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Nate Kaufman
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. I’m excited today to have Quint 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. I got up with my little transparencies, and I put all these silly things down about strategy and marketing. And everybody listened, then 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 addition. He’s an entrepreneur, an author and a philanthropist. Welcome Quint to our podcast.
Quint Studer
Nate, I still remember that. I remember exactly where it was, it was in Alabama. We were so lucky, because when I got there... because to meet you... since then, you’ve always been, to me, one of my thought leaders. In fact, I tell people that I take your posts and I send them to CEOs on a regular basis to read. Because sometimes CEOs are just so busy, or they’re hearing things from one perspective, and sometimes they - sometimes even I - don’t like to hear things that I might not agree with or might challenge me a little bit. You and, of course, your good friend Jamie Orlikoff, we were a little bit of a threesome. And I love you. I love everything about what you do and have done and continue to make a difference.
Nate Kaufman
I appreciate that. For our audience, why don’t you give us a little background on your origin story, how you got into this, and where you are today.
Quint Studer
Yeah, I got into it - and I can go way too long, but I’m going to bring up one topic that I think is really interesting - I was a special ed, vocational ed teacher for ten years. I worked with special need adults helping them to learn job skills. You might say, what does that have to do with this? Well, what it has to do with this is breaking complex things into doable steps. 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 said, I’ve been hearing this for, like, 40 years... “Nothing’s never been worse” - I’ve been hearing this for 40 years, the perfect storm. I’ve been hearing this for 30 years, since George Clooney’s movie. So I think it is important to, as a leader, 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 said, Quint is the master of do-ability. That was really important to me. When I got into healthcare, I just got into it by accident. I spoke at George Washington University the other day, they asked, what about your career? My career is pretty lopsided. I’m a recovering alcoholic. I ended up working in the treatment field because I’m a recovering alcoholic - 43 years ago. But that connected me to purposeful, 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 purposeful, worthwhile work and making difference but about full time equivalents (FTEs). We were talking about acuity index, people weren’t people, they were FTEs. I get all that, but we 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 just changed my life. Because what he did is he provided skill building for all our leaders, and I saw the difference. Then I got put in charge of something called patient satisfaction. That made me gag, because I wanted to be the president of a hospital, not do this soft patient experience stuff. But he put me in charge of something. I start with a diagnosis, Nate. I think sometimes people read my stuff and they rush into it before diagnosing their own environment. Maybe they don’t need to hourly rounds, 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 that I need to get the employees happy. Okay, now I’ve got to get the employees happy and I started working on this stuff. I’ll finish with this story. I’m working getting the employees things like, gee, trust us to make a copy instead of having a copy key, get us some blood pressure cuffs, tell us what’s going on, and our patients’ satisfaction started moving up quickly. I was pumped, because I thought as long as I can 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 so December - this goes way back, some of the people listening weren’t even born then - of 1993 I got 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 in your hospital. It wasn’t a matter of if, but when. I’m an only child, my mother is 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 now. I knew my father was close to death or had died. I came into the hospital, walked up to 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.’ “ Then he said, “I hope you appreciate that nurse.” I later found out, Nate, that nurse’s shift had ended. She did something illegal; she had somebody else punch her out and she stayed. Nate, since December of 1993 I’ve not had a day of work in healthcare since then, because I think what we do is so so dang... it doesn’t mean I don’t get frustrated. I don’t mean all these other things, but 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 healthcare so that’s why you’re in it? And of course, [the answer is] none of them. First, let’s admit it’s a choice. Anyway, that’s my crazy story. Then I started doing this stuff, and we were the hospital the year, then I went to another place, hospital of the year. And I met you, and we got a decent lab going at Baptist, and then I just kept doing it. But it’s constantly rewiring me. It’s not just doing the same old, same old. Just like we change medications, we change procedures, we’ve got to change our leadership. We can’t get stagnant into [the idea that] there’s only one way to do this. Sorry to go on so long.
