then I got fortunate. I got a job as COO in a hospital in Chicago with this guy named Mark Clement, who did who just changed my life. Because what he did is he provided skill building for all our leaders, and I saw the difference. And then I got, and you know, you and I've talked, I got put in charge of something called patient satisfaction that made me gag because I wanted to be the president of the hospital, not do this soft patient experience stuff. But he, you know, you put me in charge of something. I'm gonna try to I start with the diagnosis, Nate. I always I think sometimes people read my stuff and they rush into it before diagnosing their own environment. Maybe they don't need to hourly round. You know, they maybe they don't need to do everything that I say. It depends on the diagnosis. So I went and studied this tool, and it told me I need to get the employees happy. Okay, now I gotta get the employees happy and started working on this stuff, and and I'll finish with this story. So I'm I'm working on getting the employees like, gee, trust us to make a copy instead of have a copy key, get us some blood pressure cuffs, tell us what's going on. And, you know, our patient started moving up quickly. And I was pumped because I thought as long as I cannot get to the 75th percentile, my boss will give me a real job in this hospital instead of this. I hate the word soft because I don't think this is soft, I think it's hard. And um, so December, this goes way back. Some of the people listening weren't even born then. But in 1993, I get a letter from a gentleman that came to me because I was in charge of patient satisfaction, and it said, Dear sister, because we're a Catholic hospital, my father died near hospital. It was a matter of if when. I'm an only child, my mother was dead. I tried to be there with my dad all the time, but I couldn't be there 24-7. I went home one day just to shower. I got a phone call from the nurse saying, Come back here. I knew my father had was, you know, close to death or died. Came into the hospital, came into the hospital, walked up on the unit, and just knew my father was dead. I walked into the room, my father was there, deceased, and next to him was a nurse holding his hand who said, Your father was never alone. I've been here the whole time. He loved you. And then he said, I hope you appreciate that nurse. I later found out, Nate, that nurse shift had ended. She did something illegal. She had somebody else punch her out, you know, get her out. And she stayed. And Nate, since December of 1993, I've not had a day of work in health care since then. Because I I think what we do is so, so dang. It doesn't mean I don't get frustrated, don't mean all these other things. But, you know, let's face it, you're a smart guy. When I go to presentations these days, I ask how many of you went to court, got sentenced to health care, and that's why you're in it. And of course, none of them. I said, so first let's admit it's a choice. So anyway, that's my crazy story. And then I started doing this stuff, and we were at Hospital of the Year, and I went to another place or hospital of the year and met you, and we got a decent lab going at Baptist, and then I just kept doing it. But it's constantly rewiring, mate. It's not just doing the same old, same old. Just like we change medications, we change procedures, we got to change our leadership. We can't get stagnant into there's only one way to do this. Sorry to go on so long.

What Is Breaking Healthcare Now

SPEAKER_02 7:57

No, that's great. Uh uh that's why you're here. Uh you talk about the fact that people are calling you and saying, you know, by the way, my 2005 presentation at HCHE was shelter from the storm. So I mean, I've I've been kind of a doomer and gloomer for a long time and trying to figure out how people should can survive in this crazy environment. What do you tell these people that are saying we're under unbelievable stress, the government doesn't understand, Medicaid underpays us, Medicare underpays us? What do you tell them?

