Barn Talk - The Struggle for Health: The Growing Crisis of Rural Healthcare in America w/Todd Patterson

Episode Date: May 17, 2023

On this episode of Barn Talk, we had Todd Patterson on to dive into the intricacies of mental health care and hospital management in Iowa. Todd has 20+ years of experience in business administration. He’s dealt with SARS, West Nile, MERS, Avian Flu, and H1N1. We discuss the importance of crisis stabilization units, outpatient services, and having a well-balanced team to address organizational weaknesses and strengths. We also explore the impact of COVID-19 on hospitals and the healthcare industry, as well as the struggles faced by rural communities in recruiting healthcare providers. Additionally, we uncover Todd’s personal journey and his decision to prioritize his family and community by becoming the CEO of a Hospital in his local community. Finally, we highlight the importance of workplace culture and leadership in ensuring top-quality patient and staff care. Barn Talk Merch! 👇🏻 https://www.thislldo.co/  SUBSCRIBE TO THE PODCAST ➱ https://bit.ly/3a7r3nR   SUBSCRIBE TO THIS’LL DO FARM ➱ https://bit.ly/2X8g45c  SUBSCRIBE TO BARN TALK CLIPS ➱ https://bit.ly/3BlZnqq   LISTEN ON: SPOTIFY ➱ https://open.spotify.com/show/3icVr4KWq4eUDl7Oy60YMY  ITUNES ➱ https://podcasts.apple.com/us/podcast/barn-talk/id1574395049 Follow Behind The Scenes👇🏻 ● This’ll Do Farm Instagram ➱ https://bit.ly/30KPBNk   ● Barn Talk TikTok ➱ https://bit.ly/3qciekS   ● Sawyer’s Instagram  ➱ https://bit.ly/3BtX0n4   ● Tork’s Instagram ➱ https://bit.ly/3LGZJxS    ------------------------------- ***PLEASE NOTE*** Barn Talk is a significant break from the typical content viewers have come to expect from This’ll Do Farm. Please be advised that we will be exploring a wide variety of topics (some adult-themed) and our younger viewers (and their parents) should be advised that some topics will be for mature audiences only. ⚠NO FINANCIAL ADVICE / DISCLAIMER⚠  The Information discussed and shared on Barn Talk is provided for educational, informational, and entertainment purposes only, without any express or implied warranty of any kind, including warranties of accuracy, completeness, or success for any particular purpose. The Information contained in or provided from or through this podcast is not intended to be and does not constitute financial advice, investment advice, trading advice, or any other advice. The Information on this podcast and provided from or through our content is general in nature and is not specific to you, the user or anyone else. You should not make any decision, financial, investment, trading or otherwise, based on any of the information presented on this podcast without undertaking independent due diligence and consultation with a professional, professional broker or financial advisory. Understand that you are using any and all Information available on or through this website at your own risk. RISK STATEMENT– The trading of Bitcoins, alternative cryptocurrencies, NFTs, individual stocks, etc. has potential rewards, and it also has potential risks involved. Trading may not be suitable for all people. Anyone wishing to invest should seek his or her own independent financial or professional advice. Learn more about your ad choices. Visit megaphone.fm/adchoices

All of the food we eat and much of the clothing we wear comes from plants and animals that are raised on farms. Farms are different in type, in size, and even in name. Welcome to Barn Talk. What happens at the barn stays in the barn until now. We're going to let it all out for you guys. Today's going to be a special episode. We got a guest on that we think can provide a lot of value to guys. But before we get into it, you guys know the drill. Pay the fee.

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We still really appreciate it. And if you guys want to buy some Barn Talk merch, feel free. We got it in the link in the description if you're watching on YouTube or in the link in the show notes if you're listening on Spotify or Apple. Yeah, not only that, the YouTube version of Barn Talk is on fire. It is on fire. So I don't know, but I think I'll be willing to bet you that in the next 10 days, our Burnton, barn talk subscriptions on uh youtube are going to surpass our subscriptions on this will do farm which is crazy it is crazy because we've been doing this will do farm for almost four years or up and we're in

we're almost a 50 thousand and we've been doing barn talk for what two years we're like we're going to almost hit 50 000 so it's crazy how that i think how that works i guess our our pigs aren't as interesting as we thought they are or else barn talk is just that damn you just get to run your mouth more here. That's why. I do. That's for sure. So, I'd like to say that it's wisdom, but it's probably just age. I had to put my glasses on because I couldn't remember what I wrote. So one of the perks of living in small town America, especially in the Midwest, has always been that everybody that you get to work with, you get to know because they're part of your little town, and that included, you know, your local hospital, your local doctor. And having a local doctor in a nearby

hospital is something we've all kind of taken for granted and all that is changing and and for a lot of people it has changed and for a lot of other people it is changing and I think it's going to continue to change and that's not a good thing as consolidation in the health care industry grow people are finding themselves without a local doctor and having to travel a lot further to get a checkup or a procedure and deal with people they don't know which that's never fun when you've got a health care issue and our guest today he is right in the thick of it he's the CEO of our local hospital here Washington County Hospital and Clinics and he's formerly the C.O.

of University of Iowa physicians and he he knows the struggle because he's living it every day and we thought that that was a really interesting subject that we wanted to dig into and so he's working hard to keep rural health care accessible for citizens. But the other side of that is you've got to keep the hospital profitable enough that you can keep the doors on. Todd Patterson, welcome to Barn Talk. Hi, Sawyer. Thanks for having me. Yeah, thanks for coming down. Yeah.

So to give us just a little bit of background of who you are and kind of what you're doing today and, you know, kind of how you got here. That's pretty broad, but I think you can handle it. Yeah, well, okay. I'll just start from the beginning. I'm originally from Bettendorf, Iowa, but when I was growing up, I actually lived in multiple places in Iowa. I was born in Britt, Iowa, which is north-central Iowa.

Moved from there to Cedar Falls, while my dad got his master's degree at U&I in education. And he got a job working in a tumois. So we lived there for several years until like 1982 when the Hormel plant down there closed and everybody lost their job, including him. So he got transferred to Betnorf where I finished out my schooling. So went to the University of Iowa and I got an undergraduate degree in psychology

and a master's degree in business. And while I was there, I started working at the University of Iowa Hospital in about 1997. Actually, I started there as an undergraduate student in 1994. And I would copy charts. I copy patient medical records. and mail the, you know what copy machine is? Yeah. I don't know if I've ever used one, but I know of one.

I used that and a typewriter and microfilm back in that day. So that's where I started, like sort of the quote-unquote copy room and kind of worked up from there and got a full-time job after I graduated in 97 and, or 96, 96, 97. and did some sort of nondescript kind of jobs for a little while. And then I started to get into health care administration in early 2000s. And so my, and the way I got into administration is I screwed some stuff up. That's kind of an interesting story. I had some really good ideas that didn't work out particularly well. But the ideas were really good.

And so I had some, mentors that kind of took an interest in me from kind of vision and idea standpoint, not necessarily execution standpoint at that time, which is still kind of an issue I have. And so my first kind of real job in health care was I was an assistant administrator in the ear, nose and throat department at the University of Iowa, which at the time, and maybe still is, was the second ranked E&T department in the country. And so I worked, I did that, became administrator after a year and a half or so of doing that. So I was no longer the assistant.

And then I did that for about eight years. I got a call from the dean of the College of Medicine who I did not know at the time. And he said, I need a chief of staff and you're going to be my chief of staff. And, um, yes, sir. I said no. I don't want, I don't know what that means. What does that mean? For one thing. But it was assistant dean for administration or what we used to call the ass dean.

I guess I should ask, can you swear on this thing? Yes, you can. Within reason. Oh yeah. Oh, yeah. It has the right disclaimers. All right. So, you know, I thought that was kind of funny.

So I went down and at least talked to him and I said, I don't think I want to be the ass dean and the chief of staff. I don't know what this job is. And so I was playing basketball. ball a couple days later and a guy came into the gym and literally put me in a hammerlock and he said you're going to be the dean's chief of staff go see him today end the story and the guy was Peter Denson who uh is a infectious disease doctor and so I went in to meet the dean his name was Paul Rothman is still a friend of mine and became his chief of staff which meant I basically

whatever needed to be done. I did. Within the medical school, within the research enterprise at the University of Iowa, or within the hospital that required, I guess, dirty work, like the Hatchet Man.

Yeah. I'd help them meet with donors. You know, we'd go down to Miami, for instance, for the Orange Bowl in 2010, and we'd meet with all these donors, and he'd give me a big stack of paperwork and said memorize all this stuff. And then we'd,

be sitting down with these very rich donors and I'd be like this is John Smith he likes to bake and he's got a 48 inch deck on his lawnmower and he really likes to talk about you know and then the dean would talk about that so he actually left in 2012 and he became the president and CEO of Johns Hopkins Medicine wow and I took a look he recruited me out there I took a look at doing that but this is my wife's hometown she's got a yep a business here, he's based here. And I said, hey, should we look at Baltimore, you know, to look at going to Hopkins?