Nate Kaufman
No, that’s great. That’s why you’re here. You talk about the fact that people are calling you and saying... by the way, my 2005 presentation at American College of Healthcare Executives (ACHE) was “Shelter from the Storm,” so I’ve been kind of a doomer and gloomer for a long time, and trying to figure out can people 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 under-pays us, Medicare under-pays us, our expenses are... what do you tell them?
Quint Studer
First of all, I don’t think you’re doom and gloom; that shows how maybe unhealthy I am mentally. I don’t see it 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: a 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 that person. I got a call from a doom and gloom guy the other day, and I said, why don’t you quit? He goes, but I love it here. I said, okay, so I may tell people they should keep the Serenity Prayer somewhere in their office and read it on a regular basis. What can you change and what can’t you change? I think there’s a lot of challenges in healthcare, personally, and so I’m not going to sugar coat it. I think we make a lot of mistakes, leadership mistakes, because it all comes down... 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 wondered why he was talking about fishing when I’m talking about the hospital, he later told me he said that because he needed a new buffer and he was told he couldn’t get one. And so it sounds crazy, but we’ve got to look at the top. One of my favorite stories, Nate, is a pretty well known organization that called me in because the top executives wanted to talk about dealing with problem employees, low performing employees. I said, well, the only thing we have to agree on is we can’t talk about anybody who is not in this room, because if you’re talking about low performing employees, somewhere, somehow, they’re reporting to one of you - so let’s talk about you. I think there are big challenges. I think the Medicare Advantage has been a disaster. I think it’s absolutely terrible. I was working with an organization and 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, the head of Ohio Health - it wasn’t Ohio Health, but the association - said that about 99% of the denials are basically overturned. So why are we denying? I think that’s tragic. Then all of a sudden, I’m on a board of a place, Nate, that used to have three people who are dealing with denials, and now they’ve got 48 people dealing with denials. I think what’s happened with the payment mechanism is horrendous, what they’ve done. I think the other huge thing is physician enterprise losses. 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% margin and at a 2% margin, we’re one of the most successful healthcare systems in the country. Well, somebody’s going to 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 that you, Nate, 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, - I think the great, elusive miss right now is we’re not measuring the experience levels in healthcare. We’re misunderstanding how much inexperience is costing us. It has always cost us, but we’ve never had so much inexperience. For example, I’ve not been to an organization yet that 30-60% of their managers have more than four years experience. Now, 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. 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 system and we’ll find in some of their ICUs that the most experienced nurse has two years. Yet I was at Baylor the other day - 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, what’s your biggest concern right now? And I said, it’s the under-spending on investing in people. We’ll brag and brag - and I get it - we’ll open up a new cancer center. I love the fact that we’re opening up a new cancer center. We’re spending $100 million. You have a great one in your area. The cancer centers, I’m very much into. I’ll be at an MD Anderson in a couple weeks, presenting at Moffitt. I deal with a lot of great cancer centers. I literally go for almost nothing, because I believe in what they do. I do think MD Anderson’s paid me a thousand dollars - which isn’t that much - but I go because I believe in what they do, and I want to learn. That’s great, then we’ll brag about Epic. I mean, everybody wants to brag, and Epic or Cerner... we’re investing $70 million in our technology system, all good. But then when it comes to investing in skill development, they go, $75,000 - that’s a lot of money, that’s real expensive, can’t we do this some other way? I think there’s tremendous under-investment in skill building. One of the reasons is I don’t think we’ve had good skill building [is because] sometimes it’s not been effective and it hasn’t moved the dial. So I think those are some of the big challenges. And then I think somebody asked me - and gosh, I’ll probably never get asked to speak at another healthcare system again after people hear this - what’s driving all these mergers? I said, severance packages.
Nate Kaufman
Yeah, I’m still trying to understand the Sutter/Allina merger.
