Good afternoon, everyone. Really excited. This is the H&H Podcast. My name is Charles Hall, and I’m spending some time with RADM (ret.) Pamela Miller, which I’m very excited to spend the next 45 minutes to an hour with her exploring healthcare. Thank you for joining us.

Oh, it’s a privilege to be here. Thanks for the opportunity, Charles. Well, I know that as we were talking in a little bit of pre-production how humble you are, and I’ve gotten to know you probably over the last 6, 7 months. We’ve had some time together at conferences, maybe a dinner or so, and speaking to candidates and just getting to know each other in different parts of the country. There’s a true statement.

I had to reflect on that. And, and one, I’m happy that you’re here. And two, extremely, extremely impressed on your journey. Well, thanks, Charles. I tell you, it’s, it’s, it has been quite a journey and I’m really grateful for just where life has taken me and where I got from point A to point B.

You and I have a really good chemistry in, in just how our relationship has evolved. Um, and as you know, there’s a little humor on my side, things that I pop in that I won’t pop in because it may make you blush a little bit. I have a list of all of your awards. I can speak if you like. No, no, don’t do that.

Okay, that would turn you a little bit red, but, uh, they are numerous. They may be about yay long, so it’s good. But, uh, let me introduce everybody all to our listeners who, uh, the Rear Admiral is here. Um, uh, there are several pathways to healthcare and there are several pathways to leadership. Um, some happen to go in it from a second career or at a different level depending on their background and their education.

And there’s these special leaders out there that come from the ground up.

And Pamela Miller is one of those. She started out in healthcare as a nurse, emergency department nurse, and moved her way up to an emergency department physician. And then she just became a flag officer, a senior advisor. And a board-level healthcare executive advisor. Those are a lot of fancy components, but that journey from bedside to command leadership to subject matter expert is really impressive.

Um, she- and correct me if I’m off- back in, uh, a year or two ago, 1989, you entered into the Navy Reserve Nurse Corps, earned her D.O. in MHA from Des Moines University and completed emergency medicine training at the National Medical Center in San Diego. I’ve enjoyed that duty station as well and held multiple senior operations and command roles across the Navy and the Marine Corps Medicine as a transformational leader and a healthcare executive with more than 3 decades of experience across clinical care, enterprise, military, global security, crisis leadership, hospital operations, academic healthcare, and large-scale enterprise organizations. She served as the command surgeon for US Indo-Pacific Command and later as a medical officer for the Marine Corps and vice chief of reserve policy and the integration of Bureau of Medicine and Surgery Admiral, what did I miss? Oh, geez, that’s plenty, Charles.

That wraps it up. I can keep going. This is great. And so, um, I- that, that’s a lot. That’s super impressive.

But, uh, probably to just bring it down to earth here, um, love to hear a light version. You’ve been around the world, you have some prominent memories and some great leadership impact. Tell me about your journey. Oh, wow, Charles. So I will tell you that I’ll back up the train a little bit before I went into a nursing program.

I really consider some of my most valuable healthcare experience was really starting out as a nursing assistant and a unit clerk, nursing home and in a hospital. Really valuable. Like as a foundation to my healthcare journey, because stepping from there up into nursing and then where I’ve gone from there, I can honestly say when I’m working with teams or talking with people, I have literally probably walked in their moccasins. And I think that’s very important to understand people and understand the challenges that they’re experiencing. And I’m so grateful that I kind of took a, a wandering path to get where I am because everything just layered in another layer of understanding, a new perspective that now allows me to look at life and healthcare and leadership through this really blended lens of deck plate people like the CNAs and the unit clerks that make our world go around in healthcare.

We couldn’t live without ’em. To the nurses, to the administrators, to the physicians, whether it’s civilian or military, to just completely have a comprehensive understanding of what team means and how important that is. I consider it a gift. I really do. So it was a sometimes a hard path and a lot of learning occurred, but I’m super grateful for it and I wouldn’t have wanted it to happen any other way.

So that’s really, you know, such an important aspect of leadership is understanding your team and understanding their challenges and how to help them get through those tough times and help them when they fall down and scrape their knees to get back up when you’ve actually been there and experienced those same things. So for that, I’m grateful. So I’m glad I didn’t go. A lot of people will ask, aren’t you sorry you didn’t just go straight to med school? And I say, absolutely not.