And she said, no. I said, well, we should discuss it, right? And she said, no. And so that was the end of that. Nope. So then I moved on with, you know, you don't want to be the chief of staff for the next dean because it's kind of a personal relationship.

So I became the executive director of the Hart and Vascular Center at the University of Healthcare then, which was a really big job about an $160 million endeavor at that time, probably much bigger than that now. And it encompassed cardiothoracic surgery, so heart and lung surgery, heart transplant, plus cardiology, you know, heart interventions, cath lab, and also vascular surgery. I did that for a little while, and I got a call from the University of Iowa Physicians

group and kind of like what happened when I was in the other place. He said, hey, I want you to be my, I want you to be the chief operating officer for the University of Iowa physicians, which is the, I don't know, those 1,100, 1,200 physicians that serve all the locations in the University of Iowa healthcare. Yep. So on main campus and all their outreach areas, et cetera. And he said, no, I don't want to do that. So they kept searching and they called me back and said, no, you're going to have to do it. So I did it on interim basis. And then I took that job full time. So I did that for four years until 2018 when the CEO position here in Washington, Iowa opened up.

And I decided that I'd have had enough of commuting. I've been commuting from Washington to Iowa City for about 21 years. And really, I felt like that I had developed skills at that time that I could bring back to the community. and apply those here in a way that I could see them be more effective. So, you know, when you work at a place like the University of Iowa, at the time I worked, there was 16,000 employees, you know, it's hard to make any sort of, it's hard to see the impact. And so I wanted to, or, you know, if you have a good idea,

you've got to convince 800 people that it's a good idea and the bureaucratic aspects of it and the administrative burden and inertia is really hard to kind of overcome. So I felt like if I was down here, it would be a lot more autonomy, freedom to kind of decide what direction we want to take, and then feel like you have a direct impact on your family, your community, the people you know. Right. You know, and so that's what, that's what prompted me then to move in 2018. So I've been here now just five years in April and have really enjoyed it.

So that's also, I guess I should say I was an extremely talented athlete. Yes, there you go. Throw that in there. Hammer throwing? Yeah, hammer throwing. Yes, ball peen. That was in the ballpene division. Absolutely.

Well, that was good. I nailed it. That was quite the backstory. I loved it. Well, and that's a little bit. well I guess I don't know how unusual that is but you know a lot of people think about it had to be a little bit of a culture shock because you have i health care and i'm pulling this out of my butt a little bit but if it isn't the biggest it's got to be close to the biggest health care system in the state of

i would yeah i would yeah it would be there's there's a couple big ones unity point yeah and mercy one uh and but they expand you know there in terms of a central location in particular killer they're definitely the largest yeah and so to be in that wheel one to have the thought to get out but then to actually get out that had to been a little bit of a culture shock as you talked yourself through it you know all the things that the reasons why you're going to do it but then to actually do it was probably a little bit of a like how did that feel how did that feel going from that system to where you are now i was scared to death uh i was terrified of that because you got i had to the time I had 21 years in at a single place. I knew the stuff inside out. I actually really

liked my job. I liked my boss. Doug Van Dale was my boss, fantastic administrator and otolaryngologist. And so it was a total leap of faith. And I told my wife, I said, I may not do, I'm going get right up to the edge and decide not to do this at the last second. And so, I, I, you know, It was, you know, the board here was incredible. I interviewed with them and I thought, I may not make the same, you know, when I come down here. But they made sure that they not only matched it, but did better than what I was making at the university. And so I was like, it's kind of, the signs are there. It was, you know, supposed to happen.

And I was, I was scared. Actually, I was in Washington, D.C. when they made the offer to me. And I was giving a talk at the double AMC, which is the American Academy of, I don't even remember what it stands for now. But it was a big event. It was a big deal.

Yeah, it was so big, I can't remember the name. Well, you want to tell you the story about that? Yeah. So a colleague of mine, her name is Beth Jaggers, she asked if I would, so you send an abstract in and you say, this is what the, we want to talk. about right because in academic medicine at the university you've got some requirement to you know either publish some papers or do poster sessions or

present so every year I would do a couple of presentations so I told her I would help her do a talk on project management and healthcare which is something that I've done a lot of I mean that is to say hired project managers I mean I would be a terrible project manager my attention to detail is terrible so anyway we were supposed to talk to a room of a about 45 or 50 people. And so we were kind of prepared. She's like, I'll handle the presentation.

I'll handle everything. So we got there that night, they called and said, yeah, they've changed, you had to change your room. You had 150 people who are signed up for it now. And, you know, I'm thinking, I don't, you know, I've not really seen the material all that. I'm not feeling great about it.

You know, it's kind of, you got to Washington, you check the box, you know, you're going to do your talk. And the next morning, they call. and said we had to change your room again. We got 450 people signed up for this now. You're not sure how tight you are on the material. I'm like, I don't want to do this anymore. So we got into the lecture hall.

It was a huge lecture hall. And this guy, the sound guy, there was a sound guy. That's how big the place was. Came over and he put a lapel mic on me. And so I'm standing there and I'm thinking, you know how like you have to, you have a paper due or a test that you're totally unprepared for in school? Oh, you'd know, of course.

I know very well. Right. And that's how you're feeling. You're like, oh, my, and I'm starting, you know, I'm starting to get, I'm starting to sweat. And then they bring in, they bring in four huge cameras at the back of the room. They're streaming it and they're, they're taping it for posterity. And there's all, all these people just start piling into this place. And I'm like, not only is what I'm talking about not particularly innovative, like, which is what you'd like.

Right. It's, I don't even really know what I'm talking about. So, like, I was just standing there and the walls, there was this huge rumbling that was coming. Rurr, brr, rhr, rhr, I'm like, what in the hell is going on? And everybody's looking around like this. And the sound guy comes over and he goes, sir, you're breathing into the lapel mic too hard. It was, it was my breathing. I was so nervous.

So, anyway, I got through it. It wasn't very good. It was done. You know, it was just one of those things. Anyway, I went back to my hotel room. David Bruns calls me. He's like, I'm here with the board. And this is an offer.

We want you to come work down in Washington. And so I basically accepted it right on the spot. And my boss at the time was in Washington, D.C. with me. So I was like, hey, you want to grab a drink quick? And I told him, I said I'm leaving. And called my staff from the airport the next morning, came home and made plans to start working down here. That's awesome. Um, one of the biggest, I guess, themes or things we wanted to hit on today, uh, that we think can just relate to a lot of our listeners is just like the crisis with rural health care and small town health care and the problem with consolidation and, you know, going and see your local doctor.

Like it's becoming in some places across small town America, it's becoming really hard to have a local doctor. You don't have a local doctor. You got to travel. you got to go travel and when you got a health care issue you don't really want to go travel as far as you have to um so like just talk about what you're what you're seeing what you think's the biggest problem and how you're trying to combat that here in our town maybe maybe your thoughts on because obviously large hospital systems are struggling too i mean it's the whole system has problems But like how did we get to where we are today? Because everybody knows all across the country,

there's a lot of smaller hospitals that are either closing or getting bought up by somebody else. And then sometimes they get bought up. And then the next thing you know, they're still closing. So like what, how did we get here first? Well, I think there's a lot of factors about how we got here. What I would say first about Washington County Hospital in particular is that I've got a mandate from our board of trustees that we're to remain an independent autonomous hospital. And I think the reasons for that are pretty clear and compelling. So number one, you keep the control of health care and the health care decision making local.

So I don't report to Des Moines or Iowa City or Quincy, Illinois, or Omaha. I report to the board of trustees, which are elected officials in Washington County. So that's my mandate. And we've seen it, I've seen it where, you're seen it recently, in fact, where larger systems, to your point torque have purchased or done. something could be asset transfer, whatever it is, with other smaller hospitals. And that small hospital probably will lose them money when they start or was losing money before, which made them sellable. And so those larger systems usually don't care that much about that hospital. They either

want it to make money or they want to take a competitor out or they want to close it. Right. And so, just recently, for instance, you know, Quincy, Illinois, Blessing bought Keekuk, Keekuk County, or whatever, I don't, Keukukuk Hospital, I'm not sure. Lee County lost maybe $700,000 in that first year, and so Quincy closes them. So now Keekuk has no hospital. They're trying to get things righted again now. But, you know, for the larger system, they're trying to add scale. And then the problem is, is they don't, you know, if that scale is causing them a loss,

it's no issue for them to just close it. Right. The impact on the community is huge. Right. So that's the first thing I would say about some of that consolidation. You've seen the same thing in Iowa City with Mercy, Iowa City, which had Mercy One out of Des Moines was their managing partner for, I don't know, the last seven or eight years. And, you know, they're focused on Des Moines, you know, and they're focused on.

you know, and they're focused on some of the other smaller hospitals they have. And Mercy is kind of on the verge. They're insolvent. They're on the verge of bankruptcy right now. Yeah. And so that's kind of where we are living right now in Washington, which is we're going to fight like crazy to make sure that we're not put in a financial position where being acquired or purchased looks like an attractive deal.