SPEAKER_03 8:26

First of all, I don't think you're a doom and gloom. That shows how maybe unhealthy I am mentally. I don't see that way at all. I think you give us objective data that we have to look at. I look at things like a physician looks at something. You know, physician looks at something and the diagnosis isn't good, but at least they're objectively looking at it so they can provide the treatment plan for for that that person. The first thing I got a call from a Doom and Gloom guy the other day, and I said, Well, why don't you quit? He goes, but I love it here. I said, okay. That's controversial. So, you know, all you know, I I tell people they should keep the serenity prayer somewhere in their office and read it on a regular basis. So, what can you change and what you can't change? So I think there's a lot of challenges in health care personally. And so I'm not going to sugarcoat it. I'm not going to make it. And I think we make a lot of mistakes, leadership mistakes, because it all comes down, you know, um, one day I was walking in the hospital and I told a housekeeper the hospital looks a little dirty today, and he said the fish starts rotting at the head. And I wonder why he was talking about fishing when I'm talking about the hospital. And he later told me because we had he needed a new buffer and he was told he couldn't get one. And so it sounds crazy, but you know, we've got to look at the top. And and one of my favorite stories, Nate, is a a pretty well-known organization called me in because this top executives wanted to talk about they're in they're dealing with problem employees, low-performing employees. And I said, well, the only thing we have to agree on is we can't talk about anybody not in this room. Because if you're talking about low-performing employees, somewhere they're reporting to one of you in somehow. So let's talk about you. And so I think there's big challenges. I I think the Medicare Advantage has been a disaster. I think it's absolutely terrible. I I was working with an organization, and and um United Healthcare had gone in and bought a bunch of physicians, and then they threw Medicare Advantage in, and I think that's really, really been hard. They have big grips in the organization. I was at a presentation not too long ago. Um, the head of Ohio, you know, the like AHA or AC of Ohio Health, so it wasn't Ohio Health, but the, you know, the association said that like 99% of the denials are basically overturned. So why are we denying? And I think that's tragic. And then all of a sudden I'm on a board of a place, Nate, that used to have three people were dealing with denials, and now they've got 48 people dealing with denials. So I think that's horrendous what's happened with the payment mechanism and what they've done. I think the other huge thing is physician enterprise losses. And you and I have been around a long time, Nate, and I sit at boards and they say, yeah, we're losing this many millions, but gee, we are making it up because we're doing these other procedures, and that gives us the 2 percent margin. And as a 2 percent margin, we're one of the most successful healthcare systems in the country. Well, somebody's gonna have to say, how long will this last before we do something about it? I don't have the answer for that, but I will tell you one of the questions I get, Nate, that you can really help with is hospital CEOs ask me, can you tell me a healthcare system that's really running their medical practices really well right now? Because I'd like to talk to them. I think the other, and I'm just almost throwing up on you here, Nate, but I think the great elusive miss right now is we're not measuring the experience levels in healthcare. And we're miss on we're misunderstanding how much inexperience is costing us. And it's always cost us, but we've never had so much inexperience, Nate. So for example, I've not been to an organization yet that 30 to 60 percent of their managers have less than four years experience. Now, the we'll go pay a consultant a ton of money for length of stay, and they put a lot of technology in, all good stuff. However, it doesn't move length of stay, because that's not the issue. It's not the system or the process sometimes, it's we have so many new people. And if I have a lot of new people, things are going to take longer. Staffing levels should be adjusted based on experience. So we'll study a healthcare hot system, and we'll find in some of their ICUs the most experienced nurse has two years. Yet I was at Baylor the other day. Not when I say the other day, that means within the last year. My other days are within the last year. And the question I get was, you know, what's your biggest concern right now? And I said, it's the underspending on investing in people. You know, we'll we'll brag and brag, and I get it. We'll open up a new cancer center, and I love the fact that we're opening up a new cancer center. We're spending$100 million, and you have a great one in your area, you know, the cancer centers. Um, I very much into I'll be at at MD Anderson in a couple weeks presenting um Moffitt. I deal with a lot of great cancer centers, and I literally almost go for nothing because I believe what they do. I do think MD Anderson's paid me$1,000. But anyway, which isn't what I'm saying is I go there because I believe in what they do and I want to learn. And but that's great. Then we'll brag about Epic. I mean, everybody wants to brag and Epic or Cerner or you know, no, that hey, we're investing$70 million in our in our technology system. All good. But then when it comes to investing in skill development, they go, oh,$75,000, that's a lot of money. That's real expensive. Can't we do this some other way and let's do that? So I think there's tremendous underinvestment in skill building. And one of the reasons, Nate, is I don't think we've had good skill building. I think sometimes it's not been effective and it hasn't moved the dial. So I think that's that's some of the big challenges. And then I think um somebody asked me, and gosh, I'll probably never get asked to speak at another healthcare system again after people hear this. They said, what's driving all these mergers? I said severance packages. Yeah, I'm still trying to understand the Sutter Alina merger. Well, I'm still trying to understand the um Aurora atrium merger. So um I I I think now there are some national systems like HCA that sort of pulled this off in one line. They have a big system. I I think they've been very effective. I I've known them for a long, long time. Um they've sort of pulled it off with system standardization. They also do a lot of good training. They have good secession planning. I mean, they they're they're a good organization, but for many, it just isn't easy to do this stuff. And Nate, I went to a bond rating presentation and they showed that regional systems perform better than national systems. So why are we running a national system, you know? Um, and I also think that pays the price because um they don't make much sense. But the other thing is the tremendous amount of turnover in the C-suite. You know, you work with, you know, as you know Hartford with Jeff Flax, who you and I both know, and you know, I knew him when he was just a young pup. But uh, you know, they run a really good organization. Well, I probably spoke there 20 years ago, and Jeff was there 20 years ago. Um Mark Clement, who just announced his retirement, but he has a great secession plan in place with Terry Hanner Bremer, who was named the CEO. He's been there. This is his 11th year. And I think if you're gonna build a culture, you can't build it in two years or three years. And now we might read about a CEO who shows up and they say he's marvelous. He's usually just a better PR person. If you look at their operations, it takes a while. Even the best COs take a while. I I look a lot of times, it takes four or five years just to stabilize some things. So I I just think that we, you know, Jim Collins, when he wrote his book, Good to Great, says it takes 10 to 11 years to become great. And if the average CEO in a hospital is four years or eight months, you're never gonna get great, you're never gonna get consistency. And last story, I had too much coffee today. I remember a CEO at a hospital, and and Nate, and again, I'm not saying every merger is based on severance agreements and things like that, and he had a great community hospital. And he he was happy, he was great, and he really prided himself on having a great community hospital. And all of a sudden, I read that they're part of a system now. And you know, not that he's not value-driven, but I called him up and was surprised. I said, What drove this? He said, Yeah, I'm getting three years' salary. And anyone can make a case to grow something or shrink. Now, he did put his hospital in a very good system. So that's sort of nice. But anyway, I know, you know, those are my issues: managed care, inexperienced of health care providers, physician losses, and just sometimes not making good long-term decisions on the culture of an organization in a community.