Hands down, I was a better physician and I’m a better leader because of my career in nursing first. And prior to that, as a nursing assistant and a unit clerk, I am a much better physician with different skills than people that go straight to med school. So I wouldn’t change anything. First of all, I love the journey I took, and I really owe it to my mother. I really went after nursing from the time I could probably speak as a child.

I said I was going to be a nurse. I never wavered off of that. I wanted to be a nurse because that was my mother. And she was so amazing, and I was so inspired by what she did, particularly as a single parent with 4 kids. And her nursing career was just so inspirational to me that I, I wanted nothing more than to just follow in her footsteps.

So I was one of those lucky people in life. I never spent 2 seconds double thinking, you know, what I wanted to be when I grew up. Um, so I think I’m very lucky there too. And the military has been amazing. I am a much better person for the 36 years I spent wearing the cloth of this nation and 18 years as a reservist and 18 years on active duty intermixed in there allowed me to bring the best of the military to civilian medicine and it allowed me to bring the best of civilian medicine to my military roles.

So I’m like one of the luckiest people on the planet. And as a healthcare leader, to have all of that to bring to my everyday leadership mission. So if that’s kind of in a nutshell, Charles, that’s kind of how I see it when I look back on it now, 36 years later. You know, it resonates quite a bit to me. I know as I was working through levels of healthcare myself, pursuing further leadership.

I remember one of my mentors, a CEO of a large academic facility, said, you know, it’s going to be difficult for you, Charles, and I’m going to probably resonate with you a little bit. He called me a scrapper, and that scrapper is because you came through the ranks, you know so much more about every level than those that are responsible for you. And sometimes that’s a bit of a threat, but it puts a lot of value in who you are and what you bring to the table. But it’s a longer, harder road. That is- I completely agree with that, and we do share that in our past.

And I can absolutely tell you that came to play for me, especially- I will highlight during my internship and early residency days. Like nobody wanted to hear how you thought maybe we could do something a little better, and you had to learn to just kind of shut up and roll with it for a while and like bite your tongue so hard it was bleeding and just live through those times until you could get to a point where- and you just took mental notes the whole time, right? You’re just taking mental notes like, I don’t ever want to be this type of a leader and that’s not listening and doesn’t care what people have to say and You’re taking mental notes about all the great people you’re around, and you want to capture those characteristics. But you learn just as much from the people that you really couldn’t wait to get out from underneath, you know, during those times. And so I share that.

And, you know, it’s kind of funny you use the word scrappy. Like, every person in my life has used that word, including the Commandant who did one of my retirement ceremonies from military. Eithannai, what an honor. The Commandant Marine Corps, helped retire me, and even he described me as Scrappy. So there must be something to it.

I don’t know. Well, it’s a- that could be a call sign. I’m not sure if you have one, but, but that Scrappy nature really talks about the grit of, in this case, leadership and healthcare and being able to experience it. Oftentimes I use statements like Uh, the hotter the fire, the stronger the leader. That scrappy nature.

You had to experience great leaders, and you had to experience maybe not so great leaders, and you had to choose which pathway you wanted to go. I wanted it to be this type of leader and clearly not that type of leader. And so I, I hear all those themes as you kind of reflect. I think that’s absolutely true, Charles, and I, and I think just different leaders are wired differently. And some of us- and maybe it’s a little bit of the ER in me too- like, you can take the personality ER, but you can never take that ER personality out of the person.

And like, you’re drawn to those challenges. Like, the more challenging or messed up something seems to be, you’re just drawn to it like a magnet, and you get excited about it, and you see it as nothing but opportunity rather than, wow, what a big headache this is going to be, I can’t believe this, or this just can’t be you take it as like a personal challenge, and you’re like, I got this. I’m going to get after this. And so, I think it’s just one of those traits that’s either kind of in a person or not. There is- in the military, it resonates.

But in healthcare, it also resonates. We don’t generally talk like this. It’s about detail. You know, details save lives. Attention to detail.

Detail, detail. And so as we do that when we assess our patients, as we do that when we care for them, the lab values or signs and symptoms or touching, assessing our patients, now we translate that into attention to detail as a leader. And they make or break cultures. They make or break folks. Attention to detail matters.