Quint Studer
Well, I’m still trying to understand the Aurora/Atrium merger. I think now there are some national systems like HCA Healthcare that pulled this off and they have a big system. I think they’ve been very effective. I’ve known them for a long, long time. They’ve pulled it off with system standardization. They also do a lot of good training. They have good succession planning. 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 do we run a national system? I also think that it pays the price, because they don’t make much sense. But the other thing is the tremendous amount of turnover in the C-suite. Hartford, with Jeff Flaks - who you and I both know, and I knew him when he was just a young pup - they run a really good organization. Well, I probably spoke there 20 years ago and Jeff was there 20 years ago. Mark Clement, who just announced his retirement, he has a great succession plan in place with Terry Helland Breen, who was named the CEO. He’s been there... this is his 11th year, and I think if you’re going to 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 CEOs take a while. A lot of times it takes four or five years just to stabilize some things. Jim Collins, where he wrote his book, “Good to Great” says it takes 10-11 years to become great, and if the average CEO in a hospital is four years or eight months, you’re never going to get great, you’re never going to get consistency. And the last story - I had too much coffee today - I remember a CEO at a hospital - again, I’m not saying every merger is based on severance agreements and things like that - he had a great community hospital, and 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 not that he’s not value driven, but I called him up and was surprised, I said, what drove this? He said, 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, those are my issues: managed care, inexperience of healthcare providers, physician losses and just sometimes not making good, long term decisions on the culture of an organization in a community.
Nate Kaufman
So let me give you my challenge. As 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 lead 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. It is so challenging for me to watch that in lots of health systems where, okay, we need a decision. Well, there’s no one who’s making the decision. All the verticals go up and they’re just worried about their own objectives. It’s very frustrating to me. Do you see this and if you do, what do you believe needs to happen?
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Quint Studer
You’re the best in the business, so when a doctor comes to me to ask me a question, I say call Nate Kaufman, because this is what he does. You, to me, are the 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. I also believe that’s where good CEOs can’t delegate some of these things. They’ve 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. I have story after story where somebody gets credit for saving money here, but it costs you three times or ten times that much over here. 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. I’ll tell you a mistake I made, when I got to the hospital, we had this IV startup nursing division, like 11 nurses went around starting IVs. So at budget time, I said, we’re in a crunch, why don’t we just have all the nurses start IVs? We stopped these 11 nurses, this IV team that went around and coached people on how to start IVs. And, man, it looked great. They were saving like, $700,000 right off the bat. Even before we implemented, I was telling the board how brilliant I was - until six months later. 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. I think we don’t understand cause and effect. We fix something or whack a mole - so I see it - and that’s why I think people like Jeff Flaks, people like Mark Clement, people that understand the regional nature of this, they’ve got to be at the table. I always would say, when I sat down to talk to a CEO, anytime they brought one more person into the table, the odds of success kept going down and down and down and down. I can tell you there are specific job titles where people feel like they have to prove they can fix something. So, yeah, I think it’s really challenging. What do you think’s happening, Nate? What is it? How many doctors are part of the enterprise? 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’s another example. What’s your answer to that?
Nate Kaufman
When you look at the situation, first, we have to understand what’s the cause and effect. The primary cause is the fact that between the insurance companies and Medicare Advantage and Medicare itself, they’ve rendered independent private practice financially unsustainable. Second piece is there’s a shortage of docs, and I believe that - as you do - whoever has the best doctors wins, the most best doctors wins. We need to recruit these doctors and retain them in our organizations. Unfortunately, in order to do that - I don’t consider it a loss, I consider it an investment - we have to invest in our physicians. Now one of the things, 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, 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 are 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 just what’s going on in the trenches.
Quint Studer
I love what you just said, because I think you’re right if we don’t look at it as such a separate physician enterprise; it’s part of our enterprise, just like nursing, just like radiology, just like OB. I never thought of this, Nate, until now, but when I first started in healthcare, guess where I was? Physician practices. I came from a physician practice environment, and in fact, when I got to the hospital, 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 communications. I work with a lot of Master of Health Administration 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. I wrote my book, “Healing Physician Burnout” at the wrong time because of a non-compete, I had to leave healthcare for a while, I couldn’t talk about it. It was 2015 and everybody was telling doctors to go meditate, go be resilient, blah, blah, blah. In my book, there are 12 chapters. Eleven of them have to do with running a better organization. The 12th one says to the physician, here are 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.
