Leading a Multi-Site Ambulatory Organization

Leadership Lessons Learned Early

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 Christina Carney, the Chief Executive Officer of Shawnee Health Service. Christina got me in the first 5 minutes of the podcast reminding me that while leaders change organizations – good leaders don’t change their leadership perspective. We talk about leadership burn-out, how to resist a popular leadership urge, and as a six-sigma Black-belt, Christina doesn’t disappoint when providing succinct insights on focus and results.

TAMMY:
Hello, Christina, thanks for joining the Leadership Lens podcast.

CHRISTINA:
Thank you, Tammy. I'm so honored to be here with you today. I appreciate you including me in your podcast.

TAMMY:
Awesome. Well, you have such fantastic or fascinating career journey, in hospitals, in consulting, and now on the ambulatory side, I'm looking forward to hearing things from a little different vantage point, and not so hospital centric.

CHRISTINA:
I've been truly blessed to have such a fulfilling career. But, you know, I think I'm pretty traditional in my leadership perspective. So, I don't know if it'll be a whole lot different than what we hear from others, but we'll see.

TAMMY:
So, if you don't mind, let me tell our listeners a little bit about you first. Christina is the Chief Operating Officer of Shawnee Health Service based in Southern, Illinois where she's responsible for a network of 11 Federally Qualified Health Centers, or FQHCs. If you're not familiar with what FQHC means, they provide comprehensive integrated primary care, behavioral health, dental and social services, to underserved and vulnerable populations. And that doesn't even mention all the relationships that you're required to have with other health care delivery entities to make your machines hum.

Prior to this role, Christina served in a larger organization managing FQHC’s as the Chief Operating Officer as well. In addition to having a safety net hospital and a Community Mental Health Organization. And then, before the FQHC world, Christina has held executive-level positions for a couple health systems in Southern Illinois, overseeing pop health and then big kudos for leading regional participation in one of the country's largest ACOs. That's pretty awesome Christina.

CHRISTINA:
Wow! Well, thank you for making me sound like a rockstar.

TAMMY:
Well, you are a rockstar.

Let me go on because at Tiller-Hewitt, we have the pleasure of Christina being on our team for a while. So, as a Six Sigma Black Belt, she helped stand-up our lean or our process improvement division and worked with, I would say over 50 of our partner Hospital CEOs, physicians, and practice managers to streamline access to care and improve processes, which resulted in some pretty phenomenal service line and specialty program growth. So, thank you again for those efforts Christina.

And then last before I stop talking and Christina starts. Christina is super active in the American College of Healthcare Executives where she consistently wins awards trophies for her service and insight. And she also serves as the president of the Mid-America Healthcare Executive Forum, which is a chapter of ACHE.

So welcome, Rockstar.

CHRISTINA:
Thanks, Tammy.

TAMMY:
Let me start by asking, did you always know you wanted to be a leader or in a leadership role?

CHRISTINA:
No, you know, I was a typical teenager who just knew I didn't want to be told what to do, right? But I never connected that to wanting to be a leader of others, but I was fortunate to learn early in my career that I did have the potential to become a successful leader.

TAMMY:
Awesome will tell us about was there a pivotal point in your career that you had that big ah-ha or epiphany?

CHRISTINA:
I did. So let me expand upon that a little bit and tell you a little bit about this. So, I’ve worked in healthcare, since I was sixteen years old. I went to high school half-days, and I worked half-days as part of a Workforce Development program. And at that time, I was interested in becoming a physical therapist and specifically working with children with physical disabilities and limitations.

During my first week, observing in the Outpatient Rehab Department, I'm with the lead physical therapist and there was a little girl there, who was about three years old, and she took her first step. Well, that terrified me. I had never truly been exposed to a child with physical disabilities. I didn't have the mental maturity to understand, because again I was at the ripe old age of 16. That this little girl had taken many steps forward in her life before she took that first physical step. So, at that point, I decided I didn't have what it took to be a front-line caregiver. I just wasn't wired, I wasn't strong enough for that, and I determined based on some other observations that I had done in this Workforce Development program, that I was better suited to care for those who care for our patients.

But as I grew older, I learned of the opportunities to celebrate each milestone of achievement and accomplishments, but I'll tell you, I have no regrets and I still feel very comfortable that my role is to care for those who care for our patients.

TAMMY:
Man, that's tweetable Christina, “caring for those who care for patients” - I love that.

Well, you know, a couple of things came to mind in your story. First of all, you were fortunate that you had that experience when you were so young.

CHRISTINA:
Absolutely. That's why I said I was so blessed to learn early in my career that that wasn't the right path for me.