You talk a little bit about your leadership philosophy. How the clinical world, maybe a little bit of attention to detail to your leadership and command levels, how they kind of mesh together in that journey? Absolutely. And I think, you know, when I say attention to detail, I don’t want it to equate to like rigidity, like you’re an inflexible leader. What I mean is you have to see things developing before they’re a blazing inferno in front of you.

You want to see the smoldering, not the fire. And also, I think one of the most important things you need to do as a leader is you have to know and care about your people. You have to see your team not just as a means to an end for you to accomplish a mission, but you have to care about them. You have to value them first, because if you invest in them, they’re going to invest in your mission and in the overall objective to a lot larger degree than if they just feel like they’re a widget in the wheel. So developing that culture of first and foremost attention to detail is knowing your people too, that they, that they walked in the door today and something’s wrong.

They look different than they normally do. And you take a minute. It doesn’t matter how many meetings you’re supposed to be in and 10,000 things on your mind. You feel a heavy yoke because all this important stuff is happening and you stop all of that. You push the pause button and you walk over there and you kind of walk them aside.

And ask them how they’re doing and is, is anything wrong because they look a little down today and, and they will know whether you’re genuine or not. But if they feel like you genuinely care about them, two things come from that. It’s a two-way street. What you know, what you give, you’ll get back in spades from your team in dedication and loyalty because now they see you as the kind of leader they want to follow. Which is exactly the kind of leadership that you want to develop.

In the military, it’s very important. People will do what you say for two reasons: out of rank and out of requirement, because they have to do what you say because you’re in a particular position or have a particular rank. But the second and most important reason that they will do what you say is because they want to, because they’re inspired by you and you’re what I call a follow-me leader. Where people just want to follow you and they’re inspired by you and they want to do what you- what you’re asking of them, even if it’s hard, even, you know, and that’s a quality that you have to- you carry to your civilian leadership roles and responsibilities is, is developing followership as much as you develop leadership and being a servant leader, which is really what I’m talking about. It’s, it’s not a checklist kind of a thing.

People will see through that. It has to be genuine. So, and I think that discipline and that attention to detail starts with your people, and then it starts with processes, and it starts with outcomes and indicators that you are always watching the leading edge stuff, not the lagging indicators. You don’t want to know about something when it’s gone wrong. You want to see something when it’s starting to waffle..

And when it’s starting to potentially look like it’s, it’s could derail or might go in a direction you don’t want to go, you don’t want to be reaction. You want to, you in a reaction mode, you want to be in a prediction mode and always looking over the horizon. So attention to detail is, is it takes on many flavors, starts with people, processes, outcomes, culture. You can apply it anywhere, Charles, but If there was one thing, one phrase from the military that completely translates, it’s attention to detail. Yeah, I, I think it’s when I hear kind of you’re speaking accountability to self in a leader as well as accountability to your team.

Accountability is a, a fun word, sometimes misunderstood, uh, holding people accountable and being accountable. They do go hand in hand. And that’s in the leader, that’s in followship, and that’s building that culture team. It absolutely is. And, you know, things kind of begin and end with accountability, right?

And if there’s anything that, you know, the military knows that better than anybody because you are accountable without question for everything that happens in your rank and file, whether you had any earthly knowledge of whatever or not, as a senior leader, you’re held accountable for it, and you’re held accountable for meeting the mission and following the direction of whomever you’re taking orders from. And it’s a really kind of a black and white thing in the military, um, when it comes to accountability, and it’s not fuzzy. And somehow what I’ve noticed is when we talk about leadership in the civilian sector, this becomes this fuzzy, ill-defined thing of accountability. And if you take all the most important things in your organization and you were to put them kind of in a matrix, if you can’t pinpoint accountability- I mean pinpoint it like one belly button- it’s okay to have teams out there, and they can have teams, but you need a single sole source of the go-to person for accountability. And sometimes what I’ve kind of seen in the civilian sector with leadership is you, you end up with trying to lead by committee and being accountable by committee.

That just doesn’t work. I’m telling you, does not work. So anyway, that’s- I think that’s one of the best things that could be captured from the military in the civilian sector is very clear lines of accountability to a single person. But you open the door for another topic. Accountability and leading to civilian leadership.

It’s not a common word we use. Military, it’s an everyday philosophy, and that’s readiness as a healthcare leader. So accountability, accountable for my role, accountable as a leader and for others, leads to dot, dot, dot healthcare readiness. And so I think as we start thinking about readiness and how it doesn’t only apply to emergency preparedness. That’s generally what people think of right here, but it also has categories of like workforce resilience, leadership depth, succession planning, operational discipline that goes into that.