Nate Kaufman
We have as much time as you want.
Quint Studer
It’s a comparison thing, Nate. We’ve got a baseball team, okay, I’m going to talk Double-A Pensacola Blue Wahoos. Some of these guys get paid big money, but most of them don’t. They come in and here’s what they get. For Major League Baseball, we have to have nutritious meals available for them from 12 noon - depending on if it’s a night game - till about 10:30 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 gosh, strict nutritional profiles that they want these players to eat. Why? They want them to be healthy. Number two, they all have assigned mental health coaches because baseball is tough—you go out and strike out, you’re depressed, you’re sad. They need to help you handle failure. Now think about it: a doctor walks out of a room where somebody has died and has to walk right into the next room. So each baseball player, mandatorily, gets a mental health coach to work with them on handling failure, things like that. So they have nutritionist, a mental health coach, then they get a skill building coach, depending on what they do, who works with them on skill building. What I’m saying - I said to this in the conference - a Double-A baseball player gets treated better than a cardiovascular surgeon. And - you’ll like this - a 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 this. I think we went from saying, oh, doctors are God to they’re not God. But then this pendulum has swung - we don’t have a dining room because they’re not in the hospital anymore. We don’t have a medical library because they’re not there. We’ve isolated these physicians, and that’s hard, because they’re never isolated in residency. They’re never isolated in medical school. Now they’re isolated at times and I think we have them go to continuing medical education. I just think we’ve gone to this extreme with physicians. Let me talk about other industries. My wife and I are in New York, and they’re shooting a Lucy movie there years ago. So they had these signs on the street, you couldn’t park, they’re shooting a movie and we noticed these really nice trailers, and guess what? They had names on the trailers. And you know what 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’re the only industry that doesn’t treat our high performers like they are high performers and they’re special because we’ve got this thing that everybody is sort of the same.
Nate Kaufman
Well, what we do actually, is we pay them well. You take that cardiothoracic surgeon, I’m sure the CFO is thinking, well, I’m paying a million bucks, he or she should be happy.
Quint Studer
I think we’re paying baseball players 34 million, and they should be happy, but we’re still going to treat them well. People used to say to me, hey, you’re really subservient to physicians. I said, yeah, isn’t that smart? When I talk to the docs, my idea is always say, 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? I went to great, great lengths. We were doing a construction project and I thought dust might go into the physician parking lot so everybody got free car washes as long as that was going on. You might say, well, Quint, 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. That’s in my book “Healing Physician Burnout.” I wrote it because a doctor wrote me and said we’ve got to treat these physicians better - and I agree 100%.
Nate Kaufman
When you look at the industry, 60% of our cost is personnel. You’re 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. What are the mistakes that we’re making, and how do we fix them?
Quint Studer
Sure. Well, first of all, I think sometimes we don’t... I’ll go into great detail. Number one, sometimes we try to fix something and we don’t actually fix it. We say we’re going to build people skills, so we create an OD (organizational development) department. But then I’m no longer responsible for teaching and building the skills of the people who report to me because they’re going to get it somewhere else—but they’re really not, and most places don’t do that well. So I go back to baseball: if I知 a hitting coach and there痴 a roving instructor, it痴 still up to the hitting coach who痴 there all the time to work with the player on hitting. I really love precision based medicine, because it goes N = 1. What I’m really into right now is precision development. How do we take that individual, that leader - based on their learning style, based on their job - and create a plan for them for skill building? I think it can be really sophisticated, but it can’t be overwhelming. 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 is their problem solving, and what skills do they need? And we also overwhelm people. We bring them out for free to fire hose information into them. Well, 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 be developing them on an individual basis. 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 on with this person right now? Some of them couldn’t answer that question, because sometimes we have delegated skill building to another department. When skill building, like a parent - you have these great grand-kids - but teachers should be teaching my kids, but ultimately, as a parent, it’s up to me to do that. I spoke yesterday to an organization, they did a three hour leader evaluation, leader development program, first one they’ve ever done. They said, we appreciate the fact that you’ve taken three hours. I’m thinking, come on, you have not invested. And remember, about 92-93% 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 - they’re running a small business and we don’t give them near the support that we could. 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 bio-metrics. We should do the same thing with development of talent.