Yeah. In terms of how we got here, you know, there's been all kinds of changes in reimbursement. You know, there's been, especially this year and in the last couple of years, wage pressures, you know, coming out of COVID have been really significant. And I don't know if you guys know anything about inflation right at the moment. But the inflation on medical supplies in particular is really, really difficult to overcome. So you're seeing places that during COVID or maybe immediately prior to COVID we're turning reasonably good margins are now either break even or losing money. And so there's a lot of those kind of things that have come together. Another complicating factor, and this is one thing that we talked to the governor about when she was here this week, is the shortage of physicians and the shortage of health care providers in general.

They're typically being, you know, consolidated in larger urban areas, and it makes it difficult for rural communities to recruit those providers. And so, you know, we're lucky in some ways that we're this close to Iowa City. It gives us a chance to recruit from there, and we have actually a lot of doctors that work down here that don't live in our community. They live in Iowa City. That has, it's a double-edged sword because we also have to compete with them, Iowa City. but I think it's been helpful in our case. The governor's bill, in an effort to help ameliorate recruiting, you know, is giving PA's physician assistance the ability to practice without the

oversight of a physician, which gives us a broader labor pool to recruit from. Yeah. So expense-based changes, changes in reimbursement, and that, you know, I'll give you another example, tort issues, so malpractice. which is a real challenge for especially obstetrics. And, you know, we closed our obstetrics program soon after I got here. Yep. And the obstetrics group in Iowa City that's not affiliated with the university

is filing for bankruptcy because they had a large tort claim. So it's those types of things that kind of, it's a confluence of factors that are creating the crisis. ish. So how do you, what are the steps you're taking to avoid getting bought? Like, what are you trying to do to combat those, those issues? How are you doing that in it? Because like you said, you got to try to go recruit talent at Iowa City and be competitive, but you're a small town hospital. You got to keep, you got to keep it profitable. You got to keep the door coming somehow. Yeah, so I think one of the first things to do. For us, it started with culture. It's a big thing. So we are very different culturally

than the University of Iowa. And so we, you know, I tell our staff all the time, we want to make this a great place to work. So for one thing, we don't pay the same as the University of Iowa, probably never will. But it's much more pleasant to work just from a general environment perspective. So we start with culture. The second thing is we partner to the extent we can with our competitors. So I don't want them too close, but I don't want them too far. So I want to look at things that are strategically important to them and then figure out if we can provide that to them without them having to come and get it themselves. If that makes sense. Yep. So I'll give you an example. The University of Iowa has a lot of employees that live in Washington, that work in Iowa City and live in

Washington. They have to go then drive up to the University of Iowa to utilize their health care insurance because they're in network with that, right? So I was like, why don't we just do that for you down here? We'll get into your health plan as a tier one provider. So your employees don't have to go up there. They can just come and see us down here. and then when they need some sort of specialty service, then they can go up to the University of Iowa. It helps both of you. Say that again?

It helps both of you. It helps both of us. So we try to partner with our competitors like that. So there's kind of mutually assured destruction isn't the right way to say it, but you understand it keeps people in check, really. They have no reason to come down here now. And that freezes out a competitor from our market.

But there's a bunch of little things just strategically like that that we try to do. The other thing is to get financially healthy. So when I got to Washington County Hospital, I think we had 80 days cash on hand, which is irresponsibly low for a hospital. I think we're about 185 days cash on hand now and trying to get to about 210. We've done that through expense moderation activities. We've done that through targeted growth of certain types of services. And then we've also tried to diversify our funding streams. So if the only money that you have coming in is from patient care, you're single-sourced.

So, you know, you probably hear us talk about our foundation all the time. Well, you guys were just out of. So coming up with investment income, which we didn't, when I got here, we didn't have any investment income to speak of. So we've diversified our cash reserves into certain investment strategies. We've increased our focus on philanthropy. And we've also then targeted services that generate margins so that we can drive profitability. The other thing is, though, you can't, not all your services are going to be margin generators. Our community's got to have things available to them.

Mental health is a tough one. It doesn't make any money, but we've got to provide it for our community. So how do we then, you know, take a margin producing service and help offset the losses with that? So we try to be very thoughtful about how we approach the services that we provide also. It's a balance you've got to find of helping the community and making money. I think mental health is probably one of the biggest. We talk about it all. We talk about us surprisingly a lot because this day.

age for sure that's something in our political system that neither side really wants to touch so the mental health services in this country had were hollowed out a long time ago and we have more and more and more problems with people that probably should have somewhere to be that don't have and nobody wants to do anything about it and i don't know how bad it's going to get before the government at the federal level and the state level in some of these states address it. But I feel like neither. It's something, it's really odd. Usually if there's a problem, one side or the other, that's like their baby and they want to

take it and tell you everything they're going to do about it and everything that the other side's not. But mental health, I feel like is one of those that both sides just like, we don't really want to touch it. And it's too bad because it's, it's a major. It's a really tough issue. And I think there's there's ways to approach it. First of all, there's not enough money in that particular system. I mean, you guys know as well as I do that if there's money to be made in it, people will do it. Yep. Right. So there's, and there's so many really good

people working in the mental health field that are willing to do it not for a paycheck. They're, they're wanting to help people. But the reality of it is if you want to have more providers in it, you want to have more resources. There's got to be more money available for it. There's also some really unique ideas, like crisis stabilization units that they have in Johnson County, that I think we could use one or two in Southeast Iowa that give people a place to go just to get past their acute symptoms when they're, you know, I don't know how else to say it, but having to freak out, right, rather than go do something. stupid, they've got this resource available to them.

But one of the things we were seeing was, you know, so if you try to work up the chain, so if you try to treat people at the level of diagnosis and get things under control at that point or before identify it earlier, you can keep them out of the acute phases of things better. So we were having, when I first got down here, we had people who were coming into the ER in acute, mental health distress, whatever that was. And they'd end up in our ER. We'd have trouble placing them. So we thought, you know what we need to do?

That's costing us a lot of money. And they're sitting there. We need to back it up so that we have outpatient services that they can utilize sooner in the arc of that progression so that we can keep them out of our ER and then out of the hospital. And that takes some pressure off the resources that exist. So I'm hoping this, week we'll actually add our second outpatient mental health provider down here.

And it's a huge need in our community. And like I said, we only have one even now who's packed. But adding a second would double our capacity. And I'm hopeful. Yep. That's good. You mentioned culture as your- He could have written, he could have read the outline without us even knowing.

I know, right? But telepathy. It is. He's feeling it. Probably one of the smartest people you'll ever have on this show. You're like Ricky Bobby, you just wake up every morning, piss excellence. No, but I was just going to say, you mentioned culture and how that's like your biggest, you know, trying to recruit people here, culture, getting people to enjoy what they do.

And like, I've heard from many people, because I know people that work at the U and other big hospitals, that's something that they feel is missing. You know, that is something that I think. I think, you know, small hospitals can provide that a better lifestyle or a better work-life balance. That goes a long way. So I guess just talk a little bit about your experience or culture, what you try to do to instill it because a lot of people miss on it. But it can be really, really important in any business. Right, any business.

Because I've been businesses that I have worked with, worked for, I've been at them long enough that I've seen the culture build, and I've seen the culture change, and I've seen the culture go in a bad direction. And you can have a lot of things. I don't care whether you're in health care or construction or what, raising pigs. We try to have a good culture here at this will do farm.

Just yell at each other. That's our. work, we work through our feelings pretty well. But no matter what you're doing, if the culture's wrong, nothing else is going to go right. Well, I think there's a couple of things. You have to have a lot of clarity around what you're trying to accomplish. So, you know, how do you communicate what you want to do as an organization to people? And our, I tell our new staff all the time, there's two things we want to do.

Take really good care of our patients and take really good care of our staff. Those are the two things that we care about. And if we're not doing those things, they need to escalate those concerns to us, and we need to deal with them. When I started down here, I tried to convey to people,

this is what we're going to be about here. And you can either be part of that, or you can, what I called it at the time, was self-select out. And the first year I was down here, we had a pretty large exodus of people that had, in some cases, worked here for a long time. And it wasn't necessarily what I was expecting to have happened, but I realized it needed to happen. And the concern behind that was always that, oh, you won't be able to recruit replacements for them. And I sort of disagreed with that because I thought, well, if it's a great place to work, why would we have trouble recruiting people? people, even if it's, you know, in a small town. And so, so what I tried to do is say, this is

what we're going to be about. If you want to be part of it, we'd love to have you. If you don't want to be part of it, no problem, but you should go, right? Go find something else to do. And so we had a lot of that. And that, that changed the culture, started to change the culture. You have people who are self-selecting and saying, I want to be here. I like what you're saying. I like what you want to do. and then we started to hire for that, right? So now you're starting to hire and saying, this is what we're here to do, this is what we're trying to do. And then I think the big, and so we used,

I used Patrick Glencione's ideal team player, hungry, humble, and smart, if you've read that. That's one of the things that we try to think about when we're hiring people. Is this person hungry? Is this person humble? Is this person smart? And then I think they've also added peaceful and courageous

recently, but does that fit with our culture? And then I think the biggest thing that I've learned in my career that kills culture is when you don't make, you don't manage poor performers. So if you allow bad apples who have bad attitudes who are going to infect a particular area, if you allow them to stay uncorrected within your organization. Doesn't mean you have to fire them, but you have to tell them this isn't going to work here, right? You either need to address that and change it or find something else or we'll help you find something else.

