Leading in All Seasons

Mind-Numbing Pace of Transformation

INTRODUCTION:
You’re listening to Tiller-Hewitt’s Leadership Lens Podcast. If you’re a leader - or an aspiring leader - who wants to stay relevant and impactful… YOU’RE IN THE RIGHT PLACE.

At Tiller-Hewitt we believe it’s faster, smarter -- and less painful -- to learn from leaders who have walked before us. That’s why we invite top leaders to be our guests on the Leadership Lens.

Your host is Tammy Tiller-Hewitt – Founder of Tiller-Hewitt HealthCare Strategies. Let’s jump into the podcast.

TAMMY:
My guest is Jim Carter, the Senior Vice President/Chief Operating Officer of Archbold Medical Center.

This podcast interview is so full of leadership insight – it was difficult for me to create a short summary. Today’s interview is for leaders in ALL SEASONS of their careers. We talked about role models – good and bad – even from some very unpredictable places, we talked about imaginary scorecards and about important leadership lessons learned – especially when thrown into the deep end. When asked about the leadership challenges, Jim talked about the mind-numbing pace of transformation forced on leaders today and how the tried-and-true solutions just aren’t working.

TAMMY:
Hey, Jim, welcome to the Leadership Lens Podcast. I love having Chief Operating Officers as guests because you guys or gals don't pull any punches, which is why COOs GET STUFF DONE!

JIM:
Thanks, Tammy. It's a pleasure to be here.

TAMMY:
I know that you joined Archbold twenty years ago as the Director of the Ambulatory Care Center (ACC) and have advanced to the Vice President before your current Chief Operating Officer position - so, can you give some advice to our listeners, who have their eye on the C-suite? Maybe the do's and don'ts on career advancement?

JIM:
Well, I think sometimes I was a little bit of the frog in the in the boiling pot. The heat just gradually got turned up and the next thing I knew I was boiling. But honestly, I wasn't necessarily trying to advance to the C-suite as fast as I could. I was, to be completely honest, focused on the jobs that I had at the time andas I was, at least to a certain degree, successful when those opportunities presented themselves. That just happens to be the way my path worked out. I know some people have a very clear goal and are working aggressively towards it, but mine just was a series of logical steps that happened. I guess everybody's paths are a little bit different.

TAMMY:
Right. Well, It's nice that someone saw that so you clearly were getting things done. That reminds me in the book Good to Great, they talk about the principles from the leaders from these great companies and one of their secrets was that - that they just kept their head down and kept the wheel moving and that's what was part of the secret to the success. They didn't grandstand and say, “Excuse me did anyone see how great I am”? So, it sounds like you're following a Good to Great Model – that's actually awesome.

In addition to you having an MBA, you also have an industrial engineering degree. So I'm interested, has that helped you in any of your leadership roles that you would recommend that degree again to other learners or leaders on the line?

JIM:
Sure. I actually think an industrial engineering degree is a great degree for a lot of different career paths. To be honest, when I studied industrial engineering at Georgia Tech, I really didn't have any idea at all that I would end up in a healthcare career. Healthcare is one of a thousand little fields that Industrial Engineers can get involved with. And a friend just happened to recruit me to a company that let me apply my industrial engineering skills to healthcare. Industrial engineers work together in teams. They solve problems. They focus on process improvement. They look at data. They look at processes. So all of these things are applicable in healthcare in a huge way. So, I'm a big fan of industrial engineering. It's kind of funny when I was in school, someone said, ‘hey there are a couple of healthcare electives in the Industrial Engineering School that are easy.’ I figured what the heck and I took those electives honestly not having any idea that I would truly use them and then go on into healthcare. I can tell you the healthcare electives might have been easy, but healthcare itself is not quite so easy.

TAMMY:
Right, they tricked you. I love what you said. You're so right. Teamwork, problem-solving, process improvement, data, I mean those are the basic things you think that everyone just knows intuitively, that's what a leader needs to have strong skills in, but they don't always and so I love that. I guess that means you didn't always want to be, or think you would be in a leadership role or, or did you always know you wanted to be in a leadership role?

JIM:
I think I was interested in leadership before I had any idea what that would mean for my career or even was thinking about careers. As a younger person through things like Boy Scouts, I tended to want to get things straightened out and organized. So, you end up taking on leadership roles. I ended up realizing I enjoyed that. But at that point, I was not thinking, okay, in my career, I want to have a leadership role. I think I've always paid attention to leaders, real and fictional, even TV characters. I think back about Captain Picard on Star Trek, people like that are fascinating to me because you see how they face issues, how they kind of seek counsel among the leadership team, how they try to lead with some type of moral compass. So, I think, throughout my life, I've paid attention to that. But truthfully, as I mentioned earlier, I wasn't on some fast track where I knew I had to get to some top-level position. I just was interested in how they did it.