TAMMY:
Yeah. For some people that takes years. Yes, exactly. They graduate from college and get into the job – of what they thought was going to be their dreams, and they hate it. What a blessing in disguise! Iit also proves that our kids need to be exposed more. They need to get jobs - go out there. How awesome was that, that it was a work/school kind of development program.

CHRISTINA:
Absolutely. And that's you know, you don't always know at that age, what you want to do? But a lot of times you can decide what you don't want to do. And so, I think there is a benefit for that.

TAMMY:
Agree totally.

What do you think of the top talent leadership challenges today professionally and organizationally?

CHRISTINA:
I think, having competent and compassionate workforce is always a priority. And, you know, we've just talked about people sitting in the right roles and, you know, this has become such a huge challenge now, as a result of the pandemic and even though it's always been a priority.

So, we're known for quite some time that we would not have enough individuals in our workforce to replace our boomer generation, right? And as a result of the pandemic, we saw many of these individuals who would have generally exited in a more steady pace, exit the workforce in mass. As a result, we're now left with critical shortages nationally in all positions, and a hesitation for people to enter healthcare in any capacity.

Healthcare has always been hard, but now the general public has seen firsthand - or through the lens of the media - what those who are on our front lines of healthcare deal with, and they're now intimidated by the industry. So, we have to try even harder to encourage people to see the positives in the healthcare field and give them pathways to success with minimal barrier.

So, I live and work in a rural area, and we're really trying to be creative in developing ways for individuals to start their healthcare careers, their healthcare journey. One example that I'd love to share is in our dental practices. Our dental practices have followed the exact path that I just discussed. We've been in a national shortage of dental assistants for a while, then during covid, dental practices were closed for months. Many individuals left the field, or took other jobs, or determined that they no longer needed to work. People learned they could survive on a lot less than what we could survive on before this pandemic. And dental health is so extremely important to the overall health and success of an individual. So, we're starting an apprenticeship for dental assistants, where we're going to hire individuals. We're going to train them on the job. We're going to prepare them for their licensure exams. And then we're going to ensure that they have a position after they become licensed. This is going to eliminate some of the costs associated with education. Ensure that they have income during their education and create a pathway to a successful career.

Our next phase is going to be to create scholarships for local high school students for dental assistants. And this is going to be a great opportunity for those individuals who don't want a long college program but would like to have a good stable career. So, we're really working on growing our own workforce, which I think is a challenge that many organizations are going to have to look into further.

I'd say one of the other top leadership challenges is determining what our organization, regardless of the type of organization you lead, what that organization is going to look like post-pandemic. For healthcare, we're going to have to redesign care delivery. Appropriate telemedicine must be a normal part of our system. We've seen the value of tele-visits for behavioral health, some general monitoring visits, and some acute visits, and we can't lose that going forward. We have to find ways to make accessing our services quicker and easier. Whether that be to continue with the scheduling acrobatics, as I like to call it, that we have become so good at during the pandemic or whether we're implementing new technology that's going to allow us to decrease paperwork, streamline check-in whatever that component of technology assistance may be that we've just kind of lagged behind on.

And we also have to be very mindful of what our consumers are going to endure. No one has ever wanted to sit and wait in a waiting room. And they're certainly not going to do that post-pandemic and not for long periods of times waiting on physicians or health care providers in the future like we've seen in the past.

TAMMY:
A couple of things that you said, caught my ear. You’ve always known that you weren't going to have enough individuals in the workplace to replace the boomer generation. So overlay all of these issues we're facing, with now generational compounding of exiting the workforce. That was very good. I've not heard people talk about generations.

CHRISTINA:
It's just something nationally that we've really kind of known, but again this mass exodus is what I think what has been the new component of that.

TAMMY:
Right and then you said appropriate telemedicine, is there a story behind that?

CHRISTINA:
Well, I think that you know as anything we can let the pendulum swing one direction or the other and we've got to make sure that it lands in the middle. We can't sacrifice quality for convenience. And so, there are times that patients need to be in the office. They need to be seen. They need to have that physical exam. They need to have their blood pressure monitored by a professional. They need to have their weight assessed. So, I think, just making sure that we don't go too far on that pendulum, you know, to the side of tele-visits.

TAMMY:
You know, about Tiller Hewitt since you've been on the inside, but you know, we work with organizations that want their leaders to consistently deliver strategic growth and measurable results. So curious, what are your secrets and success strategies really around strategic growth and measurable results?

CHRISTINA:
Well, you know for strategic growth to be successful, you have to know and understand both where you are, and where you're going. Now, that may sound like a given, but many times organizations will start with where they perceive they are, or where they think they are, or where they think they should be, rather than where they are actually. Sometimes you get people who want to appear that, they're further along the process or maybe they want to make sure their leaders think that they can achieve more than what's really feasible, and that's just a disaster that leads to blame and failure for all. So, I think that a key component is to be honest about where you are organizationally and personally and start from where you are and grow appropriately, but definitely start, that's the key component with that!