That is what kills the, your top performers, if they're around people like that, are just like, what is the point of me being here and doing this? So if you don't deal with poor performers, you're sunk from a culture perspective. You have to continually address that. Are you, I know you say you don't just fire those people. If they are poor performance, maybe you put them somewhere else. But are you of the mindset? I've always heard this when it comes to culture, just hiring and firing.

You know, hire slow, fire fast. You know, if they're not a good fit and you know they're not going to be a good fit, fire fast. Because you're never going to, you hire somebody, you do the interview, and they could say all the right things. then they come in and then they suck, you know, and it's, it's, so just firing fast, getting rid of that bad apple, is that something that you kind of try to? I think there are definitely times when you've totally missed the mark in hiring.

We have a recruiter and we have a really good HR person. We've got good managers. And we look very carefully, what I would say is we look very carefully for red flags in the hiring process. And I've over the years learned to listen to my gut in hiring. It's very important. If something doesn't feel right, it's like when you get married. Like, you know those things that are kind of annoying before you get married

are now extraordinarily annoying after you've been married for a long time. Those things that you're noticing red flags on at the time of hire will probably become huge issues later. So I would rather not hire somebody and maybe miss on somebody that I should have hired then have to deal with them over a period of time and then ultimately fire them. So I've got a low It's hard It's hard to

When I hire you It's because you've been fully vetted But yes I would say you got to cut it If it's a clear miss You got to cut it The other thing though Is just to tell people

This is the expectation Just be really direct with them And say look This isn't what we want here This isn't how we want to do our business And again You know If you don't like it

You know it's fine But you should look for something else. You know, don't stay here and pollute our environment, you know. So, but yeah, we'll definitely fire people if it needs to happen. So give us a little idea. What, when you show up on Monday morning in your position, what is, what's priority number one on any given day? Like, where do you start? Well, um, so, you know, I usually Sunday night is, kind of my, that's my main time. I mean, I work, I'm in the office every day.

And part of what I try to do is structure my week so that I have time to think. So if I'm not careful, Monday through Friday, 8 a.m. to 5 p.m. can be meetings every half hour, right? which is okay and needed, but in my position, you lose sight of the vision, the strategy. And so Sunday nights, the night where I kind of go in, I make, I look at my, you know, I look at my calendar for the week. I think about things I have to get done. And then I sit there and as I'm just kind of absorbing things, I'm thinking about,

all right, where do we really want to be going? what's happening here actually. And just because it doesn't hit like lightning usually, right? It's a constant, like I'm still thinking about this thing. I'm still thinking about week after week. And then all of a sudden one day you just kind of have an answer or an approach to something that you hadn't seen before. Or you had that idea, but now you've galvanized that it's the fact that it's the right way to go. So my whole, the way I structure things and my whole existence,

is to make sure I have time for me to think about what I'm doing. Otherwise, it's just assembly line, you know, keep the trains running on time, you know, which is all very important, but you can get lost in that and not do the important thing. So is that kind of the biggest, is that the most important role as a CEO is, I mean, I guess it's different in every business, but in your role as a CEO of a hospital, is it, are you the vision guy? Or is that what you really like, that's what you're good at, that's what you're going to stick to, and you'll go to the meetings, but like at your core, that's it.

Yeah. And yes, it's the short answer. I don't know if that's true of every CEO. We have, so one of the things I tried to do early on in my career is figure out what my strengths are. And the reason I wanted to know my strengths is because I wanted to know then what I wasn't very good at. And the things, what I found, how that equates is the things I'm not very good at are the things I don't like doing, which are detail-oriented, scheduling, planning, you know, those kinds of things. And so as I went through, I didn't really know what all that meant, but I kept that in mind.

I'm like, I like the ideas. I like, so on my team, when I set my core team, I need to have a back. of people that like to do those types of activities that I hate. Yep. So I've got to, there's another Dr. Schumer. I don't know if you know Dr. Schumer. He's an idea guy like on crack. I mean, he is, he's beyond me.

He's got, we try to get one idea that's valid out of 10 that he does. The rest of them are two. I'm not even ready for prime time. I can even share them with you. But he and I, often Monday mornings, or several mornings a week. We'll just sit in his office or my office. And we're just, hey, what do you think?

Hey, what do you think? Hey, what do you think? He's like, that's stupid. I say that's stupid. And then we bring it back to our core group and they're always like, oh, my gosh, that's crazy sounding. Okay, but let's actually figure out if we can do it, right? And then I've got people that compliment me in terms of their ability to,

how do you take a project from beginning to end, not missteps? and, you know, keep it on schedule, keep it on budget, which is not, I mean, maybe I used to kind of be able to do it, but not really. My wife would tell you I can't. You better take notes, buddy, because I know. That's, it sounds about right around here. Well, it is. But the attention to detail isn't our strong suit. We like the big ideas. Yeah. So, you know, I have, I have done sales, and I loved sales, and at one point, I offered to take less money if they would give me a dedicated person that when I sold the project, they just took care of everything after that. And I could just go sell the next one. Yeah. Because I was really good, really good on the front end. I was not good. In fact,

in fact, I'm pretty sure that all of the contracts and paperwork that people sign today are different than they were when I was there as a reaction to all the things that I missed when I was doing that. Which, and from from there, then I, you know, then I worked in management, managing a group of people. And that was really good for me, but my heart, the thing that I am the worst at is I start out delegating. and if it doesn't go the way that I think it should go, then I want to go, I want to go fix it. I want to go do it. I'm the guy that, with my boys,

I'm the guy that stands over their shoulders and gives them about three seconds ago, oh, just let me do it and watch me. And that's one of the hardest, for me, managing other people was way harder than selling because just the way I'm wired. and for for anybody that's one of the hardest things of the progression of any business you know as you start something you get to a certain scale where you have to start delegating

yes and for a lot of people the most difficult part of that is the delegation and letting those people do what they're good at and also what you said recognizing what you're not good at. And being okay with that. And being okay with it. It's interesting. I was talking to Kiowa just the other day. We were sitting around the fire pit and he's doing this social media management business for lack of a better word, I guess. And it's getting to scale now where he's kind of like I need to kind of maybe outsource some of this. How do you maintain that quality control? Right. And I told him, I said the hardest thing that I have ever done in my career is going from being a strong technician, somebody who's good technically,

to handing that off to somebody else to do. And what I've learned is that if you're going to do it, you have to be okay with the people doing it differently than you think they were going to do it. And what I've also learned pleasantly is sometimes they'll come up with something better than what you were thinking. And so I have just, I figure if I hire right and I got the right people, I'm going to let them run. And it's tough sometimes. But I also don't have time to really micromanage. So it is definitely, when you get to scale,

because you might be the best person at that thing, can you replicate yourself? It's really challenging. Yeah. And nobody that you hired to do a job that you are doing or have done is going to do it in your mind. Right. As good as you.

But. They don't have to. They don't have to. And they might do it better. You also got to be a strong enough person that you can back and go, wow, I wasn't near as near as good at this as I thought I was. This person's way better. I think that's really insight.

And you got to kind of check your ego a little bit, I guess. And, you know, if it's better for the organization, I don't mind if they came up with the idea and I didn't, you know. Right. 100%. So what can. What can people here in Washington County do to kind of help what you guys are trying to do? What, like, what your vision is for our hospital? But I guess broader question, if there's another community out there from one of our listeners or watchers,

like if they, if they're in a small town and they feel like they don't want to get bought up, what can they do to support their local hospital from that happening? Because I think a lot of people on this. show want to keep small America, small town America going. They want to have local health care. They don't want consolidation. They don't want fewer choices. Yeah, they don't, they don't want fewer choices. They want their options. So what can they do? Well, I think first of all, they can patronize the local hospital. You know, if they need health care rather than go to a larger system, at least give them a chance. I think our community,

in particular is incredibly supportive. So, you know, when we have new physicians come into town, you wouldn't believe the response we get from people. They're just overjoyed. We just hired a pulmonologist the other day, and we're having a specialist social early in June where the public can come in and meet the specialist. And they're just so appreciative of the doctors.

That doesn't happen in the more urban areas. I would tell you that. There's that relationship. People really want them here. But, you know, giving the doctors that feel, you know, have them want to come to some of these areas. You know, there's programs also, I would say, you know, we can access loan repayment programs because we're rural that other places can't. And there's things that we may be able to offer.

