Episode Transcript
[00:00:01] Speaker A: You're listening to the Doc Lounge Podcast. This is a place for candid conversations with the healthcare industry's top physicians, executives, and thought leaders.
This podcast is made possible by Pacific Companies, your trusted advisor in physician recruitment.
[00:00:20] Speaker B: Welcome to the Doc Lounge Podcast. I'm Stacy Doyle, Senior Director of marketing, and today I'm joined by my co host, John Polk, COO and a founding partner of Pacific Companies. We're excited to welcome Dr. Mark J. McGinley, a critical care specialist with over 30 years of experience in patient care and physician leadership. Dr. McGinley is here to share insights from his new book, Critical A CEO's Guide to Transforming Hospital Culture, where he tackles the key challenges hospital CEOs face from retaining top talent, enhancing patient satisfaction, and staying profitable. Let's dive into his expert strategies for reshaping healthcare leadership. Welcome to the doc Lounge podcast, Dr. McKinley.
[00:01:05] Speaker C: Thanks, Stacy. Thanks, John. Very happy to be here.
[00:01:08] Speaker B: We're excited to have you here today. Yes, well, tell us. I know your new book really touches on the challenges hospital CEOs face today. What inspired you to write this book and why now?
[00:01:21] Speaker C: It's a great question.
I think the changes in healthcare have been persistent and ongoing. And, you know, there's an increasing corporate environment within the world of health care. There's very few standalone hospitals, so we're all part of bigger organizations that create change. And the changes are some good and some not so good. And I've heard from all my colleagues that I'm in communication with some of their negative feedback. And then the hospital I worked at in Wyoming, and it's the biggest hospital in Wyoming, Wyoming Medical center, we were taken over by a big corporation, and there were some positives and there were some negatives, and this ongoing change really sort of personally affected me. And I felt like not a lot had been talked about or written about this from the physician's perspective. And I felt like this was a great time in my life to sit down now that I've seen transitions and gone through the change, to just put my thoughts together and write about it.
[00:02:28] Speaker D: When you first reached out to me, Dr. McGinley, to tell me that you had written a book, and then I looked into it, like, oh, I got to read this.
My own experience, having worked with dozens of hospital leaders, you know, from CMOs to CEOs, many of them haven't quite grasped the concepts that you're trying to promote. I'm assuming that from your own personal experience, this sort of became a glaring issue that you needed to address. You and I both worked you were probably there a whole lot longer than I was. But for over 20 years in Casper, was there a particular event that inspired this? Get the impression that perhaps there was?
[00:03:13] Speaker C: Yes.
I'm a pulmonologist and critical care doc, and I was medical director of the icu. And actually I helped with the previous administrations at the hospital to create an intensivist program where there was right care right now in the hospital, the ICU 247 care, which was a huge success. The trauma surgeons, the hospitalists, the ER docs, everybody just loved having an in house intensivist. And it was probably one of the highlights of care in the hospital because when people got really sick, they could count on a very high quality icu.
And when the larger corporation took us over, they wheeled in some robotic EICU equipment and we weren't even asked if we wanted it. We were like, well, why do we need remote care when we got someone in house 24 7?
And then it became clear with time that their model of care was to reduce the number of intensivists, particularly at night, and replace them with remote care. And I think that was the tipping point for my group. And that was where I felt like, okay, I need to write about the experience of this to share, not in a critique way of saying, oh, you know, shame on you. It's like, how can we learn from this? And this is a customer service experience that could have been so much better and the outcome could have been so much better. And that was the tipping point for me.
[00:04:58] Speaker D: I have a recollection first speaking with Dr. Smith at the inception of the recruitment effort. And if my memory serves, and that was a lot of years ago, he was the only pulmonologist in that community that serves. I don't know, you would know the number better than I, but a quarter of a million people every thousand people we serve. Yeah, yeah. And I. I remember reading here in chapter four about your recruiting experience and then the impression that you left with that he met you at the airport. But take us back to when you first got there. You were like, oh my gosh, you must have been sort of flabbergasted that here's this one guy taking care of all of the critical care there.
[00:05:50] Speaker C: I think many things in life are all about personal connections. And I just really connected with Don Smith and he was phenomenal. He ran the office, he did sleep studies, he did all the bronchoscopies, he read the icu, he did the pulmonary consult, he wore five hats. And I sort of jumped in line with him, but he was 18 years older than me and it became clear we could not recruit to that old model of you do everything. Just the young people coming out of training were like you, you guys are nuts. So that's when I pitched the idea to form an intensivist program where you recruit to the office and those people do a great job with outpatient pulmonary medicine and you build an intensivist program where those people can have protected time on and off. And it's a win win. And initially Don was part of that, but then he retired and yeah, it was a sense of pride to work with the board of the hospital, the CEO of the hospital, get this thing up and running and we built it.