Nate Kaufman
So one of the other challenges I see is in healthcare organization systems. 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. And 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?
Quint Studer
Well, that’s because I don’t think matrix systems work. 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 - again, people might not like what I’m saying - don’t usually have good performance evaluation systems. I was at a system, they had seven global, seven main operations; this was a big place. They had 900 something leaders, that tells you about 13,000 employees, okay. They had seven organizational goals and they had 900 leaders. They had an evaluation system that was like “exceeds,” “greatly exceeds,” “meets,” “needs improvement,” - so three pluses and one “needs improvement.” Out of 900, something like 890 had evaluations that were either “meets,” “exceeds,” or “substantially exceeds.” Now, when you looked at their performance, it didn’t match. You have to have a good performance evaluation system. We put in a new system for them that was basically based on metrics and weights, the whole stuff. I’ll tell you a story on how that worked. Let’s say you have a doctor who is a physician, a chief quality officer, but none of the nurse managers report to this physician because they report to the Chief Nursing Executive (CNE). And if they’re not careful, the CNE can even make that person look like they’re just not great. So with this system we said to every nurse manager, what quality indicator do you want on their evaluation - because they’re not going to have 100 but they’re going to have some - what metrics should you be looking for? The CMO says - the Chief Medical Officer of quality - that gave him the feeling that we’re all aligned on the same page. Chip Heath and Dan Heath, in their book “Switch: How to Change Things When Change Is Hard,” which I agree with, say 80% of failure is a lack of clarity. We just don’t do well at goal setting, don’t do good at waiting, don’t do good doing priorities. Many of the reasons are 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. I think we have a real lack of performance evaluation, because they’re written by HR people, not written by operators. Again, I’ll give you this as a story. I was speaking to physicians, and I said their organization was putting in a better evaluation 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 time should be on that evaluation, next is OR turn around time. 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 really improves it when physicians know they have influence over the person they’re dependent on and they’re aligned. It’s about alignment and accountability.
Nate Kaufman
You mentioned some books like the Heaths’, 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. We’ve taken most autonomy away, and as a result, the physicians I find... I went and talked to this one doctor. He was head of 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 RVUs (Relative Value Units) 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.
Quint Studer
Matrix struggles because matrix is too vague, and that’s why if you have it you can improve matrix if you put in good performance evaluation measurements, because then at least you’ve got things that you can influence that impact you. So I agree with what you said.
Nate Kaufman
And then the second thing is benchmarks; you have to measure what’s important. If you look at HCA Healthcare as an example, they do focus on measurement for sure. As we close, I always like to give an opportunity to provide any general advice; health systems first.
Quint Studer
Yeah, a whole bunch. Number one is we use the word “get to” versus “got to” and “have to.” Now Nate, here I go again with my (Nate Kaufman: Studerisms.) [Laughter] I used to hug everybody. Anyway, we use the words “got to” and “have to.” And when you use the words “got to” and “have to,” you’re dealing with your subconscious now that tells you that you have no choice. You’re a hostage. You’re a victim. When I go to a healthcare job: I have to go to this meeting, I got to do this, I have to do that. I joke and I say, now, how many of you, when you knew you are going to come hear me talk this morning, said to your partner, I’m so excited I get to go to this. No, it’s you “got to,” you “have to.” So my first advice is, move the language from “have to,” “got to,” to “get to” - that’s number one. Number two is look at emotional performance as much as other performance. We were looking at Johnsonville Foods, who has a good job of retaining. Can you imagine? They do a better job connecting people that are stuffing bratwurst than we do, than people who are saving lives. 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. I spoke 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. I think it’s that joy of connecting. We can talk about why - you’ve got to connect every job back to how vital they are and the difference they make. It doesn’t have to be where you cut somebody’s chest open. It could be something else that’s really important. A friend of mine, Jeff Atwood, his daughter Madison, she got a job at Culvers, and she’s a special needs adult. I’ve known Madison since she was about a year old. 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 going to go to Vanderbilt. They go to Vanderbilt, they’re completely overwhelmed. They’ve got this little girl, they’re terrified, they go to the very good children’s hospital - and I’m a big fan of Vanderbilt, Princeton and Gerald Hickson and all of them there - of course, they’re overwhelmed. They come out, and they’re just wondering, is this where we should be? And when they came out the security guard 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.