TAMMY:
I love it. Was there a pivotal point in your career, maybe a defining moment that you knew you were where you were supposed to be, or where you weren’t supposed to be?

JIM:
I mentioned that I hadn't originally intended on being in healthcare. I graduated from Georgia Tech at a time when there was a recession going on. I graduated in 1991, and there was a recession going on, and a lot of Georgia Tech students were not graduating with jobs, which was a real shock to Georgia Tech students at the time. A friend of mine got a job first with an alliance of hospitals in the southeast, that provided group purchasing and consulting services to those member hospitals, and he recruited me, probably because he got a referral bonus. I joined that company and very quickly was working on-site at hospitals, and I was working at a hospital in North Carolina, really two hospitals that had merged, and they were about to plan and build a new hospital to take the place of their two existing hospitals. Over the several years that I worked there, just working with clinical leaders, learning healthcare, planning a hospital, planning for the operations, and seeing that thing rise from the ground, I realized okay, I can make a real difference in healthcare. This is a great place to be. That was an epiphany for me that I never thought about healthcare. I don't want to put down other industries, but for me, personally, I like delivering healthcare more than I think I would have enjoyed making some other product. That was an epiphany for me.

Another more subtle epiphany during that same time period, during that roughly five years that I happened to work at that hospital, I had a certain kind of leadership epiphany. I worked for a gentleman named, Russ Payne. I don't remember any single incident, but I really learned from him that you can be a leader with integrity, that you can do the right thing, that you can be honest. You can treat people with respect. That made an impression on me as a young person entering the working world and I've carried that with me. I've considered Russ Payne a role model my whole career – for the simple fact that he always thought to do the right thing. So, I came away from that first assignment loving healthcare and realizing I could lead with integrity.

TAMMY:
I love that to think that you still think about him is awesome and to show the impact that we can have on people without even knowing it, by just doing the right thing.

JIM:
He was not a dramatic person, and he was not a preachy person. He did not make a big deal out of it. I saw a difference in how he acted from how some other leaders acted, and it made an impression on me.

TAMMY:
What do you think are some of the leadership challenges today, both professionally and organizationally?

JIM:
For people in the healthcare field, I think this is obvious to everybody, but for me personally, and it's definitely true for our organization, the pace of the transformational change that's happening around us or to us, if you want to say to us, is kind of mind-numbing. Then in response to that, the pace of transformational change that's required of us is mind-numbing and we just don't seem to be able to roll along with the tried-and-true solutions for very long. People that work in healthcare know this but massive shifts and how insurance companies and individuals are willing to pay for healthcare, which means we have to make massive adjustments in the cost structure of healthcare. That's huge. The sudden burden of unfilled nursing positions and high-cost traveling staff – that's huge. To me, I think we can make a list of the topics that are challenging, that's only the surface of the challenge, but the deeper challenge is, how do we adapt ourselves and our organizations to deal with those things? Are there different leadership skills, are there different ways to use our teams, or our approaches? How do we change the way we respond, in order to respond fast enough? That's the real challenge. If I had the complete answer, I'd write a few books and would probably be done with this, but I don't.

TAMMY:
You're right. Those are very similar challenges that other leaders are sharing as well. But I think talking to each leader, you come a little bit closer, you know, as you kind of brainstorm with your colleagues. I've heard a lot around the pace. I've heard if they described it in one word, they would say, “tired” or “exhausted”. I think you said it probably the most articulately and when you said pace of transformation change to us and requirements of us so that's good that it is mind-numbing and exhausting. So, have you guys come up with anything innovative at your organization to tackle anything that you listed?

JIM:
For the topic of staffing, and again, we're not alone in this, you're really looking at what do we have to do to both recruit and retain staff. We tried to figure out what part of it is compensation. What can we do on compensation? We had to go to our board and request a multimillion-dollar, out-of-budget, proposal to raise our wages and various ways across our whole system. So, we focused on compensation.

But we've also done a very detailed survey of what other things would make a difference for people. We're working through that list right now. It's everything from daycare, to the ability to work from home in certain job categories. Part of the challenge is that every one of the ideas that people suggest to us, could cost us millions of dollars. You have to be very strategic about where you spend the money you have to make a difference. That's something we're looking at all day, every day. We had the opportunity to fill us our CEO position, a little more than a year ago. That was a unique opportunity to bring in fresh perspectives. I'm not saying you have to have somebody leave the organization and bring somebody new in, but you have to have some way to bring in a fresh perspective, either from a peer group that you're interacting with, or when you do fill positions, seeing what kind of experience people have, and could they maybe bring something new to the table? That's helped us a little bit too.