Leverage those types of programs. In our case, another thing has been. establishing a foundation. So we have a foundation that's a separate tax ID, separate entity. That allows us to, as I mentioned earlier, diversify our revenue portfolio. And that has allowed us to offset a lot of capital purchases in particular and, you know, facility improvements. And that's been a huge thing for us. It's been a lifesaver. a game changer in fact. You know, they,

the community in 1995 started that with like bake sales, you know, and it is now a huge part of what we do on a daily basis. Yeah. Do you enjoy being here, like do you enjoy running the ship here more than what you, what you experience at a bigger hospital? I do.

Yeah, I do. Primarily because of the impact, I feel like I can have on my local community. So you guys live here, right? If you need medical care, I want us to be able to take care of you. Right? And up there, you know, when my job before, you'd walk the halls. You'd never see anybody you know, right?

I mean, it wasn't, you didn't feel like you were serving your community per se. Right. So this, and that's a personal thing, I think. That's just for me, you know, kind of. I'd like to serve our community in in different ways. And that's one of them. I think that we should have good health care. And, you know, so that's what I'm trying to do.

And for me, I can see it. And that makes a big difference. So what's next for Washington County? Like what's your next project or goal that as a hospital you guys are working on accomplishing? So there's multiple facets. You know, kind of one of the recent ones was adding the helicopter, you know, which was kind of a cool project. So that's here three days a week.

I like to move that to a 24-7. Are you flying that? I've ridden in it. They actually asked me not to fly it. Yes. I can imagine that that was probably a good choice. Yeah, they actually asked me not to touch it. You know, and the point of that was to,

not only to help our patients, you know, if you have a heart attack or stroke and you're in our ER and you can, it's a 12-minute flight, you can be in the cath lab at the University of Iowa in 15 minutes getting a stent put in your heart. You know, if you're having a heart attack versus, you know, much longer if you're, it's still fast by ambulance, but it's much longer. But not only that, but you cut 20 minutes off of your response time from flying down to southeast Iowa someplace else. So it's not only for us, but for this corner of the state, it's very helpful. We're trying to also add specialty care. So in the last, I'd say 18 months, we've called it two years. We've added general surgery, endocrinology, which is hormone treatment, diabetes.

We have the only endocrinologist between here and St. Louis. We've added rheumatology, which, you know, arthritis, lupus. We've added dermatology. And I just mentioned last week we added pulmonology. And these are individuals working, you know, in most cases, four and a half days a week at our institution. And they're pulling regionally.

So continuing to add specialty services as we can, we're considering oncologies cancer care and a larger orthopedic presence over time and then we want to continue to bolster our primary care so we've got multiple primary care providers that are going to be retiring and so we need to continue kind of freshening that well of primary care providers so if you have colds

or you need your physicals or whatever you can be well taken care of what has to happen in this country for smaller systems to get obstetrics back? Well, I'll give you the, I can kind of give you the financial reality of what we were facing when we closed. So the last year we were open, which was 2018, we performed 130, we did 130 births, whether that be there's a vaginal birth or a C-section. Yeah. And so in order to support those 130 births, which is like one every three days. Yeah. For us, you have to have two OBGYN physicians that are basically surgeons because if you have a C-section that has,

then they have to be on call 24-7. So you've got two and they're on call every other night. You've got anesthesia that has to be on call 24-7 in the event that you need to. C-section. And you've got nursing that has to be on call 24 by 7 as well. So you're talking about millions of dollars in outlay for 130 births. So, you know, there was one of two directions you could go, I suppose. One is that you close, which we decided to do. The other is invest a lot of money to become a regional birthing center. And at the time, there were more options. There are more options.

So more of closed since we closed. So the first thing is the, there's not enough OBGYNs. That's number one. So staffing is very difficult. There's much like healthcare, there's not enough money in the system to make people want to. I'm just being real. I know we want to do obstetric care. But if you're losing millions of dollars on it a year, you're threatening your ability to do primary care.

Yeah. Do you're threatening your ability to provide any hospital services at all? Take down the whole ship. It'll take down the whole ship. One of the things they recently did is they did pass tort reform limits. So you may not know, but obstetrics has the highest risk on the tort reform. So it's the most expensive malpractice stuff that you can find. Iowa has been pretty thoughtful in fixing that.

So staffing the financial model. which doesn't work, especially in rural areas, and the tort reform, which has kind of been fixed. But that's the financial reality for us. Yeah. Just not, really just not a big enough market to make it work financially. Well, I mean, the way we analyzed it, so when I got here, I'm like, maybe we can save obstetrics, because they'd made the decision to close. And there was a couple months after I got here that we actually did close it.

So I thought, in that meantime, I'm going to make sure. that it's the right decision. I thought even if we were to get every birth in Washington County, which would have been impossible, maybe we're looking at 300 a year. Still looking at one a day. And so it just, you know, I think that if the financial model turns around,

if we have, you know, PAs and people like that that could maybe do parts of the process differently than relying on OBGYNs, maybe there's a chance that we can revitalize these in rural areas. But you'd have to get scale. You'd have to make it a center. I would think we'd need about 600 births a year to have that start to make sense. It's up to your generation, Sawyer.

Yeah, have a lot of babies. Better just get busy. Have a lot of... Better get busy. Better get going. Me and Kyle would better get going. Yeah, I sort of envy you. Sounds kind of fun.

Yeah. Yep. Practice makes perfect. Yeah, it does. Got to get your reps. Got to get your reps in. This is kind of a curveball, but I was just thinking about it sitting here thinking, you know. There you go.

I don't know. I feel like, this is a broad question. This is a big question, but 2018, you took the job, right? Uh-huh. Two years later, big health care crisis across the entire world. Uh-huh. COVID. How the hell did you handle that shit show? And, you know, there's a lot of stuff that come out of that. But, you know, a lot of people thought, you know, it came out that a lot of hospitals out there were reporting as much COVID as they could to get funding from the government. And I think a lot of people out there lost a lot of trust with big hospitals that were doing that shit, you know, because they... they were, what do you say?

Doing something, they were telling the numbers, they were saying the numbers were one thing, but they weren't actually that. It wasn't really that way. So how did you handle that? And what are your overall thoughts about just COVID as a whole in the hospital? Well, as far as your hospital, like, how did that affect? Because on the one hand, in that situation,

everybody's thinking about health care, but you had the same problem that every other business had in the fact that nobody could go anywhere. So unless it was, if I'm right on this, unless it was like emergency surgery, everything else got shoved out of the way. So you weren't, you weren't doing your normal amount of business. What was that? Yeah. Well, so first of all, it was the most miserable time in my career. And I'm, you know, to be honest with you, I'm still kind of processing parts of it. Because I really couldn't figure out what was

at times I couldn't figure out what was happening. I think we all were in that part. Our reaction at a national level it was so surprising to me that I you know I I don't know if I was taking it too lightly

at the beginning, you know, I, so, you know, my, I've been through SARS, West Nile, MERS, avian flu, H1N1, during my career. Yep. So when I was in the heart center at the University of Iowa, H1N1 flu, was killing young mothers. And for whatever reason, we had a system called Equipers. extracorporeal oxygen ECMO. I don't know.

Elizabeth is going to kill me if she watches this. Hopefully she doesn't. Anyway, it's basically a heart and lung machine so that when your lungs are damaged and your heart isn't working, they put you on this and it allows your lungs and things to heal while you're on this heart and lung machine. So when you have that flu,

that respiratory flu, it won't kill you. And then they put you back on your lung and heart and stuff like that, and then hopefully you, but every day, all of our ECMOs were full during that time. And so I'm like, well, this is just what we do, right? We just, we take care of these patients. So when COVID came along, I'm thinking, well, this is another MERS. This is another H1N1.

We'll deal with it like we have before. And then, you know, the difference was you didn't read about it in the paper every single day. and there wasn't this massive panic also. You know, like, so I think I went into it kind of like, we'll just handle this like we've handled other things in the past. And so, you know,

and then, and then, you know, we started meeting to try to, you know, figure out how do we need to protect people? And so, you know, we have what I was thinking were standard precautions. So if you're going into a patient's room or treating a patient that's got tuberculosis, we already had mechanisms by which we would treat them.

I'm like, why wouldn't we just use our standard kind of precautions? And, you know, people worried about our hospital getting full. But the reality is kind of in that March, April, May time frame of 2020, 75% of our volume just went away. Yeah. Went away. There was nobody in our hospital. Yeah.

Couple, maybe. but the most we had COVID patients in our hospitals nine and that was the max we could hold and there were a couple times November of 2020 was the worst that I recall when the university was totally full and Mercy was totally full and we were totally full and there was no place to move people

so from that perspective it was completely devastating for some people but again I go back to the H1N1 flu was completely devastating for some people. devastating for some people there too. Right. So I was not fully understanding the reaction we were having to it. And still to this day, I'm kind of working through it.

But we did some things that were really innovative during that time that are also, you know, we shut down our clinics and we created a respiratory therapy clinic just designed to take care of infectious, you know, respiratory issues. Everybody was gowned up like in hazmat suits and, you know, um, you know, we had to downsize our staff. Just in that short period of time, we lost, I think, $3.7 or $3.9 million. Yeah, because basically you weren't doing anything else.