So I love to have you talk a little bit about readiness as the lessons of military in a civilian industry, that side of healthcare, and how readiness could or should apply if you see it or don’t see it? That’s a great question, Charles. And you’re, you’re absolutely right. Readiness is an everyday term. We live in readiness charts.

We put red, yellow, green on things. There’s graphs. And because our senior leaders on the military side, they most definitely want to stay ahead of any trend, right? So they’re all over readiness and, you know, readiness also as it relates to resourcing, right? But in the civilian sector, I think a lot of thought is not given to elements of readiness that are not completely just like obvious right in front of you.

Like how ready are you for even crisis management? There’s layers of that. But are you ready operationally to run your OR for the day? Are you ready in the ER to manage strokes, STEMIs, you know, traumas? Are you ready for those things?

But if you really break it down to what does being ready actually mean, that’s where things get much more fuzzy. I’m not talking about just the code cart checklist and yeah, we have all the gadgets and the medicines. It goes well beyond that. And so I think where we break readiness down, like in the civilian sector, some of it is more obvious, like quality, for example, are you ready for a program inspection? If someone comes and inspects your STEMI program or your comprehensive stroke program or your labor and delivery program, are you ready for some entity to come inspect you?

That’s like the most basic level of readiness. Are you ready from a staffing standpoint? Do you have the actual staff to do what it is you’re trying to do? Those are like the basic elements of readiness. But what we sometimes don’t get into a lot, to your point, in civilian healthcare is talking about how much resilience is built into your program.

And, you know, if it’s not going to take much to topple your apple cart, that’s a problem. You know, when a hurricane strikes, how much resilience is built into your staffing plan so that if in a moment of crisis, 50% of your staff are going to say, nope, I’m staying home with my family, you know, my family comes first, how much, or if or they’re personally affected and taken out of the equation and they can’t come in. How much resiliency and redundancy have you built into your even crisis response plan? But other elements that we talk about in the military are personal readiness and administrative readiness. And from a personal readiness, how much time in the civilian sector, even if you’re talking about a crisis response plan, do you sit down and have a conversation with your employees?

Like, do you have a readiness checklist in your house? What does your personal household readiness checklist look like? Do you have a plan for your aging parent? Do you have a plan for your pets? Do you have a plan for food and water?

What about your medications? Do you have all of that set at home? Because if you don’t have it set at home, you will be completely distracted in a moment in time of need professionally when your institution needs you. You’re going to be eyeball deep in trying to make sure your home is secure first. So personal readiness is a thing.

Administrative readiness in a hospital or an organization, you know what I have just seen, Charles, unfortunately over the years is people get a little lax. They don’t revisit policies like they should. They’re, you know, even their own policies say that they will update these annually or every other year and they haven’t been touched in 8 or 10 years. And And when it comes to an emergency response plan, a lot of times it’s paper deep. They have it on the shelf, but they’ve never once exercised it.

Or if they did, it was just a tabletop. They’ve never done a real drill. So it’s not a plan until you’ve exercised it. But probably the most important aspect for senior leaders, Charles, that I see it is, are they professionally ready? And what I mean by that is you owe it to yourself and to your organization to show up as the best version of yourself every single day.

And what the best version of yourself needs to look like, not just today, but 2 and 5 years from now, because you got to plan for these things. And you have to be on chart a course for being a lifelong leader. For me, Charles, that is number one. People need to be a lifelong leader, and you can’t just show up and be content because you have the very basic elements of what you need to do your job. So people need to be seeking mentors and understanding the opportunities they need to have, whether it’s to further their education.

Maybe they need a degree, maybe they need a fellowship or some extra training. You know, maybe it’s just some extra technical training they need. But what do you need to keep advancing yourself constantly? You should never sit back and be content with where you are. And that applies to everybody- nurses, doctors, administrators, technicians.

Nobody should be content with where they are. You have to keep moving and keep getting better because we- every great leader, that’s like to me something that differentiates good leaders from great leaders is are you on a journey to be a lifelong leader, to do better by the people that you serve? It’s not about you. People can say, well, I’m not going to make more money if I do that, so why would I do it? And I’m in the- you know, I don’t plan on leaving this type of a job, so why should- well, the reason you should do it is because you owe it to whether it’s patients in the, you know, in the civilian healthcare system, to your patients and staff that rely on you to show up as the very best version of yourself possible every single day.