SPEAKER_02 17:40

So let me give you my challenge is you know, I represent doctors sometimes and I'm negotiating with health systems. And when I do that, I end up negotiating with what I call vertical silos. There's the physician leader or medical group leader, there's the hospital leader, there's legal, there's HR, there's administration, and each one of these verticals has an objective or a goal. Classic example was the situation where a supply chain person was told to reduce costs, and so they limited the number of implants. And sure enough, the cost per implant went down, but a number of doctors left because the supply chain vertical did not focus on the overall good of the system. And it is so challenging for me to watch that in lots of health systems where okay, we need a decision. No one is making the decision. All the verticals go up and they're just worried about their own objectives. It's very frustrating to me. And do you see this? And if you do, what do you believe needs to happen?

SPEAKER_03 18:46

Well, first of all, you're the best in the business. As you know, when any a doctor comes to me and asks me a question, I say, call Nate Kaufman. Because this is what he does. So you to me are the specialist of specialist. I believe every time one more person comes to the table, the odds of getting something done multiply, and not in a good way, but in a bad way. And I also believe that's where good CEOs can't delegate some of these things. They got to sit there because they're the ones paid to see the big picture. I also believe, Nate, because we're so busy looking at expense lines isolated, we don't realize cause and effect. So I I mean, I have story after story where they get somebody gets credit for saving money here, but it costs you three times or ten times that much over over here. And I'm I think docs are trustworthy. I think when they have the evidence, they get it. I'm a big fan of physicians. I am the same way I can give you reason after reason. And I'll tell you a mistake I made. When I got to the hospital, um I we had this IV startup nursing division. Like 11 nurses went around and started IVs. So I said at budget time we're in a crunch. I said, Well, why don't we just have all the nurses start IVs? We can stop these 11 nurses, this IV team that went around and coached people how to start IVs. And man, it looked great. They were saving like$700,000 right off the bat. Put these nerds, I mean, even before we implemented, I was telling the board how brilliant I was. Okay. Until six months later. And if you looked at the cost line, the expense line, Nate, it looked good. Now, unfortunately, if you look to hospital infections, they've gone through the roof. But see, that's me not understanding cause and effect. And I think we don't understand cause and effect. We fix something, it will whack-a-mole. So I I see it, and that's why I think people like Jeff Flax, people like Mark Clement, people that understand the regional nature of this, and they've got to be at the table. Um, I always would say, Nate, I sat down to talk to a CO. Anytime they brought one more person into the table, the odds of success kept going down and down and down and down. Especially, you know, I can tell you specific job titles that just because they're out to prove that, you know, they that they can fix something. So yeah, I think it's really challenging. What do you think is happening, Nate? You know, what is it? How many doctors are part of the enterprise? I mean, you must see healthcare systems losing major, major dollars on physician enterprise. And of course, we justify it, but we're not duplicating, and that would go here. Well, what's your answer to that?