Nate Kaufman
And the other question I have for you as we as we close is, what about advice for patients? Both you and I have been patients, and as we approach our senior years, we’re going to be more patient. [Chuckle.]
Quint Studer
I’ve been a patient a lot. I’ve been dealing with some melanoma on and off, and, gosh, yeah, as a patient, you’ve got to be assertive enough, but not crazy enough. 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, tell them we want to work collaboratively with them, we’re not here to be difficult. We’re here to ask questions. I found the beauty about young physicians, particularly, they’re much more open to giving their cell number out. They’re much more open to texting. A friend of mine, Marv, passed away a week ago today. Been friend of mine, we knew each other for 44 years. His wife 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 make their job easy. We’re really fortunate right now because we’re more educated on asking questions. We’re more educated on controlling our own health. as you know, Nate, I’m a big fan of physicians, I’m a huge fan 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 know whose husband had a massive heart attack. We sort of knew him, I was in my 30s and 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 go find somebody else.
Nate Kaufman
But as an insider, you also know you want to find the right doctor, and you’ve got to find the right health system. There are not commodities in this business. There are people that are better and there are health systems that are better, and there are others that need to be improved.
Quint Studer
I like the transparency. 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 and relative in the country. He told me the name of the urologist he was going to in Milwaukee. 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, Moffitt, that’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 the place to go. Do you ever notice, Nate, that the better places actually are also better at getting people in for an appointment? That’s always amazed me. I have friends that go to MD Anderson and they could get into MD Anderson in Houston quicker than they could get into the doctor eight miles from their house.
Nate Kaufman
The other interesting fun fact, as we close, is that those places often get reimbursed better. There’s a trade-off between cost, quality, and access. If you don’t have sufficient funds to hire the nurses and doctors you need, you have to be more efficient—but then either access will suffer, or quality will suffer.
Quint Studer
Well, healthcare is so crazy. I agree with you on the reimbursement, the cost. I mean, I am amazed what they accomplish with what they get. I think they are miracle workers. My book, “Results at Last,” Microsoft named it book of the year. Microsoft had me go speak to Microsoft clients 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’ve 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. I don’t have an answer for this, but I’m glad there are people like you. I also would really encourage people to look at Jamie Orlikoff’s new stuff on boards. I went to his presentation at ACHE, and I thought, man, they should have a track for board members. I was with a board member from TriHealth. She took copious notes because Mark Clement sends his board. 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.
Nate Kaufman
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.
Quint Studer
Oh, 100% and we allow the CEO to pick the comp plan to do this, you know, the incentive plan? Again, you and I are big fans of certain CEOs. We’ve 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. That’s why I’m a fanboy of Jamie, I just thought his presentation at ACHE was just worth the whole entire trip - outside of yours - worth the whole entire trip of going to Houston.
Nate Kaufman
Yeah, Jamie is a very close friend, and every once in a while, even a blind squirrel finds an acorn, so I will say that. But 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.
Quint Studer
Well, thank you for your friendship. As you know, I had my own health challenges, and one of the things you’ve always done, Nate, is ask me how I am, how I’m doing. One of the things I tell people is you’ve got to tell them you love them. So Nate, I want you to know I love you, and I’m so appreciative of what you do.
Nate Kaufman
Well, thanks a lot. And that’s the end of our podcast. This is Nate Kaufman signing off.
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