Because if you don’t do that for yourself, Charles, how do you help them become the best version of themselves? And to me, that is the ultimate goal of a servant leader, is to elevate people, help them become better versions of themselves than they ever saw possible. And if you can’t role model that and be a mentor for people, how do you expect that to happen? That you owe it to, you owe it to people. I, I, as I listen and reflect and a little bit of brainstorming here, there’s the category that you’re speaking about is professional.

I’m gonna, I’m gonna, I’m gonna slash it cuz it’s, it’s a little bit of two, it’s professional and organizational readiness, right? Being personally prepared, holding ourselves accountable, organization as well. I often go to some healthcare themes as we think about this subject. And how do we understand readiness? I’m going to do this language, vulnerability analysis.

And I say that because even though those are a little bit fancy words in here, that assessment of myself as a leader or assessment of the organization. And I’m going to use another statement about weakest link, right? Weakest link is not necessarily a person. It’s the weakest link that can topple over an organization, an individual. And many times that piece of vulnerability is a- what I’ve learned recently from a professional course I took, it’s called the silver bullet.

Mm-hmm. Absolutely. You don’t see that coming. Whether that silver bullet was rightfully or wrongfully there, it comes from left field. And it cripples the individual.

It cripples the organization. It topples them over. And it’s generally around the high-risk, low-volume, low-opportunity moment that creates that if we don’t get ourselves ready, if we don’t invest in that time, if we don’t get our organization ready, it’s that out-of-the-blue silver bullet that pushes the leader or the organization over whether it’s right or wrong. And the outcome is negative. Absolutely.

And I think, you know, really astute C-suites and leadership teams, regardless of the size of the enterprise, they sit down and they brainstorm what those silver bullet type scenarios look like. Like, what does that look like for them individually as leaders? And what do they look like as an institution, even if they’re low probability but high risk when you do one of the quadrant risk matrix that some folks are familiar with? I mean, even if it’s low probability, but high risk, then that’s where they need to invest some time into being very proactive in managing that. And that’s where you develop a safety net and you build some resiliency in.

And there, you know, you shouldn’t have too many fly balls from left field that nobody ever heard of in their entire life or saw coming. Most things in our enterprise are predictable if you spend some time thinking about it. I’m gonna, I’m gonna move to- we talked about readiness, and I’m going to jump to the back end called outcomes, because readiness and then outcomes is a definition. So no matter what we perceive ourselves to be or our organizations to be, you know, there’s a lot of lip service to, uh, how great thou art or how great things are. It really is about leadership outcomes, and outcomes can be seen in a lot of different ways.

Turnover, that’s an outcome. Yes, that is an outcome. Satisfaction or engagement surveys, those are outcomes. Clinical outcomes, we, we see that in hospitalcompare.gov because that kind of is those things. You have so many metrics there that talks about an organization’s outcomes, whether it is satisfaction or hospital acquired infections, mishaps or errors.

It’s all there, those outcomes. So readiness to the back end of outcomes, how effective are you? Can you talk about outcomes in your leadership and how you see that in your philosophy? 100%. And, you know, we should all be very outcome driven, right?

But really great leaders understand, because I’ve worked for different types of organizations over the years, and some organizations are- the outcome and what their mission target is at all cost, you know, cost to your employees, meaning in personal cost, cost to the culture, um, burnout and all of that. So you have to put all of the outcomes on a, you know, on the table and look at them simultaneously. And what I have found both in the military and in the civilian sector is that if you look at those indicators that some people call soft, but I call them soft maybe, but critical, whether that’s, you know, patient engagement, patient surveys, staff engagement surveys, those start telling the story long before you start seeing negative results in your outcomes. Comes. Because if you have a culture of accountability, then the mission will take care of itself, generally speaking, because everybody understands it, they care about it, they’re shooting at the same target, um, they’re looking for ways to avoid any negative, uh, outcome of any sort, and everybody is free to say something and put an idea on the table no matter what role they have in the organization.

Everybody is heard. If you create that culture and layer that culture of everybody’s involved, everybody is part of the mission, and everybody is heard from a cultural standpoint, and you layer on top of that you care, you care about those people, and you show that you care, and through different ways that are important to them to make their work life better. Quality of work life matters. And then you layer onto that the culture of accountability, the outcomes almost take care of themselves, Charles. But you, and you share that, it has to be a constant 360 loop.