It was the first of its kind in Wyoming and it really functioned extremely well until it was changed in certain pivotal ways that made it implode.
[00:07:11] Speaker D: Is that model that you had there, and I've never seen that before, and that's not to say I should have, but in my, my experience I've never seen a two week on model that you had there. Is that, is that something that could be replicated in other facilities elsewhere? And sort of a follow up question, is that where the beginning of your concept of critical relief and the physician is the customer, Is that where that all evolved?
[00:07:42] Speaker C: You know, I would be very disingenuous to say I figured all this out. It sort of happened as time goes by, but it was a sense of critical relief because when Don retired, I was left on my own and I needed to come up with a different model. But yes, this model has been out there for many years. Before we started it in 2009 at Wyoming Medical center, there were several hospitals on the east coast and there was a hospital in Duluth, Minnesota that wrote all about this.
So yes, it gave a life balance. Sort of, you worked hard, you were focused, but then you had these chunks of time off, which really was easy way to recruit. We were able within a couple, two, three years to fully staff the model. We had no problem finding high quality people because this was extremely attractive. And yes, it's, it's a model that's sort of spread throughout the country. There's plenty of similar models. I do some work at St. Mary's Hospital in Grand Junction that, that's the model they use. So yes, it's, it's a very, I think, win win model where the patients are getting attention throughout the day and night and the doctors have a chance to recalibrate and get some time off before they do their two weeks again. So, yes, it's, it's, I think in many ways a superior way to deliver critical care.
[00:09:14] Speaker D: Tell us a little bit of how that has benefited when it was in place, Wyoming Medical center, and I'm familiar with St. Mary's in Grand Junction, having worked there in the past as well. Well, how does that benefit? I mean, in other words, I think a big part of this challenge is to get the C suite to adopt some of these philosophies. So are there numbers, are there metrics that you can share with the audience to say this is the impact that that model had once it was implemented in terms of perhaps reducing the number of days, the length of stay, some of these kinds of things, less readmissions, whatever.
[00:09:52] Speaker C: Yeah, that we did not, you know, we're, we're sort of not an academic hospital. We didn't capture that type of metric. But what we did capture were, you know, ventilator associated pneumonias, line infections, time on the, on a ventilator, they went dramatically down within a year of starting this. We never missed a bonus because we were always hitting those quality metrics because we were there all the time. It also had, I think, an indirect cost benefit in that we weren't requiring on locums. There was great retention.
And then there was the sort of the smooth transition of getting people out of the icu, getting people in, because you never had to call someone from home. There was always someone there. And then it's hard to measure the effect on the ripple effect on the cardiothoracic surgery program, the neurosurgery program, the trauma program. They are sort of so happy that there's always an intensivist in house. And then on top of that is, the nurses were our greatest advocates. They were happy, content. They never had to wait on the phone. They could deal directly with a physician. There was that instant communication and teamwork. So it had multiple benefits. And in the literature, and I quote some of these studies in my book, the more robust academic centers have shown reduced length of stay, reduced hospital costs.
[00:11:28] Speaker D: Yes, that's. I think that's going to resonate. That's the kind of thing that you would think that the C suite would be focused on. How much resistance or how much acceptance have you, have you sensed or have you observed from some of these ideas? And I presume that you must have had some conversation with others to say, hey, well, let's give this a try. I'm just kind of curious as to how well these ideas have been received thus far.
[00:11:57] Speaker C: You know, I have to give Credit to the leadership at Wyoming Medical center, the cmo, the CEO at that time was Vicki Diamond.
They asked me to present to the board and I got some help from some of the statistical financial people to launch it and show the upside. And it was a leap of faith to do it, but they did it. Maybe it was just the reality that if they didn't, I was probably going to go and they'd have nobody. I don't really know what made them believe in my presentation and this concept.
I then connected with a friend of mine, Dr. Thompson, at St. Mary's he was burnt out. A lot of their physicians were getting to retirement age. I said, why don't you guys do it? You've got the same sort of draw area catchment area, same sort of demographic. And I gave him all the data and he presented it to the board at St. Mary's and they went for that concept back in about 2010, 2012. So I think it's very sellable. I think it's a superior way to practice since I've seen before and after. And I have 12 colleagues at St. Mary's who can all vouch for the same. You know, I'm not a national physician running around the country doing this, but in my regional experience, it's very well received.
[00:13:28] Speaker D: Stacy, I want to get you. I know you had some questions that you wanted to ask, and I'll let you jump in here real quick.