There wasn't it. So I was like, you know, most of the people who were there weren't dealing with acute respiratory issues. So we had to start putting, and at the time they had the enhanced unemployment. So I'm like, well, let's get them off our payroll role. and get them on that. They were making more money in some ways doing that anyway.

To your point, Sawyer, you know, I could see, we certainly didn't, but there was an enhanced payment for patients that had a COVID, what's called a DRG or diagnosis-related group. So if you had a patient that had COVID, you were getting some kind of supplemental payment. my experience was that that wasn't happening, at least people trying to take advantage of that in any sort of structured way. I didn't see that.

Definitely not here, but I didn't really see that happening and certainly not as a way to get rich. Then all the other things that happened around it, I mean, we were working, I think our management team probably worked 70-hour weeks for three months or more, you know, and we had people kind of just breaking down.

But it wasn't necessarily because we were being overwhelmed with patients. We were planning and trying to come up and trying to deal with rules and regulations that were coming in. And then there were times where we did get overwhelmed with patients, and then we were dealing with that also. But, you know, I'm still, my management team, well, they know, they were involved. It was tough for me, really personally tough for me.

For one thing, I'm a big, I'm a registered Republican, but I'd say I'm a libertarian. And I'm big in personal accountability and personal choice. And I don't like when I'm told to do something. And so I struggled with that part of it a lot. Yeah. And also, you know, having kids in school who are getting their experiences, cut short, augmented, and I didn't think it needed to happen. That was really tough.

I was a little bit scarred from it. Yeah, I think that's a real. I mean, I think that was the reality for a lot of Americans, you know, they just felt like, you know, you have the experience of being in the healthcare industry through all those other diseases or viruses or pandemics, but Americans did too. And then we, it just was so crazy that it was hands. handled it in such a different way when it wasn't like it was it wasn't like the numbers were

coming out that it was a the black plague where everybody was dying it was very similar as those other as like the other there were definitely aspects that were so i you know you got to be everyone's different a little bit and there were it was you know this was a serious thing but um you know the thing that kind of drives me crazy is nobody's like kind of going back and saying oops we you know yeah what'd we do wrong yeah what I think at some point when we get a little further there's going to be papers that come out of this that say you know this is really how we should have done this or this is how we should have approached this differently um do you feel like that's the consensus right now in health care just cross the nation just most hospitals just are kind of like just processing what the hell

happened and like, why did we do this? Well, I don't know. That's what I'm doing. I think that a lot of places think that they did exactly what they needed to do to save lives. And I certainly think there's some validity to that. But I think it's also kind of overkill. I mean, there's been, and it's changed the culture. Yes. In a lot of ways.

And I think that's, I think that's an interesting. aspect of this in ways that I don't really understand anymore. It seems like it's sort of led into a whole bunch of things that don't make a lot of sense to me. I think one of the one of the takeaways that has really stuck with me is just how individual people process that and the it's like everything in this country and the fact that you have people with differing views on everything. But the, The reaction, the reaction from on the one side of they, they wanted to go about their everyday lives, like nothing happened. Right.

Yeah. And that it was, I think there's some people out there to this day that don't even believe it was real. You have that. And then the people that were like literally afraid to leave their home or if someone in their family had it, they would quarantine that person. Yeah. not even let them out of their bedroom.

So you, it was just a, it's a really, culturally, you're right, it has changed, it did change the culture. And that broad reaction and the, and the conflict between people with differing viewpoints, kind of crazy. Oh, it was crazy. It was very, it was very polarizing. And really the answer, of course, is probably some. something in the middle.

Yeah, correct. It didn't seem like we could ever get there. No, we didn't. Like, you know, if just for instance, you say, well, you don't need to wear a mask in a store, it's like blasphemous on one side and blasphemous on the other. Like, you know, you couldn't even, there was just no middle ground. And that's, I agree with you, Tork. I mean, I think it's, and, and, you know, like for me then also, I know how I personally

react. If you're telling me I have to do something. I'm going to... Yeah, my instant reaction is... I'm going to move away from that, right? And so... Yeah, it's hard. I've always been that way.

And so if you provide me with the facts and you say, these are the things we think might be good to do. Yeah. Then I'm more apt to do them if you say, you have to do this. Exactly. And you just couldn't get past that kind of, you know, there was a right way and a wrong way,

or, you know, even a right way and a wrong way the other way. So it's somewhere in the middle, as it usually is. Mm-hmm. Yeah. I still, I mean, to this day, I still think there's cultural inside hospitals anyway. I mean, you still have hospitals where you are required to wear a mask no matter what. And, you know, it's getting to a point now. You back to that happy employee thing.

I think employees are sick of it. You know, some employees are getting really tired of still being told you have to wear a mask. And this whole mask thing is still going on when we're three years removed. It plays in that you have places that they're not giving the mask. The mask is dependent upon whether or not you receive the vaccination. Yeah. So it's a whole, you're not giving the employee their personal freedom to express themselves however they want to.

Well, there's that, but also I would say, so we stopped having people mask in March of 2022, at least maybe 2021. It might be two years now, really early. And so what we just started to do is we were like, okay, let's track the data. Let's make sure that if we're having people do this, that it's for the right reason so that we know that we're actually protecting them. So our patients, are we spreading anything to our patients or vice versa? or are we seeing a higher incidence of employees getting COVID than places where they're wearing masks? And we just didn't really see it, at least at that point.

Right. And so, you know, but what we were doing also is just utilizing our medical knowledge to employ standard precautions. So if you have a patient who's coming in and is exhibiting signs of an infectious disease, and you put a mask on. Ask them up. And you gown up and you do all the things. And I couldn't figure out ever, why is it not just that?

If you're coming in with a broken toe, you probably don't need a mask. Right. Now, I understand, you know, there were some elements of COVID that said it could be spread asymptomatically. And I don't discount that. I don't actually, I don't know.

But really, to me, it came down to if they're, if they look like they have COVID, you should take precaution to make sure you don't get it. Right. If you are symptomatic and think you have COVID and you work for me, stay home. You know, it's not an issue.

Yeah. But don't just be afraid for the sake of fear. Let's look at the data and see what it's actually telling us. And, you know, I mean, that's what I struggle with. Because it seemed like it wasn't always data-driven. It was, there was some fear. There was some propaganda on both sides. And, like many subjects we cover.

Ibermectin, like a whole, I mean, that was the other thing. Like, did you guys, I just want to know, and you can answer this or not, but, you know, they pretty much banned that and said that that was the devil. But, you know, we've seen or we've researched that it was like one of the most used drugs to treat illnesses in the entire world. It was very, very, well, yeah, so Ivermectin has been around for a long, long time, and it's treats multitude of things. I thought you were going to go down. I just wanted to know if you guys ever used it and if you ever saw good results with it. Here's what I would say, again, so we're,

you know, we try to be a hospital that is autonomous and, you know, we try to allow our physicians to practice under their license in the way that they deem most appropriate. I'm not a physician. I am not dictating to our physicians how they practice medicine. We had some of our physicians were completely against it and some of our physicians used it. And I was asked the question because, you know, again, this is one of these things that just got such political blowback. Yeah, it got rolling. Yeah. I don't know.

I don't know if it worked or not. I think kind of not is the general impression. I've gotten, although some people think it really helped them. So I don't really have hard data to tell you that it worked or not. But what I do know is that I want every therapeutic option available to the doctors that work for me. And they work that out with their patients. And it's not me to, you know, if they're giving them heroin, you know, I got maybe

would say. You know, I need to step in. Yeah. So, so I'm a hospital administrator. I'm not a physician. And, you know, if it was, if it was effective for some people, great. If it wasn't, you know, I guess the concern is that it may have hurt people or was used instead of a more effective. Yeah.

You know, those, but that can, that happens across the spectrum of medicine all the time. And I'm, you know, so. Well, I think you can respect that. I mean, if you're giving the doctors the freedom to treat their patients that the best way that they think. That's all you can ask. I mean, that's what you want. So it was a pretty difficult time. And so we, you know, we did some things after that. You know, we've got what's called pharmacy and therapeutics where, you know, ideally we'd bring the providers together and say, okay, well, these are the drugs that we're going to carry on our formulary. These are the things that we're going to

allow. But it's a medical decision. And they would come to some consensus across that. And they would come to some consensus across that as medical doctors, not as an administrator, for instance. Yeah. And they, you know, that's part and parcel. They do that with drugs all the time. Are we going to carry this thing or that thing or not? And so, again, there it could just be plugged into our normal process. Mm-hmm.

So. Yeah. It's like most subjects that we end up dealing with on Barn Talk, what we always say is today, whatever, whatever the problem is, is common sense is in short supply in a lot of areas. And usually just like the problem we talked about, the way you explained it, seemed like you guys are using common sense. And that works pretty well. But there's a lot of places in our society where it just seems like there isn't anybody in that room that says, you know, wait a minute, let's, there's got to be a middle here. Let's think this through. And that's where we get off.

and I don't care what it is. The extremes of both sides. Yeah, we get off on these tangents and you just shake your head and you're like, what are people thinking? Well, a lot of times the fear or the emotion. Yeah, get involved to a point. And then common sense kind of goes out the window. I think, and I mentioned a couple times already, I'm a data geek.