And then for the measurable results, again, you have to have a strong foundation to build upon. So, it's important to appropriately identify in advance, not only what you're going to measure, but how you will measure. You must define an advance, your metrics, and your parameters. You need to pull your baseline data and confirm that information. And then you need to present your baseline data to those who are actually producing inputs or doing the daily work that actually determines what those outcomes are. Explain to them what you're trying to achieve, and make sure that what you're measuring is a good representation of what their efforts are going to produce.

It's also important to resist that urge to change everything at once. That's probably the most difficult, right? We're fixers in healthcare. We're here to solve a problem, but if you turn every knob and dial all at once, you're not going to be able to identify what created that success, and then you're not going to be able to replicate it and capitalize on any success that you were able to achieve, so you’ve got to resist the urge to change everything all at once.

TAMMY:
Oh, spoken as a true black belt right there. Yes, that was good. I love how you talked about the disaster that leads to blame and failure for all. What's the deal about this industry and the blame game? Instead of fixing it, we like to point fingers, don’t we?

CHRISTINA:
Yes. Yes, and we've got to remember when you're pointing one finger out, there's at least you know, three other ones pointing back at you.

TAMMY:
I'm hearing my mother’s voice ring through. Hey, so let's move on. What do you think about how, how can leaders consistently re-energize themselves as leaders? Everybody forgets about leader burnout, we talk about doctor burnout and nurse burnout, but what about leader burnout?

CHRISTINA:
It is very real as you said, and so I think it's really important for leaders to reconnect with what created their passion for their profession in the first place. And that's been tough for us right now during this pandemic for sure. And we're, inching up on two years now and for me, I'm really looking forward to reconnecting with our employees, providers and patients, in-person. I know we get to interact with them on zoom. I personally still have been in the office every day. I haven't done a remote work. I have just felt very passionate that there are some of my individuals that I work with and work with us and our patients that can't do their work from home. Therefore, I need to be in the office as well. But, you know, I haven't been able to really interact. I haven't been able to walk around our clinical areas. I haven't been able to talk to our staff and our patients and that's always extremely rewarding to me, you know, being able to see what our employees can do on behalf of our patients is so fulfilling and really ignites me and reignites my passion and re-energize me. So, I think it's just real important for each leader to recall why you got into your profession in the first place and make sure you reconnect with that from time to time, pandemic or not.

TAMMY:
That's good. That's very good. Well, speaking of leaders what mistake do you see leaders make frequently?

CHRISTINA:
One of the mistakes that I see leaders make frequently is something that unfortunately has been magnified and even a necessary evil during the pandemic, which has been pushing leadership agendas and decisions from the top down. As leaders, we generally need to set the vision and tone, but we don't need to micromanage situations, but during the pandemic, it was also often necessary to keep up with those ever-changing environments. To make those changes, to be the one to tell individuals how they had to practice, how they had to work through their day and really micromanage situations that generally we would not do. And so typically we hire individuals in our organizations to do a job that they're highly skilled for and trained for and we need to let them do that job for us. That doesn't mean we can't change or don't need to step in from time to time, but that shouldn't be our normal process. And so, I've seen it be very hard for individuals to get back out of that that state and individuals who have a need to control things that's really played into that need to control things for them. And so that makes it really difficult. And, you know, there's nothing more deflating for a staff member who's been working hard on a goal, or a project and the work not come to fruition or somebody unnecessarily change that plan and it becomes one of the leaders of their organization. That's just so, so difficult for people to swallow.

TAMMY:
Yeah, that's good, so you basically, you say it so eloquently, I'll say it. We fed the egos of the control freaks and now they have to give the control back up and they're struggling.

As a COO, you’re hiring people and building teams all the time, so what do you consider before you promote someone?

CHRISTINA:
Yeah, that's a great question and it's something that we in my role that I'm at now, we've really been having some conversations about that were knee-deep and some succession planning for our organization. So, it's really good timing for this. And that's one of those again necessary evil things that you've gotta do to really be forecasting for your organization. And so, I really look first at the credibility that the individual has gained among their peers. I look at their true desire for the work at the next level, not just the title and the salary. And I also look at whether or not that promotion sets them up for success. You know as a leader, it's my responsibility to create opportunities to ensure that every member of our team can be successful. If we over-promote an individual and they're not successful, that responsibility lies with leadership, not that individual. So, it's very important to me that we promote people when they're best prepared for the role. You know, I've had people in the past who've talked to me about advancing and you know what they wanted for their next step, and you know of advised them that you have lots to do in your current role, where you still have an opportunity to learn and grow, let's focus on that before we get to that next level of promotion. But then as a leader, I make sure I help prepare them by giving them those learning opportunities, giving them those additional duties that help prepare them for that next step where I know they're wanting to go.