TAMMY:
That's very good. Yeah, that could scare some CEOs like you're about to get whacked because we need some fresh perspective in here. But no, I know you're not saying that.

JIM:
But when those situations naturally occur, when somebody retires like they did in our case, it's a chance to say, Okay well, what would be helpful right now? Is it somebody with for-profit experience? Is it someone with not-for-profit experience? Is it somebody with experience in a bigger system? I think perspectives are important too. You've got to have the right leadership team in an organization and there's certain traits that you want every leader to have. You want every leader to be able to work together with others. You want every leader to have a desire to make things happen. You said something about this earlier, but kind of a willingness not to be in the spotlight on every topic, to work together as a team. But you also have to find some way to have diverse perspectives. Sometimes that means bringing somebody to the team like we were just talking about, but sometimes it means when you're working on something, realizing who you need at the table. You've got the people who are always going to keep patient care front-and-center. You've got people who are really good at understanding the financial impact of something. You've got people who are going to be focused on the immediate details, and other people that are good at looking into the future and saying, ‘well, what’s coming after this? You need to make sure you have all those perspectives. Sometimes we have them in our organization, but we don't bring them to the table like we should. If you're sitting in a room working on a problem and you think to yourself, ‘Boy, the Chief Nursing Officer would really not like this idea at all’, you probably need to have the Chief Nursing Officer at the table to talk through and to give her perspective and to figure out if there's a way to have a better solution. I didn't mean to kind of go down a rabbit hole on that, but I think you need to have different perspectives.

TAMMY:
That was excellent leadership advice. I think we end up having, these hallway conversations or quick huddles, and you doforget some major stakeholders in the decision. I love that, that you're more about being more inclusive than exclusive. And I do agree with you, it's like pay now or pay later, and not everyone in your group will actually be people that you really enjoy being around because they're constantly challenging you, or they're constantly focusing on finances, but you said it perfectly, Jim.

JIM:
It reminds me of a slightly related topic about physician engagement. Our Chief Medical Officer dropped off a little button on my desk one day, without even telling me about it. I just found out and it said, “Engage Physicians Early”.

TAMMY:
Oh I love it.

JIM:
Physician engagement is a whole other topic.

TAMMY:
Yes, it is. But do you need somebody at the table that's going to represent the physicians as well…back to your inclusiveness. What do you think the warning signs are of when an organization is getting close to running off the track?

JIM:
Well, you have all of the concrete indicators, like declining volumes, negative operating margins, quality issues there are all of those things. But if you mean, how can you tell when the culture is falling apart? I've seen it when the leadership team doesn't have what we were just talking about. When the leadership team is not coming together and groups of two or three or four, and tackling problems together, and bringing different perspectives in. I've been in organizations where you realized, Okay, this leadership team is not working together, not collaborating. Everyone is focused on themselves probably trying to find a way to get themselves out. So, when you see a broken leadership team, I think it's a pretty good predictor of an organization that's going to run off the track.

TAMMY:
Wow, very good. Let's talk about your approach. You know that Tiller-Hewitt works with leaders to consistently deliver strategic growth and measurable results. So, what are your secrets or success strategies around strategic growth and measurable results?

JIM:
Well, on the subject of growth, I mentioned that we got a new CEO, a little more than a year ago. And He decided to make strategic growth a significant priority for us. In fact, this is, of course, how I came to know the Tiller-Hewitt organization. He had worked with your organization before, brought them in to help some of these initiatives, but he began to frame every discussion in terms of: How can we grow? Where can we grow? What are the barriers? What's not coming to us? What’s the potential geography? What are the services? And after a few months, beat us over the head a few times, we finally wake up and realize, ‘Oh, okay’. We kind of caught on. We, need to grow and we better refocus our strategies towards that. Now, of course, growth isn't our only strategy, but it was something that we, as an organization, needed to focus more on. It kind of became woven into everything we do. When a new physician comes, what are we going to do to help grow that service line to help get that physician up and running? Or if it's a service line, that's been kind of stagnant for a while. What can we do? What can we add? I think just weaving it into everything we do is kind of how we've tackled strategic growth so far. On the question of measurable results, there are the cliches, like, inspect what you expect. But you really do have to decide what the key metrics are and then actually monitor them and actually discuss what's going on.

Covid, combined with a staffing crisis, has kind of wreaked havoc on a lot of our metrics. But now that we're, I guess into our third year, we can't use that excuse forever. We need to adjust our goals and focus on what we can do now reset the baselines to see if we're moving in the right direction. I think that's a key thing there.