And instead of feeling like you take the outcome data and maybe you’re not quite on target yet, and you pivot back to the staff, instead of it becoming a flogging, I’m going to flog you until you comply and get us to where we need to be from an outcomes, and you punish them, you know, because we’re not yet at outcomes. But rather, if you have a culture where you share that data and they’re like, shoot, we’re not on target, how can we be better? And they help produce part of the how, of how you’re gonna close that gap. They have to be involved in that and they own it. Then it just becomes an everybody’s mission to get the accountability data where you want it.

And they take great pride when they’ve got the patient satisfaction surveys, the hospital surveys, everything from Healthgrades, all these different things that are out there. They take great pride when you’ve moved it in into a state of excellence. But it has to be everybody rowing, you know, everybody’s rowing together, not, you know, you’re whipping people from behind them, you know, trying to see how hard you can push them. It has to be everybody rowing and in stride in the same direction. So I think, you know, accountability is super important and outcomes are super important.

Of course we’re going to focus on those. But there’s a few ways to get the outcomes that you want, right? And we’ve all worked for the type of organizations that are just going to put people’s heads in a vice and squeeze it until you get there. Well, that destroys the culture, and that’s a place that’s on a path of demise, right? They may temporarily get there, but they definitely can’t sustain it because it’s going to lead to turnover and burnout and people hating life.

And that’s obvious to everybody, including your patients. So, you know, and I’ve worked in an organization that we went from one kind of in that category to building it to something where there was like a waiting list of people who wanted to come work for that organization because of a cultural turnaround. So that’s, that’s my take on it, Charles, is there’s many paths to seeing what outcome-based you know, activity looks like, how you choose to measure it and how you choose to invest in it is what matters. So I, as I reflect on your insights, I’m going to put a couple, 3 words probably together or a bit of a statement. Mission-driven culture, competencies, and team accountability are that equation for success.

I’m hearing those themes out of you. Am I missing something? No, I think, you know, um, you, you hit those right on the head. And I think that- and, and if you look at those as sort of part of a pyramid building to where you want to be, uh, underneath all of that is just the word culture. Yep.

You know, you know, culture of caring and a culture of value, valuing the people whose shoulders, you know, it’s upon their shoulders that all of this will happen. You know, you can sit in any C-suite and the CEO can want what they want, but if people are not invested under you, you’re not going to get there. And so I think underpinning everything in the fabric, the key threads in the fabric, are really that the culture. And culture starts at the top, and it is very obvious to teams, whether it’s just words and stuff on a wall and a nice piece of paper and something that’s great to show people, or whether it is actually how that organization fundamentally is designed. It’s very transparent to people.

Um, yes, I think, um, when we think about healthcare organizations and how to build them, You and I have used a few fun words called wonky, clunky. Those are polite ways of saying things are a little bit- Those are some of them that we use. Yeah, they are some of them. And it’s a plainer way that says everything- it’s a plainer way than saying everything is backwards, other words for that too, and upside down. And so that purposeful building mission-driven culture that accountability, that competency, that investing in people performing and having other people perform to build the direction you’re going.

If you don’t have that beacon, that, uh, lighthouse on the hill that serves not only as a warning but as a guiding light, if that piece isn’t there, how can an organization meet its, uh, mission? Well, it won’t, or it might transiently meet its mission, but at some point it’s going to crash into the shoals. That’s an absolute given. It is going to crash because it, it couldn’t see what was coming at it. It’s like they’re going to crash because they have failed to exercise what they needed to do as a leader to actually see over the horizon and see what was coming.

And they will crash and they will definitely run ashore.

It’s been demonstrated time and time again with- you see them peak and then you see them fall. And almost always it’s out of a lack of their ability, A, to remain focused on, you know, on outcomes, have very clear vision for how they identify and solve problems. That’s really critical. How do you identify and solve problems and who’s involved in that process? And then to what degree have you invested in your people and invested in your culture?

Because if you’ve done that, even if the organization is going through some heavy seas and they’re experiencing some, you know, headwinds, the people will help you see it through because they’re rowing with you, not because they have to, but because they want to.