TAMMY:
Wow, that's that was a powerful and a perfect leadership answer, I'm impressed, that was good. Many leaders don't see that as their role to help, it's like, I'm here to lead I'm like, well, leading is also about helping others through their journey. That's good Christina.

CHRISTINA:
Yeah. So, let me tell you this. I typically write some quotes, I've just turned my chair to read you the quote that is on my white-board that I have written out here and it's a quote from Eleanor Roosevelt and it says, “For our success to be real, it must contribute to the success of others.”

TAMMY:
That's good. That's very good.

Well, let me ask you as a black belt because I always love to pick your brain and see how you're making things more efficient. But what are some tips for other leaders about how to be more efficient and get more done?

CHRISTINA:
And you know, this answer will change with circumstances, right? And so, I think where we're at now, as a society, as leaders, particularly in health care, we have to make sure that we're prepared for the work we’re doing, regardless of what our role is. So, if we're overly stressed or we have too many things going on in our life or our mind, we can't be efficient. We can't be effective. We can't get more done. And as a leader, our staff is going to look to us to see how we respond. We need to be able to lead with an even temperament. If the leader is frustrated, their teams going to be frustrated. If a leader is overwhelmed, their team is going to be overwhelmed. We've all heard so many times, okay leave your issues at the door before you come in. You know, pretend there's a tree, pretend there's a branch – leave it at the door. And one of the things that were starting to see now is that we're beginning to make that shift from just leave it at the door, to understanding that it's okay to take time for yourself so that we can be a better version of ourselves. So, if you need to take a quick break from your office, if you need to take a day off or have a conversation with a trusted source, whether that's a friend, a family member, or a professional, do what you need to do to be prepared to take on whatever task is at hand. Self-care is so important, that helps us to be present, helps us to be available to do the work and then that enables us to be more efficient and get more things done. So, that's kind of where my mindset is right now, just because of where we've been as a world for the last two years.

TAMMY:
I like, how you said, if you're overwhelmed, they'll be overwhelmed. It's almost like parenting a little bit, if you come in and you're all hyped up, you know, your family responds the same way.

CHRISTINA:
So much for the team as well. You're right.

TAMMY:
Well, from an insider's perspective this is a popular question for people who aren't in healthcare that think they know it all because of news, but from an insider's perspective, how would you describe the current state of the healthcare system in our country?

CHRISTINA:
We're tired. We're really tired right now. We didn't stop during the pandemic. You know our work increased. It changed daily, or more frequently, especially during the early days of the pandemic. We've been caught in the middle between science and medicine and politics. The general public, as you just indicated, has made so many assumptions and the media has portrayed whatever lens they want to project, you know on things out there, and we bring it in the middle of it. So, we all desperately want to be able to move to whatever beyond covid looks like. But I'll tell you because of that, I think as an industry, we're ready for change and we're motivated to change. And so, as healthcare leaders, our task now becomes ensuring that the changes we make are in the best interests of our patients, our staff, and our providers. We have a huge challenge still coming, but I think it is a challenge that can unite our industry and make it to where we have a better outcome for individuals, both internally being our staff and our providers, and externally being our communities and our patients.

TAMMY:
Well, I cannot believe that our time is just about up. I love all of your answers to these questions. Wow, your insights are awesome. Before we end, I like to close with what we call the Fast Five wrap-up.

CHRISTINA:
Sounds exciting. Let's go.

TAMMY:
What are you currently reading?

CHRISTINA:
So, I'm just beginning Permission to Dream by Chris Gardner. He was a virtual keynote speaker at a conference that I recently attended, and I'm really looking forward to reading his book.

TAMMY:
What words or mantra do you live by?

CHRISTINA:
I do not say no to new learning and opportunities. Now sometimes this will take you down an unusual or an alternative path. But when you've done things, that others were not willing to do or willing to learn, you end up with a skill-set skill set that is rarely matched.

TAMMY:
How do you start your day?

CHRISTINA:
You know, I get right to it. I get up and I get going.

TAMMY:
What is the most important characteristics of a leader?

CHRISTINA:
I would say to be respectful and respectable.

TAMMY:
Last, one word or piece of advice you would give to your younger self?

CHRISTINA:
I'm going to air quote here “setbacks” (in air quotes) are not only inevitable, but they are where and when you learn and grow the most.

TAMMY:
Very good. Very good.

Well, Christina, thank you so much for being our guest and for all of your insights that you shared and hopefully you will come back another time as our guest on the Leadership Lens.

CHRISTINA:
I would love to thank you for having me, Tammy. It's truly been a pleasure.

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.