SPEAKER_02 21:36

So when you look at the situation, first we have to understand what's the cause and effect, right? And the cause primarily is the fact that between the insurance companies and Medicare Advantage and Medicare itself, they've rendered independent private practice financially unsustainable. Yes. Second piece is there's a shortage of docs, and I believe that, as you do, whoever has the best doctors. Than most doctors wins. And so we need to recruit these doctors and retain them in our organizations. And unfortunately, in order to do that, I don't consider it a loss. I consider an investment. We have to invest in our physicians. One of the first transactions I ever did was a cardiology group, actually in Atlanta. And I said to the head doctor, I said, Charlie, you know, if we buy your group and employ your doctors, we're going to lose$40,000 per doctor. And he said to me, Nate, how much do you think you lose employing a nurse? Because as you said, people aren't looking at cause and effect. And the industry has changed. Private practice is not sustainable for most. They're going to be employees, and now we have to figure out how to run this practice. Now, the biggest problem we have is the insurance companies shadow price Medicare. And so the prices that the hospitals can negotiate for employing these physicians is not sufficient to cover their costs and other things. The second problem we have, and this is where you probably come in, is we don't walk around. We don't talk to these doctors. We don't find out what their problems are. We hire administrators who have never run practices to be in charge of the physician group. And as a result, while there's always going to be an investment, that investment really increases because of lack of focus on, you know, just what's going on in the trenches.

Commercial Speaker 23:30

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Treat Physicians Like High Performers

SPEAKER_03 24:13

I love what you just said, because I think you're right. If we look at it and not look at it such a separate physician enterprise, but it's part of our enterprise, just like nursing, just like radiology, just like OB. I do also think I I never thought of this, Nate, but before I got involved in when I first started in health care, guess where I was at? Physician practices. So I came from a physician practice environment. And in fact, when I got to the hospital, I said, after I saw how the hospital ran, I said, I'm surprised they're not more aggravated than they have been with the way things don't run on time, the way things are communication. So I yeah, I I almost think I work with a lot of MHA programs. I think almost everyone should have to rotate through a physician practice before you go work on any other part of the enterprise, because that's really the key to this whole thing. And, you know, I but I wrote my book, Healing Physician Burnout, Nate, and and I wrote it at the wrong time because then because of a non-compete, I had to leave healthcare for a while, so I couldn't talk about it. It was 2015. And everybody was telling doctors to go meditate, you know, go be resilient, blah, blah, blah. Um, and and um so in my book, there's 12 chapters. Eleven of them have to do is running a better organization. The 12th one says to the physician, here's some things you might want to do for your own well-being. And so I'm doing this presentation and I'm comparing, I own two minor league baseball teams. Okay. Our baseball players who are young, and only 5% of them, Nate, will ever make the major leagues are treated better than physicians. Let me tell you, and I know we might run out of time, but let me compare it because I think it is a comparison thing, Nate. So we got a baseball player. Okay, I'm gonna talk double-A, Pensacola Blue Wilds. And, you know, some of these guys got paid big money, but most of them don't. Okay? So they come in and here's what they get. We but from Major League Baseball, we have to have nutritious meals available from them from 12 noon, depending if it's a night game, till about 1030 at night. We can't throw pizza in there. We can't throw bread in there. I mean, maybe pizza if it's gluten-free and whole wheat. However, they have strict, honest to God, strict nutritional profiles that they want these players to eat. Why? They want them to be healthy. Okay. Number two, they have all assigned a mental health coach. Because you know, a baseball player is tough, Nate. You go and you strike out, you're depressed, you're sad, they need to hand you failure. Okay? Now think about it. A doctor walks out a room where somebody's died, and they've got to walk right into the next room. So each baseball player, mandatory, gets a mental health coach to work with them on handling failure, things like that. So they have a nutritionalist, a mental health coach. Then they get a skill building coach, depending on what they do, to work with them on skill building. And what I'm saying, so I said to this in the conference, a double-A baseball player gets treated better than a cardiovascular surgeon. And and and you'll like this. The CFO raised his hand and said, Are you telling me that we should offer all our physicians nutritionists? I said, Yeah, I bet you your productivity would go up if you treated them like every other industry, you know, and I think we went Nate from saying, oh, doctors are God to they're not God. But then we've this pendulum has swung. You know, they don't we don't have a dining room because they're not in the hospital anymore. We we don't have medical library because they're not there. So so we've isolated these physicians, and that's strong, that's hard because they're never isolated in residency. They're never isolated in medical school, so they're sort of isolated at at times. And I I think we sort of have them go CME. So I just think we we we've gone to this extreme with physicians. So let me talk about other industries. My wife and are in New York and they were shooting a Lucy movie there years ago. Okay, so they had these signs on the street, you know, you couldn't park, they're shooting a movie, and we noticed these really nice trailers. Okay, and guess what? They had names on the trailers. And you know who names were on the trailer? The stars of the movie. Okay. I live in Pensacola, Florida, the home of the Blue Angels Navy Flight Squad. They get treated extremely well because they're out there performing, but they're also risking their lives. So I think we don't we're the only industry that doesn't treat our high performers like they're high performers and they're special, because we've got this thing that everybody's sort of sort of the same.