So I work with a guy in Austin, Texas. I worked with him for years. He does all my data development. When I have a problem, when I have a vexing problem, the first thing I do is he and I get together and I say, I want to look at this from a bunch of different angles. Because I don't know the answer to this problem. Right, right?

And as I do that, my goal is to take out the unknown. my goal is to replace that with a common sense approach with a valid argument for whatever decision I'm trying to make but as you do that you remove the emotion from the process you remove the fear from the process because you're seeing okay this is you know like is this competitor beating me in this geography yeah well I don't know I'm worried that they are I'm mad at them for trying whatever I start looking at the data

they're not there or yeah maybe they are but it's not hurting us okay present that now i don't have to worry about you know so it's i don't have that emotional reaction to it and i do that as i prepare for contract negotiations big decisions that i have to make and i i find that data level sets everything and brings people to a middle ground right say okay let's work from the facts yep rather than how we feel about this and the conjecture and the fear or the gut feelings. Yep. You know? And that I found to be very effective through the course of my career.

Yeah. That's awesome. No, that's really good. I just wanted to get your thoughts on it because, you know, it's our first health care person that's been on the pod. So I just wanted to talk to you because it, you know, affect a lot of people. COVID sucked. And in some areas where people really got, really got hurt.

and I'm not even talking just patients. I'm talking about health care providers that got burned out. That got worked really hard, that were overworked, that ended up in some cases leaving the profession. Yeah. You know, it was a big hit from that perspective too. Yeah, I think we've, I think we've, I mean, there's a lot of areas that the labor side of it is going to be hurt for years from this, from the number of people that,

basically employees and health systems that just got alienated to the point that they said, you know what? I'm going to go do something else. Yeah, a combination of that and then just the general makeup of the workforce now where you've got, you know, baby boomers that are retiring at like, I think 10,000 people a day turned 65. And so you're talking about mass exodus in addition to, you know, being an unattractive field to work in during COVID. And, and that's, not only contributed to it making it difficult to find employees, but the wage realities are way different than they used to be. Yeah.

So I got to get, I got to get one more good Todd story out. And I, I talked to Kylo the other day. I feel like I've not been as funny as I normally know. No, you, this is serious. This is for you guys listening.

I've known Todd for years because my, my, one of my best buddies is Todd's step. son. So Kyle, a shout out to you. But when I told him, I was having you on, he's like, we've, we've talked to him before, but it wasn't always like, it wasn't always sunshine and rainbows to get to the point where you are today, you know? You've had humble beginnings. And talk about your, the first time you had to go buy a suit. Because I think people can really, you know, you, you seem like you know your shit, right? But it wasn't always that way. You have to figure it out as a young person. And so,

well, give him a little background on that a little bit. So when, when Kiowa, when when Kiowa's mom and I first got married, um, well, slightly before that, we lived in a garage. I mean, it was a two car. Like, I don't want to, I don't want you to think like, okay. All right. Sort of cheap, but that's way better. We don't have any money. So her, so she owns the earth moving company and they were still kind of fledgling and going through some really difficult changes in the industry at that time. And I was just getting my administrative career going. And so we lived in a garage. Like I said, this is two car. And so I, my boss at the time invited me to go to Chicago for a conference. And I was like, look, I have khakis and like a dress

shirt. And he's like, all right, we're going to go buy a suit on our way to Chicago. So we stopped at this clothing store. And I mean, I had maybe $35 in my bank account at the time. I remember that. And we stopped. And I walked in and he's like, all right, go in buy a suit. Right. So the guy is helping me. And he starts measuring me, you know, and I'm like, oh, no. I hope they have like, like, like $34.99 suits here. But he starts measure me, picks out a suit,

takes it upstairs right there, starts tailoring it for me. And takes a shirt, he grabs a belt off the rack, a couple ties, and just takes them up. And I'm not even asking any, I didn't even think really

to ask questions about how much is going to cost or anything. He rings it up. It was almost $800. And so I just about shit a pancake. I didn't know. So I wrote him a check. And I called my wife or wife to be.

And I'm like, hey, I'm on my way to Chicago. I just bought an $800 suit. She's like, you don't have any money. We don't have any money. So I don't remember what happened. We had to scramble to figure out how to cover that check. Oh, my God. And I wore that suit for that.

It was my only suit for five years, I think. I forgot about that story. No, I just thought that was a good one. Shout out to Shane Sorone for helping me buy that suit. Yeah. I had, at that time, so you had to take the GMAT to get into the master's program at the university. Yep. It was $200.

I had to borrow money from a guy to take the GMAT to get into my master's program. I did. I paid him back over three months. I paid him $60-some. a month for three months, paid them back. And then, and now I teach in the program. There you go. That's pretty awesome.

I teach usually one semester a year and teach the capstone program called business integration. I like doing that a lot. You just kept going though, kept fighting. Well, so when I was growing up, my dad was a guidance counselor and my mom didn't work. So we didn't have a ton of money. And they were okay with that. We were fine.

We're sort of middle class or lower middle class. And when I got to college, they couldn't help me very much. And so there were times in college where I was hungry, like physically hungry. I remember they didn't serve food in the residence halls Sunday night. So I would go Sunday afternoon to Monday morning without eating anything. Like I didn't have any snacks or anything. And I remember thinking, I am never going to do this again. and so that instilled in me ambition like at the time you couldn't believe i was like i'm

never going to be in a situation where i can't eat and my kids can't eat and that uh in addition to just being you know naturally ambitious those two things kind of came together and just made me want to just conquer the world i worked like a dog then after that that's awesome do you feel like this is off the subject I just thought about this, but that story you know in the farming business this is a common conversation

that I have with guys now our kids are older but I used to have this a lot when our kids were younger that we all want you know we all want better for our kids than what we had and we have this innate need that we don't want them to have to struggle

but so many, like so many great businesses that have been started and so many really good business, not only business people, but just productive members of society, that level of achievement has come from the struggle. And we, we used to talk about this. And I mean, you know, because you didn't know what, you really didn't know what you were getting yourself into, because when you were in high school, you didn't help, neither you or your brother helped that much on the farm

because you were in so much stuff. When I was a kid, like, you worked first, and then if you had time, and you could con your brother or your mother to haul your ass to town for whatever. But the other thing was, we didn't, like,

we didn't really know that it was struggle because that was just what you did. Yeah. It's like when my dad talks about, like, not to beat the, dead horse because I feel like I said it's like when people asked my dad he grew up during the depression they would ask him what that was like and his answer was always so disappointing to people that wanted a good depression story he'd say well you know we didn't have any money but hell nobody had

any money and we just ate from the garden and you know we had a cow and this and you just didn't buy anything because you didn't have any money and people are kind of like that's the best you got you know, but it was just that struggle was kind of universal. You know, it's interesting that they actually had it bad, whereas people today, by comparison, don't really have it bad and think they have it bad. Exactly. So that's my, you know, that's my, I guess my statement or my question to you is, it's like as a society, I feel like it's harder and harder because we have people coming up,

that they want a job and they don't they want paid very well and they don't want to get their hands dirty like you know they don't want to struggle i know yeah and they want to they want to move into that leadership role in a year or something there 20 years yeah and it's just so like if you don't have that frame of reference like if you don't have that frame of reference of what it is to go without what it is to struggle, what it is for things to be hard. On the one hand, it's really hard for you to have, you know, to know what struggle and what isn't. But then the other side of it is, and I think that's a problem we have today, is people don't appreciate what they have because they don't know how easily that can all

go away. I don't think we're probably going to fix it here, but I feel better getting that off my Well, I think the best gift that you can probably give a kid is a beaten. Huh? A beating? A beating? Oh, no, we'll better edit that. A beating. Is the gift of understanding the value of hard work.

So I think that if you work really hard and you see the fruits of that yourself. Yeah. And you see that direct benefit from working really hard. and whatever pursuit that is, that's the biggest gift that you can give somebody. And I don't think there's anything wrong with taking care of your kids, because like you said at the beginning of that, you want them to have a better life than where you might have started from.

But you have to also give them some perspective on, you know, this isn't what everybody has. And people have sacrificed along the way. You know, my dad was in the Vietnam generation, right? And they gave two years of his life to his country. I never, you know, I never did that. Yeah. My grandfather before him fought in World War II.

Yeah. You know, I mean, that was a miserable time. I mean, can you? Yeah. Like, and to be honest with you, I think part of it, Tork is they didn't have time to think about things being bad. Right. Like there's so much given to our generations and culture now that they don't have to work,

they don't have to grow their own food. They don't have to do the thing to keep them alive. So now they have time to think about how miserable they are on some level. I don't know how else to put it. That's a good point. People today have time to worry about how the pig felt before he became bacon instead of just being thankful that they have bacon. Yes.