[00:13:33] Speaker B: Yeah, well, one of the things I wanted to ask you, it sounds like, you know, physician engagement and trust and leadership is really a key element in having a successful hospital. So what are some, I guess, tips that you would provide to CEOs and hospital, you know, administrators to kind of work and build this trust with their, with their staff?
[00:13:54] Speaker C: Yeah, that's, that's, that's, that's a great question.
You know, I think what's happening in my analysis is that physicians are not really seen as the primary customer of a hospital.
I think most CEOs think the patient is their primary customer.
And without physicians, there's not a lot of good patient care. And I turn this thing around and say, look, if you look after your physicians, they will look after their primary customer, which is the patient. Treating physicians with this sort of widget production mentality where we're all judged on metrics and we're all disposable and there's very little eliciting of our opinion. Decisions are being made without our input and then we're being told about the consequences afterwards. All those things break down. Trust and it's really the epitome of poor customer service. So to answer your question, I think the paradigm sort of magnifying glass is look at this group of skilled employees as your primary customer and ask, what can we do to serve them better? And that means engaging, asking questions, eliciting their input before decisions are made, and looking at their pain points and treating them like the primary customer. I think that's not happening. And I don't have to tell you, in the world you're in, there's a shortage of physicians and there's an exodus of people leaving medicine, and it's this toxic sort of uncaring culture that is contributing to burnout, suicide, poor patient care. You know, the list goes on. And I think it's. It doesn't require more technology. It doesn't require a special course. It really change. A change in focus is what I'm trying to portray in my book.
[00:15:56] Speaker D: You know, in my experience, and I've been in the business now for over 30 years, I. And I hesitate to say this, but I was uniformly unimpressed, more often than not with the sort of adversarial relationship that often permeated a healthcare system between administration and physicians. And your review, your book, your work, your analysis, your personal experience, certainly shines a really bright light on this, and I think potentially offers a path for people to recalibrate this whole equation and go, well, gosh, maybe we should do this. It's interesting because this is basic good quality management speak. And, you know, reading your book, I was like, oh, this is great. I'm making notes. I'm bending corners of the pages and flagging certain things. The one thing I have to tell you that stuck out with me, and I had an experience one time where I was told by the administrative assistant that the CEO was not going to meet with a candidate. And I said, he needs to meet with a candidate. I don't think he liked hearing that message from me, but he did, and it resulted in a placement. That message that you conveyed there, if you read nothing else in this book, would be something that we as recruiters would certainly see as a takeaway, a valuable takeaway. Tell us what your thoughts are and your own observations on that.
[00:17:30] Speaker C: Every job I've ever taken is based on not so much the hard standard variables like benefits and salary and things like that. It's always been based on a sense of connection, rapport, a sense of trust, a sense of energy, a sense of vision, a sense of these human communication things that connect us.
You can offer me 10 jobs and they probably will all say much the same, which one am I going to go for? The CEO who connects with me? If you're just going to filter me down to some mid level management person to tell me a story and I never get to meet the person who's driving the ship, leading the organization, I am rather unimpressed. It's not beneath the CEO to get involved in the recruitment process.
And what I'm seeing in hospitals now is there's an increasing disconnect between the people who run the hospital and the people who deliver the clinical care. And it used to be we were much more connected and now they're putting in these sort of physician management teams as a buffer to the CEO and other administrators. And it's a huge failure of communication in, in my opinion.
[00:19:06] Speaker D: I agree with you on that. I think that there is, you, you know, Even if it's 10 minutes that a CEO or CEO or a CFO or the CMO spends with a candidate, that candidate leaves. And right now it leaves with an impression they really don't care. Or if they spend that time with that, with that C suite person, it's going to distinguish them from every place else that they've interviewed. Because it doesn't happen.
[00:19:37] Speaker C: Correct.
[00:19:37] Speaker D: I think the other thing you pointed out that really resonated with me was timing, a sense of urgency. And I have regularly instructed our recruiters and clients when I was recruiting in the past that you don't have to compete on money. You can compete on how quickly you respond and react and show people a level of interest.
[00:20:02] Speaker C: It's also called good customer service.
[00:20:05] Speaker D: Yeah, it is. I have to tell you, and I'm going to brag a little bit here. Every person that we hire here meets with either myself and, or our CEO.
And we're not, you know, a huge institution like many of our clients are, but it doesn't, it, it shows, it imparts a, a value and a standard that we really care about people. And they, the feedback we get is they're always impressed that we took the time to meet with people. So if there are any C suite people going to be listening to this, follow Mark McGinley's advice on this. It works. I know we got a few more minutes left. Stacy, you got some questions now. And Mark, I want to get it back to you. And, and, and, but I have one more question too, but I'll save it for the end.