SPEAKER_02 29:13

Well, what we do actually is we pay them well. You know, you take the cardiothoracic surgeon, I'm sure the CFO is thinking, well, I'm paying them a million bucks, you know, he or she should be happy.

SPEAKER_03 29:24

Well, I think we're paying baseball players 34 million and they should be happy. But we're still going to treat them well. We have to take our people, all our people. So trust me, but you know, people used to say to me, hey, you know, you're really subservient to physicians. I said, Yeah, isn't that smart? You know, my idea when I talk to the docs always is how do I make this a place that brings you joy and you want to work here? How can I fix things that are driving you crazy right now? And I went to great, great strengths. When we were doing a construction project, and I thought dust might go into the physician parking lot. Everybody got free car washes as long as that was going on. You know, you might say, well, Quinn, isn't that overboard? No, because I don't want them worrying about their dirty car. I want them worrying about the surgery they're doing. So I I that was in my healing physician burnout. I wrote it because the doctor wrote me and said, you know, we got to treat these physicians better. And I agree a hundred percent.

Precision Development For Leaders

SPEAKER_02 30:25

So when you look at the industry, you know, 60 percent of our cost is personnel. You're the probably one of the leaders in terms of how to engage these personnel. You mentioned that we've been making mistakes in terms of skill development. Yes. What are the mistakes that we're making and how do we fix them?

SPEAKER_03 30:43

Sure. Well, first of all, I think sometimes we we don't um yeah, I'll go into great detail. This could be but uh let me number one is sometimes we go to fix something and we don't fix it. So we well, we're gonna build people's skills so we create an OD department. But then all of a sudden, I no longer am in charge of teaching and building skills of people who report to me because they're gonna go get it somewhere else. But they're really not, and most places don't. So I go back to baseball. If I'm a hitting coach and I'm a roving instructor, I'm still up to the hitting coach that's there all the time to work with the person on hitting. Uh so I think we haven't, I I I really love precision-based medicine because it goes n equals one. And so what I'm really into right now is precision development. So, how do we take that individual, that leader, and based on their learning style, based on their job, how do I create a plan for them for skill building? And I think it can be really sophisticated, and I think, but it can't be overwhelming. So I think we have to take skill building and individualize it to the individual. I think we have to look at like pathology, how do they learn, how do they like to behave, how's their problem solving, and what skills do they need? And we also overwhelm people. We bring them out for you know, just free-to-fire hose into them. Well, I like I think global learning helps. You should bring all your people in a room. I'm sure people you know, the town halls, they're very valuable. But when they leave there, we've got to develop them on an individual basis. And I say to people, if you want to know a good CEO, sit with them and say, let's go over your executive team and tell me what skill building you're working on with each one of these right now. Then you go to your executive team and say, let's talk about all your direct reports. What's the one or two skills you're working with this person in right now? Some of them couldn't answer that question because we sometimes have delegated skill building to another department when skill building, you know, it's like a parent. You have these great grandkids, but a parent, yeah, teachers should be building my teaching my kids, but ultimately, as a parent, it's up to me to do that. So I I think we've and then we don't, you know, we we I I spoke yesterday in an organization, a three-hour, they did a three-hour leader evaluation, leader um development program, first one they've ever done, and they said, we appreciate the fact that you've taken three hours. I'm thinking, you know, come on. I mean, you you you you just have not invested. And remember, about 92 to 93 percent of our people in leadership don't have a master's, don't have an MBA. They're like everyone else. They're a real good nurse, and they became a leader, and they're scared to death, and they're running a small business, and we don't give them near the support that we could. So I think we have to rewire how we build skills, just like we've rewired how we treat patients. Today, a cancer patient gets treated differently because we now know about immune therapy. We now know about biometrics, and we we should do the same thing with development of talent. Trevor Burrus, Jr.