How do you like that time? There you go. Right on the money, baby. I think that really is sort of the case. There's not almost, it sounds weird. There's almost not enough struggle. Yeah. right? Or the struggle that there is almost as manufactured or frivolous fabricated or, you know,

I'm sure it's important to some people, but, you know, really at the baseline, you know, if you look at Maslov's hierarchy, it's, you know, we have food and shelter and, you know, whatever the other one is. I know, I have it. Yeah. Yeah. But I don't have to worry. I haven't worried about it. So, you know, I mean, is, you know, is there. You know, is there. next thing like worry about everything else and feel guilty about everything else and be afraid of everything else i know yeah i guess so well speaking of all this work all work and no play makes a very dull boy yeah and you you have actual talent not only you're a smart individual you have actual talent so what do you what do you do when you're not administrating well uh i i i like to tell people

that I try not to be your average normal CEO kind of the stuffy suit wearing boring I mean I'm generalizing of course there's a lot of very interesting CEOs but I I got to have I got to have other outlets you know some guys like golf and I don't really like golf that much and people boat I like to boat a little bit but what I really like to do is play drums and so I am in a few bands couple bands. And so we, you know, travel locally, but play a lot of gigs. And I find that very, it's just such a huge gear shift change in my day that it keeps me really centered. So not only that, I like to do theater. So I just want to preface. I was a really good athlete. I'm not just doing like music and theater now, okay? You are, you're the Renaissance, man.

I guess so. Well, rounded. I got into theater about 2018 on a dare for my wife. She told me to go audition and I was scared. Yeah. What was the first play that you were in? Was that here? Yeah.

Arsenic and Old Lace. I played Teddy Roosevelt. Yeah. Yeah, we had a couple of margaritas and I felt like I could audition then. You felt moved. I was moved to audition. Yeah. So, yeah, I love doing those types of things and it keeps us really busy.

but I got to if I'm not super busy all the time I it's you know idle hands are the devil's work or however that yeah something something like that play things is that we'll play things yeah yeah I think so that's you know yeah and I'll give you credit because I've known you for a while and you do a very good job of keeping work at work at least when I ever ever I came over You do a good job of always being the family man and having fun and never bringing that home. Yeah. Anytime I was over, it was always fun, playing drums, playing cards, always. And so I credit you for that because it's hard to leave it at work probably all the time.

Yeah. Well, I mean, I don't know. Was I going to ask you for advice? Right. I know, but maybe, you know, you're getting to the point where maybe I could now. I won't go that far. When you guys were little new pursers, there was not really much I was going to. Full disclosure, all advice given on Barn Talk is worth exactly what you all have paid for it.

Just, just no. That's right. So you're being a music guy, though. You love music. What's your favorite band all time? I guess if you can't name one, top three. Oh. I'd have to say Led Zepp one is.

probably one of my favorite bands of all time. Rush. You know, so also those are kind of the really great drummers, the rock drummers of all time, Neil Peart and Rush and John Bonham. And then I have to say the police, again, Stuart Copeland, the drummer for the police, are some of my favorites. And now I listen to lots of different stuff. actually, you know, Primus, you probably don't have never heard of them. But they were a band I followed growing up.

Grateful Dead. Yep. A big dead head. Now I listen to a lot of country music because I'm trying to learn the drum lines for, you know, old country, some modern country. Some basic. Best drum solo. Like what, if you got the radio going, it comes on, what's like? You're about to go into a meeting.

and you need to fuck shit up. What are you turning on? Yeah. Neil Perts drum solo. He's got a drum solo that was on R40. That was unbelievable. He built up over an entire career. So if you listen to his drum solos from the 70s and the 80s,

the core of it is still there. And he kept building around it and building around it and building around it until he had a fully realized drum solo. But, you know, any buddy rich stuff, too. Yeah. So there's so much good stuff. It's unbelievable.

Phil Collins. I don't know. It goes on and on. Drummer is the kingpin, really, of any band. I think he's the most important member of the band. They are. Especially if you hand all the business affairs. That's how I felt when I played rock band with Clay.

I did play the drums on rock band, and I did feel the most important. I was the bass player until you guys finally said, bad. Get out. You're not hitting the notes. We're failing. Can't do it. I would say, you know, there's the flashy folks, the divas in the band. So we got the diva singers in our band who are very, very talented.

They're out front. They get all the credit. And you got the drummer and the bass player. We're in the back and we're holding it down. You allow them to do all their fun stuff, right? So that's... Especially when you're playing live and you're kind of live without a net. you got to have somebody who's just going to be there, be predictable, you know, not leaving,

like I'm not going off and doing a 30 second drum cell in the middle of a song, you know. Well, you pace everything. You do. At the end of the day, I never, I didn't realize that. But, you know, the drummer is the one that sets the speed of that song. And if you're going to have any consistency, you got to have that or else. Yeah. Yeah.

So a lot of that's practice. And then, you know, actually when you're playing. live, like let's say John Woodward is singing a song. He's, John knows this. If he watches this, he's pretty particular about the tempos that he sings at. And so I'll listen to him, you know, is he, is he singing the song too fast or too slow? And then I'll make micro adjustments in the speed of the song as we're going, which if you were sitting there listening, you couldn't tell. Right. But you got to always be on that. You, like, I'm having fun. And I'm in, I'm kind of interacting with the crowd and partying with the crowd. Definitely enjoying watching the

crowd have fun, but I'm very much concentrating on what is actually happening. Yeah. That's cool. Yeah, I never knew that. That's awesome. Go ahead. John's going to be upset that he isn't here. I know. John, you're going to have to tell John you made it on Barn Talk before him. He tried to sell me on the idea that I should, that I should call him and he would set it up because he would want to be here. and I told him that I would do that, but in the back of my mind, I knew that while we were going to be doing this, he would be over trying to sneak bottles out of my whiskey. And I couldn't run that wrist. So we just cut him out.

Couldn't run it. Just cut him out. Last question, then we'll wrap it up. But where can people learn more about what's going on at Washington County hospitals and what they can do to help? If they can. I think one of the things is follow both of our hospital, Washington County. hospital and clinics and WCHF on Facebook. We also are on Instagram.

We have a website that's actually kind of in construction. Reach out to John. Actually, this would be Jay Woodward at WCHC.org. M. E. Keith, E.keith at WCHC.org in our marketing department. We need volunteers all the time. We're looking for event sponsors, et cetera. you know, just, you know, general support. So it's, I'd say those are kind of the main sources that I would go to.

Last thing, and then we'll wrap it up. Where can people find you if they want you to just absolutely slash the drums at any event that they need you at? Aces and Ates, Facebook, or I also play in a band called the Fat Back Boys. That's Fat Back with a P. You guys probably like that, huh? Oh, yeah. Yeah. You guys actually would like that band. All right. Well, we got to check it out.

We'll have to take out. We need to just get you up there. Right up there. Under construction. Under construction right now. Are you going to be a stage up there? Well, shit, it could be. It could be someday.

Someday. We're all, we're working to get it. I want to tell you one thing. I should have brought you some shirts. I should have brought you some fat back shirts. I didn't think about it. I'll get you some. How about that?

I also have Toddcast shirts. So that's my one of the things I was going to tell you is internal communication for culture is very important. So one of the things we've developed is a Toddcast where every week or so I do, for me, it's about five or six minutes net content that we interview somebody, you know, that we're doing something interesting. It's just an internal communication device, but I see this platform as being so valuable. Yep. I'm being able to convey information. I really like this long form kind of thing where you can just having a conversation with somebody and not trying to like sound bite stuff so yeah well yeah we really

appreciate you coming i mean you dropped a lot of i think you dropped a lot of value and i love what you're you're doing for our community and i hope that you could help some other communities out there that are trying to you know help their local community but help their local hospital too so really you want to hear the joke i told the governor's staff we'll end it with a bang all right so i was at the liquor store the other day and i went up uh to pay cashier said, can I see your ID? Just make sure you're legal. I said, sure.

So I pulled my wallet out of my pocket. And as I was doing that, my blockbuster video card fell out of my wallet and onto the conveyor belt at the store. And she looked at me and she goes, you're fine. Yes. I can identify with that. That probably's happened to you too. That might have happened to you one time or two.

I fake mine probably went away a long time ago. Yes. it would have. I'll have my moment someday, I'm sure. The one I didn't have the guts to say to him, if Khan is the opposite of pro, is Congress the opposite of progress?

Oh, yeah, that would make it. She would agree with you on that. Probably. I didn't so I actually had a couple jokes loaded up that I was going to get up and give during her visit and I got up to the podium and I turned around and there were cameras all across the back

and I was having flashbacks actually to that double AMC presentation and I was like I'm not doing these jokes no way well I'm hope I'm hoping that the walls weren't coming in on you while you're up here I'm hoping you had a good time up here but yeah we really appreciate coming on time I had a blast thanks guys I appreciate you inviting me of course thanks uh if you guys got any value from the show you guys know pay the fee share it out leave your review and we'll see you back here next week for another episode