[00:20:54] Speaker B: Sure. Well, I think this is a great entry point. Just wanted to hear, Dr. McGinley, what do you think are really the biggest opportunities for transforming hospital culture in the next decade or so. And what do you think leaders should do to prepare for the future of health care?
[00:21:12] Speaker C: Well, you know, is it a threat or an opportunity? The shortage of physicians is an opportunity, in my opinion, to deliver excellent customer service. So if you want to stop the revolving door of losing physicians or recruiting them and all the costs that go along with that, then you need to recruit really well. But not only that, when you get them into your culture, into your organization, you need to really distinguish your corporation by the excellent customer service it gives to physicians. You're not going to have much problems with retention if you do that, because we all are as physicians, we're sort of intellectually curious. We enjoy relationships, we're hard workers, and we enjoy working in an environment where we're acknowledged, seen and appreciated. And if you can deliver those things, you're going to have a very loyal workforce. And the studies show again and again, if there's consistency, there's better patient care. And so I think that is an opportunity. The other opportunity is that the demographics are changing. I'm born in the 60s, I'm being phased out. And the millennials and Gen Z, these people, they really value flexibility. They value being talked to, they value being considered. And if you're not going to do that, you're losing the next few generations. So I think that's a threat or an opportunity. It depends how you're going to respond.
[00:22:51] Speaker D: Those are excellent observations, Stacy, Great insight.
[00:22:54] Speaker B: No, I'll let you. John, go ahead. I know you had a question.
[00:22:58] Speaker D: Well, here's the question. We meet with all sorts of administrative people. We have a full coverage of the United States, of their business development team, and our senior level recruiters are often meeting in the C suite. I'm going to give you an opportunity. What's the message that we should convey to them? Are there critical points and you can condense it down to as many or as few as you wish. We have the opportunity to maybe get something started here along and some momentum along all of this. What you would you like us to tell them?
[00:23:34] Speaker C: Read my book.
No, I. Yeah, look, I think in the world of the first step is getting people to join your hospital, your organization and work for you. And you've got to do the recruitment very well to do that. And one of the things is unmet expectations. If you do not follow up quickly, if you do not show that this candidate means a lot and this candidate is important, you will lose that sort of first impression. That first ability to connect. And I think that's key. You've got to put some personal effort into this, and you've got to really look at it from a return on investment, the 20 minutes or 15 minutes that the CEO, the CMO, the CFO, whoever chief nursing officer spends with those candidates and follows up and gives great customer service. That's the first stepping stone to creating a great culture of customer service in your hospital.
[00:24:40] Speaker D: Engagement.
[00:24:41] Speaker C: Yes.
[00:24:41] Speaker D: And active engagement with frequency. Give. Give the physicians a voice, include them in decisions.
I get it.
I have to tell you, it was a delight to get a message from you. And then the reference to the book. And having read the book, I was there was. It was. It was a fast read, but it was full of valuable nuggets. And I've been in the management role for many, many years. But I got a lot out of this and I'm sure a lot of our clients will as well. Dr. Mark McGinley, I appreciate you taking the time to meet with us all the way from Paris today or this evening as the case may be. Bonsoir to you and your family setting.
[00:25:27] Speaker C: Grand pleasure. Thank you, Stacy. Thanks, John. Really appreciate this opportunity.
[00:25:33] Speaker B: Thank you so much. We appreciate it. And just I want to give our audience a chance to know where they can find. So your book is titled Critical A CEOs Guide Guide to Transforming Hospital Culture. And Dr. Mark McGinley, where can anyone find this?
[00:25:50] Speaker C: Well, if you go to the critical relief website, criticalrelief.com, it's there. But obviously Amazon.com or barnes and noble.com they both, they both will have it.
[00:26:03] Speaker D: I got mine on Amazon and it showed up about a day later. So, you know, if you want to get better and you want to engage with medical staff and benefit from all of that with a return on investment, read the book. I know it sounds like I'm plugging the book, but I absolutely am because it's a terrific read and some valuable insight.
[00:26:22] Speaker B: Thank you so much, Dr. McKinley. We appreciate you being on today.
[00:26:26] Speaker C: Thank you.
[00:26:27] Speaker D: Hope to see you soon and we'll catch up.
[00:26:29] Speaker C: Okay.
[00:26:30] Speaker A: Thank you to all of our listeners. If you would like to be notified when new episodes air, make sure to hit that subscribe button. And a big thank you to Pacific Company. Without you guys, this podcast would not be possible. If you would like to be a guest, Please go to www.pacificcompanies.
[00:26:48] Speaker B: Com.
[00:26:48] Speaker C: Thank.