Accountability Inside Matrix Organizations

SPEAKER_02 34:01

So one of the other challenges I see is we have a matrix organization. You have the operators that run the hospital, then you have the medical group that runs the doctors, then you have institutes that run across to cover the region for cardiology and other services. One of the things that I see is people wonder, well, who's in charge of it? Who am I supposed to be reporting to? I'm trying to reduce cost over here, but then this institute's kind of trying to increase cost. How do we reconcile that? Do you run into that type of situation?

SPEAKER_03 34:35

Well, that's because I don't think matrix systems work. And we're trying to make them work. And I don't think they work all that well. Particularly, here's how I recommend it. Organizations in general, and again, people might not like what I'm saying, don't usually have good performance evaluation systems. Okay. Um, I was with a system, they had seven global, seven main operations, and these are this is a big place. They had 900-something leaders. Okay, tells that tells you it's about 13,000 or so they had seven like organizational goals, and they had 900 leaders. So we put they had an evaluation system that was like exceeds, greatly exceeds, exceeds, meets needs improvement. So three pluses and one needs improvement. Out of 900 something, like 890 had evaluations that were either meet, exceeds, or substantially exceeds. Now, when you looked at their performance, it didn't match. So and and and you have to have a good performance evaluation system. So we put in a new system that was basically based on on metrics and weights and you know, the whole stuff. And I'll tell you a story on how that that worked. And so you have a, let's say a doctor is a chief physician's a chief quality officer. Okay, but none of the nurse managers report to this physician because they report to the C and E. And if they're not careful, the C and E can even make that person look like they're just not a great, you know, the we they. So when the system is, we said, every nurse manager, what quality indicator do you want on their evail? You now have and because they're not gonna have a hundred, but they're gonna have some. And what metric should you be looking for? Okay. The CMO, says Chief Medical Officer of Quality, that gave him the feeling that we're all aligned on the same page. The Heath brothers in their book, Switch When Change is Hard, which I agree with, says 80% of failure is lack of clarity. And we just don't do well at goal setting, don't do good at weighting, don't do priorities. And many of the reasons is, Nate, because if you really put in a good evaluation system, some of the executives wouldn't do that well. And if they don't do that well, they don't get incentive comp. So I I think we have a real lack of performance evaluation because they're written by HR people, not written by operators. So I again I'll give you this as a story. I was speaking to physicians, and I said their organization was putting in a battery ballast tool. And of course, they weren't that aware of it because they're physicians. So I said, why don't we talk about how the head of surgery is being evaluated right now? And I showed the metrics. And I said, what are some things that you think should be on there? And right off the bat, they said start times. Start times should be in that evaluation. Next is OR turnaround time of rooms. They now have influence into setting that manager's evaluation tool to the agendas what they're looking for, not what that manager is looking for. That doesn't solve the matrix system, but it makes it well, really improves it when physicians know they have influence over the person they're dependent on and how and they're aligned. It's about alignment and accountability.

SPEAKER_02 38:09

Well, you mentioned some books like Dan Pink's book called Drive. When we look at what motivates people, it's not just compensation, it's mastery, the ability to master your profession, it's autonomy, and we've taken most autonomy away. And as a result, the physicians, I find, you know, there's I went and talked to this one doctor who used infection control for a health system. And I said, Well, what metrics do you get to see to help you improve your performance? And he says, All I see is my work RV use. And it's one of our challenges. I keep saying the key to success is number one, a DRI, which Steve Jobs came up with, which is appoint a directly responsible individual.

SPEAKER_03 38:51

Aaron Powell Matrix struggles, because matrix is too vague. And that's why if you have but you can improve matrix if you put a good performance evaluation measurements, because at least you've got things that you can influence that impact you. So I agree with what you said earlier.