Let me just kind of give a side note about results. I guess let’s call it ‘result versus process’ or maybe another way to frame it is, ‘what you get done versus what kind of leader are you?’ One opportunity that I've recognized in my own leadership style and the roles that had over the years, is that I tend to gravitate a little more towards process, and the way I work with people to tackle issues (like engaging stakeholders, collaborating, things like that) and I've been a tiny bit less driven by outcomes, but you really have to have both. Someone who's focused purely on results with a terrible process and heavy-handed leadership style, they eventually come up short, unless they bounce from organization to organization purely on the strength of their results and never stay somewhere long enough to deal with the destruction that they're causing. But someone who does all the right things and is this great person to work with and engages people but doesn't quite achieve the results that person comes up short too. So, I think it's something to think about. It's something I think about, but I think it's good for everybody to think about. Where am I as a leader? And which side of that equation maybe needs a little focus – on the what you get done versus what kind of leader are you? That's just a little side thought on measurable results.

TAMMY:
That's very good. What tangible things are you doing at your organization to address physician relations, engagement, and retention, and is it working?

JIM:
Sure, and I have to remind myself of this all the time, but you can't hide in your office. You have to get out and engage with Physicians. You have to go in the Surgeons’ lounge, go in the Medical Staff Lounge. You have to plan opportunities to meet with physicians, to discuss issues and opportunities at their office practice or the work they do in the hospital.

You can't delegate physician relations to a department or to the people that work for you. I mean physicians are always going to want to talk with the top leaders and to know they're being heard. You said something earlier about pay now or pay later. You can distance yourself from physicians and avoid discomfort for a period of time, but it will absolutely eventually come to bite you. So, that's something we're trying to be a lot more intentional about getting out talking to people. We're trying to be intentional about the informal interactions making them happen but also the formal interactions where we are specifically getting together to talk about, ‘How are things going on? What can we do?’

One thing that just popped into my head is we've begun with new physicians, about a month after they've started. So, we've obviously talked to him during the recruitment. We talked to them right when they arrived, but waiting a month or two after they've started, and they're working in the office practice and they’re working at the hospital, then having lunch with the CEO and me – just alone, a private lunch, just to talk about how things are going. Because at that point, they actually know what’s working and what’s not working. And we can have a real conversation and make sure that we're connecting with them. Because we have a tendency to spend all the time talking to them before they start, and then letting them go many, many months before we find out, they're not really happy. There really are some things that we need to be doing. So that's an example of trying to connect with them sooner before it begins to unravel.

TAMMY:
Wow, you are giving our listeners, some major, major golden nuggets! You talked about you need both process and outcome. You talked about, you can't hide in your office. That's a tweet. And now this - having this private lunch afterwards. And you're right! They don't know what, they don't know when they first start. And to say, ‘Call me if you need me.’ Well, that's not going to happen. I love that you are proactively setting that up. For all the leaders on the line, you need to listen to these tips. This is worth the weight in gold.

Can you describe a time, and this is probably my favorite question, so, sorry to put you on the spot, but can you describe a time when you were terrified, as a leader? You know, one of my friends say, ‘They found themselves swimming in the deep end.’ But was there a time that you can remember vividly?

JIM:
Yes, certainly, and I definitely felt like I was drowning in the deep end. Actually, shortly after arriving at Archbold, I'd barely gotten comfortable leading an Ambulatory Care Center that had 80 employees, all of whom had jobs that I didn't know how to do. By the way, that was a very humbling thought one day to realize. It was really my first role in an operational management capacity instead of more of a project consulting capacity. Anyhow, one day I realized, ‘Okay. I don't know how to do any of these eighty jobs.’ I barely gotten comfortable with that, and my boss, who was the hospital president, asked me to assume additional responsibility for the main hospital operating room, and here's the kicker, in fact to serve as the OR Director. He was a wonderful man. He was a physician who moved into a Chief Medical Officer role and then became President. So wonderful man. This was probably not his best decision. I was definitely in the deep end and basically no experience for that role.

But, if I ever wanted a leadership boot camp, I got it. I learned to work with the leadership team around me, trying to respect their knowledge and not trying to act like I knew more than them because it was painfully obvious I didn't know more than them. I learned to handle brutally challenging demands from the doctors kind of a “Jim Carter in operating room four, NOW!” You know, that that kind of thing. I'd have to quickly put on scrubs or put on a bunny suit and run down there and stand in the corner and listen to whatever was not going right.