Advice For Leaders And Patients

SPEAKER_02 39:07

And then the second thing is benchmarks. You have to measure what's important. And if you look at HCA as an example, they do focus on measurement for sure. Well, as we kind of close, I always like to give you an opportunity. Any general advice you want to give health systems first?

SPEAKER_03 39:22

Yeah, a whole bunch. Number one is um use the word get to versus got to and have to. You know now, Nate. Here I go again with my lead.

unknown 39:31

Okay.

SPEAKER_03 39:32

Studism. Anyway, um we use the words get to and have to. And when you use the word get to and have to, you subconsciously, you're dealing with your subconscious now that tells you you have no choice. You're a hostage, you're a victim. When I go to healthcare, I have to go to this meeting, I got to do this, I have to do that. Um, you know, I joke and I say now, how many of you, when you knew you were going to come hear me talk this morning, said to your partner, I'm so excited, I get to go to this. No, you got to, you have to. So my first advice is move the language from have to to got to to get to. That's number one. But number two is look at emotional performance as much as other performance. So we're looking at Johnsonville Foods, who has a good job of retaining. Can you imagine they do a better job connecting people that are stuffing bratwurts than we do, that people are saving lives. But what they've done is a really nice job looking at the emotional aspect of a job. So one of the recommendations I would make to everybody on here is make sure that when your new employees start or new physicians start, anyone, you give them time to talk to the more experienced people and have the experienced people share what they felt like when they were brand new. Because we are, I spoke to at Georgetown to medical students, we underestimate the emotional challenges that newness has on somebody, a new system, a new organization. So just that one technique of having experienced people share with new people what it was like for them has a huge, huge difference. And I think it's it's the joy of connecting, and we talk about why, but you know, you've got to connect every job back to how vital they are and the difference they make. And it doesn't have to be where you cut somebody's chest open. It could be something that's really important. A friend of mine, Jeff Atwood, daughter's Madison, and she got a job at Culfers, and she's a special needs adult. I've known Madison since she was about a year old. Okay? Madison had blood oxygen taken from her brain, and obviously as a baby, they noticed something was wrong. They were in a small rural town, they were to go out to go to Vanderbilt. So now they go to Vanderbilt, they're completely overwhelmed. They got this little girl they're terrified of. They go to the a very good children's hospital, and I'm a big fan of Vanderbilt, Wright Prinson, and Gerald Hickson and all of them there. And of course, they're overwhelmed. They come out and they're just so wondering is this where we should be? And the security guard, when they came out, said, I just want you to know I've been praying for you the whole time you've been in there. And at that moment, they felt better. We have to help people realize, whatever job they do, how important it is and the impact and the purpose that they have.

SPEAKER_02 42:39

And the other question I have as we close is what about advice for patients? Both you and I are have been patients, and as we approach our senior years, we're gonna be more patient.

SPEAKER_03 42:51

I've been patient a lot. I mean, I had, you know, I've been dealing with some melanoma on and off, and um, gosh, yeah, yeah. And as a patient, um you've got to you've got to be um you've gotta be assertive enough, but not crazy enough, you know. For example, the first thing they told me is don't go on the internet. Well, I went on the internet, which was wild. I think as a patient, we've got to work collaboratively with our care provider, but tell them we want to work collaborated with them. You know, we're we're not here to be difficult. We're here to ask questions. And I found the beauty about young physicians, particularly Nate, they're much more open to giving their cell number up. They're much more open to texting. Um, a friend of mine, Marv, passed away a week ago today, and friend of mine for 44 years we knew each other. Um, his wife um could text the doctor as he was in hospice, and the doctor would text back to her to be helpful or answer a question. I think we have to be appreciative of physicians and realize and make their job. Easy, but we're really fortunate right now because we're more educated on asking questions, we're more educated on controlling our own health. So I'm, as you know, Nate, if I'm a big fan of physicians. I'm a huge fan. And because early on in my administrative career, I saw their side of the coin. And when you walk in their shoes, my gosh, Ram Rao. I remember him sitting with a woman I knew whose husband, again, we sort of knew him. He was like, I was like in my 30s, he was like early 40s. He has a massive heart attack. He's in the ICU. And Ram's working with this young wife. Should he take her husband off life support? I've never had to do that. So I think as a patient, we can have empathy for our physicians and don't be afraid to ask them questions. Don't be afraid to collaborate. But I think most of them are really good at that. And if they're not, go find somebody else.

SPEAKER_02 44:59

As an insider, you also know you've got to find the right doctor and you've got to find the right health system. There's not commodities in this business. There are people that are better, and there's health systems that are better, and there are others that need to be improved.

SPEAKER_03 45:12

I like the transparency. So my nephew was diagnosed with prostate cancer last week. So, of course, you know, Nate, if you're in healthcare, you become the triage nurse for every friend or relative in the country. He told me the urologist he was going to in Milwaukee. And you know, I could do some quick AI search and know all sorts of things about them. Another friend of mine about four months ago got diagnosed with anal cancer, and we found out MAFAC's the place to go. And do you know this week she got a clear scan? Another friend of mine had an early diagnosis of ALS, and he found out Mayo Clinic's a place to go. Do you ever notice, Nate, the better places actually are also better at getting people in for an appointment? That's always amazed me. You know, that you think I have friends that go to MD Anderson and have, and they could get into M.D. Anderson in Houston quicker than they could get into the doctor eight miles from their house.

SPEAKER_02 46:12

The other interesting fun fact about that, as we close, is the fact that those places also get reimbursed better, usually. There is a component here that there is a trade-off between cost, quality, and access. And if you don't have sufficient funds to hire the nurses and hire the doctors, and they have to be efficient, but then access will suffer or quality will suffer.

SPEAKER_03 46:34

Well, healthcare is so crazy. And I agree with you on the reimbursement, the cost. I mean, I'm amazed what they accomplish with what they get. I think it's their miracle workers. Um my book, um Results at Last was uh Microsoft named it Book of the Year. So Microsoft had me go speak to Microsoft clients, okay? Because it was not a healthcare book. So I'm speaking to hoteliers and I'm talking about healthcare. And one of them raised his hand and said, Are you telling me that when a person goes to a hospital, if they can't pay, they still got to take care of them? I said, yes. They go, how can you run a business like that? And I said, you can't, but that's what they're expected to do. So yeah, I don't have an answer for this, but I'm glad there's people like you. And I also would really encourage people to look at Jamie Orkov's new stuff on boards. I went to his presentation as ACHE, and I thought, man, they should have a track for board members. I was with a board member from Tri-Health. She took copious, because Mark Clement sends his board. They took copious notes. We also have to change the board structure, because we're running the same type of board structure we've run for five decades, and it doesn't fit today's environment.

SPEAKER_02 47:48

We also need to pick board members who are willing to challenge as opposed to be manipulated. As I say, there's more fiction written in Excel than there is in literature. And I think one of the concerns that I have is that if you don't have a board that acts as a trusted advisor and asks questions, you could run into some problems.

SPEAKER_03 48:09

Trevor Burrus, Jr. Oh, 100%. And we allow the CEO to pick the comp plan, to do this, the incentive plan. Um yeah, you go again, you you know, you and I are big fans of certain CEOs. We've talked, mentioned a few of them here. They are not afraid to challenge themselves. They're not afraid to put a board in there that questions them. Um Yeah, and that's why I I you know I'm a fanboy of Jamie Lorikov. I mean, I I just thought his presentation at ACHE was just worth the whole entire, outside of yours, worth the whole entire trip of going to Houston.

SPEAKER_02 48:44

Yeah. Uh Jamie is a very close friend, and every once in a while even a blind squirrel finds an acorn. I'll just say that. But uh anyhow, Quint, it has been great catching up and talking to you. I hope you had fun. I did, and I just want to thank you for participating in my little podcast here.

SPEAKER_03 49:02

Well, thank you for your friendship. As you know, if I had my own health challenges, one of the things you've always done, Nate, is ask me how I am, how I'm doing. So, you know, one of the things I tell people is you gotta tell them you love them. So, Nate, I want you to know I love you, and I'm so appreciative of what you do. Well, thanks a lot. And that's the end of our podcast.

SPEAKER_01 49:20

This is Nate Kaufman signing off. Thank you for joining us on this episode of the Healthcare Bridge. We hope you gained valuable insights into how strategic and financial analysis can transform healthcare delivery. Remember, building stronger connections in our healthcare system is a collective effort, and we're honored to be part of that journey with you. Be sure to subscribe and stay tuned for more conversations that aim to bridge gaps and create a healthier future for all. You can find all your healthcare bridge episodes at the Common Bridge on Substack, YouTube, and your favorite podcast platform.