I think the thing I learned more than anything else, which has probably helped me with physicians ever since then, I learned that immediately having an answer or immediately solving the problem wasn't nearly as important as taking the time to listen to them, and here's the kicker, circling back in a timely manner to update them. Whether I had a good update or a bad update, whether I was finished solving the problem or not, but to circle back about where we were on their concern. I learned that if they don't see that effort, every little issue goes on the imaginary score card. But if they see that you're working with them and making a real effort and keeping them up to date, they are much more understanding about that we are trying to make improvements and it's going to take a while to do everything they want. I learned a lot, definitely drowning. I'm sure the leaders and the staff wondered who is this guy? Why have they given him this responsibility? It was an immediate lesson in humility and collaboration, and it was an immediate lesson in how to work with doctors. I don't know that I would have mentally survived it forever. Thankfully, at some point, a new leader extracted me from that, but I learned a lot.

TAMMY:
Well, it was almost a gift, right? That you didn't know at the time, but I love those gifts that you can look back and say, ‘Wow, if I hadn't had that, if I hadn't been drowning then I wouldn't be where I am today because of all the lessons I learned. That's music to my ear, talking about following back, circling back to them. I love that. And I've never heard the term, “imaginary scorecard”. Brilliant, Jim. That’s brilliant.

JIM:
I don't want to sugarcoat this. Looking back, I learned a lot but that was a very stressful time. So, I think you know when you maybe when you find yourself in those really, really stressful times to try to hope or see that there is some light at the end of the tunnel, and you'll come away from a situation having learned something. But it was tough.

TAMMY:
Yeah. Well, it's never fun while you're going through it, right? Well kind of random question, a personal note. I know you're a dad of a couple of boys. How is what you're learning in your job, and the pace of your job, how do you stay plugged in? You have one in college, one finishing high school. How do you stay plugged to make sure that first things first, that you're keeping things in priority perspective?

JIM:
I think there are a lot of different ways. I mentioned earlier that I neverreally had a path that I was determined to get to a certain point and I was going to as fast as I could make my way up the steps I was going to get there. That's true. But another example of that is I had to make a personal decision a few years ago about whether to personally pursue the CEO job at my organization, whether I wanted to be considered for that, whether I wanted to be in a type of transitional path towards that. And I made the personal decision that I wanted to stay in the Chief Operating role that I'm in because I realized how much came with the CEO role. Everybody's got to make their own decisions about these kinds of things and you have to pray about it, talk to your spouse, talk to your family, but I think you have to decide what matters the most to you and that's important. So I've been totally happy with where I am right now, but I do try to make sure that I stay connected with my kids. I know some people start their day going and working out or something. But with the one son that I have left at home, I try to make sure that we connect even briefly every morning. You know, we don't sit around the table and eat breakfast like I did as a kid. It's so easy for us to be on different schedules at night or different schedules in the morning, but I make sure that I can at least connect and say, hey, have a good day. I love you and it’s important to me to stay connected like that. That's critical to me.

TAMMY:
I love that. Well, we're going to close up with our fast-five, rapid-fire questions. You answered one of them. How do you start your day with a fabulous answer. So, another question I have is during your crazy busy weeks, what do you look forward to most to do over the weekend?

JIM:
I like to get outside if I can whether that's hiking somewhere is always fun. But even if I can work in my yard, I enjoy being outside. It's just the opposite of kind of being hold-up in the hospital all day and I enjoy that.

TAMMY:
There's actual research that shows that when you're outside with nature, you get smarter. Really. Seriously. Okay. What word or Mantra do you live by?

JIM:
Do the right thing. I think if you find yourself straying from that, it's going to unravel on you.

TAMMY:
Always. One hundred percent. What is the most important characteristic of a leader?

JIM:
Well, not to beat a dead horse, but I think Integrity. Again, if a leader finds himself losing any sense of integrity, whatever they're accomplishing is not going to last. Integrity.

TAMMY:
One word or piece of advice you would give to your younger self.

JIM:
Eat healthy and exercise more.

I'm still on the New Year's resolution phase. If I'm not going to need a New Year's resolutions to do that. So, I just thought I'd go ahead and tell my younger self to start earlier.

TAMMY:
Yeah, there you go, hardwire it.

Well, Jim. Thank you so much. This was a fascinating interview on so many levels. So, thanks for joining us on the Leadership Lens Podcast.

JIM:
It's been a real pleasure to talk to you. Thank you.

CLOSING:

Tiller-Hewitt works with leaders who want to consistently deliver strategic growth and measurable results.

The organization is recognized as the leading experts in strategic growth, network integrity, and physician engagement. Thanks for listening to this episode of the Leadership Lens. For more leadership resources and strategic growth solutions, visit tillerhewitt.com.