I, well, I would say leadership is not for everyone. Healthcare is not for everyone. 100%. It’s, um, I’ve learned that healthcare is, oh, at least for myself, and that’s a better way to speak about it, is, has been and has always been a calling. Mm-hmm.

Um, and that calling is the why, why I’m here and why I’m doing My daughter recently did a graduation speech and she talked about passion and that passion, that calling produces an environment for somebody who doesn’t feel like they work a day in their life because they’re living their why and they’re living their passion. And the calling is there, but not everybody can make that calling.

That’s, that’s exactly right. And sometimes, and I feel saddest for people where there is a calling but it’s unrealized just out of a lack of opportunity, a lack of mentors, a lack of somebody shining a light on a path for them. Which, hats off to my mother. My hats off to my mother. All these years she kept just reaching a hand and helping pull people up a line whether they needed I mean, literally, she would come home when I was a, you know, whether I was a nursing assistant or whether I was a student nurse at the time, and she would be like, there’s a single nurse at our hospital.

She’s an LPN trying to become an RN, but she has no money for uniforms and she needs them to start. So go pick something out of your wardrobe because she’s about your size and I want you to give her some of your stuff because she needs it. And, you know, she, you know, just approached people on her staff and go, what is stopping you? What do you see as the barrier? Because my mother just, you know, faced adversity head on, and she is just a living legacy of people overcoming adversity to get where they’re going and making a difference in people’s lives, including her children.

And so she made- she dedicated her life to just elevating everybody around her. What they saw as barriers, she helped them break them down and held a hand out and pulled him up. And, you know, so, you know, it’s amazing. But unrealized calling is probably the saddest. Um, but when people have a true calling and they follow that calling, it’s usually obvious in their- just their leadership style and how they approach the whole topic of leadership is genuinely different than when it’s a job.

And it’s a paycheck. That’s right. There’s definitely a difference between a job/paycheck and a calling. I want to value your time. I probably- I’m going to probably come in with a couple last questions right here, probably reflective.

You know, you said 36 years. I would also call it a calling. So I think it’s a little bit longer than 36 years in the healthcare. That calling is a lifelong thing. How do you define successful?

Leadership today? Oh, you know, Charles, that’s a great question. And I think whether you’re talking, you know, I’ll focus kind of in the civilian sector, although there’s many threads of similarities between military leaders and civilian leaders when it comes to, to talking about this. Um, successful leadership, I think, first of all, is are you the type of leader that people want to follow? Are people inspired by what you say?

Are they inspired by what you do? Do they believe you? Are you believable and genuine? And do people follow you for all of the right reasons? I think followership is one of the greatest measures, I think, of, of leadership.

Um, do you meet or exceed expectations of whatever you’re leading? Are you meeting or exceeding expectations? And do you hold yourself to a high standard and how you show up, not only just every day how you show up as leader, but always looking for ways to bring your best version of yourself to make the people around you better, to help them be the best version of themselves, and to help the organization be the best version of itself. You really- it’s that servant leader qualities where people care about something bigger than themselves. They- it’s a service, a mindset, though, with very, um, significant threads of accountability linked into it.

People often sometimes link servant leadership with like you’re soft, or you, you don’t hold people accountable, and you’re just forgiving. That’s not it. It’s high standards of accountability. It’s how you get there that makes you different. So meeting or exceeding expectations, not of only of the organization, but of yourself, of the people that you serve, meaning do you even understand what their expectations or needs are?

And just that sense of, um, delivering for, for the organization and for other people, um, every single day and looking for better and better ways to do that. To me, those are some of the best qualities or the majors of a leader. The, the actual outcomes of whatever your mission is meeting or exceeding those layered with all of these other things of the how. The how matters. And that, that’s really my, you know, best response, I think, to that, Charles.

I love it. Well, I have a fun question to end with.

And so I know you’re on the edge of your seat because some of our fun questions are there. Knowing that you’re 29 again and again, years of age. You see how that worked out? I see. That’s good.

Um, generations is, uh, you know, I, I struggle with Gen this, Gen that, generations, how people are built based off of the time frame that they were raised in and the time frame that they work in and so forth. So generations, as you are in leading as an expert, I’m going to call you an expert, you wouldn’t call yourself an expert in healthcare and/or leadership itself, what would be the hopes for the next generation of healthcare leaders? What does that look like knowing what you know now? What would be the hope of the next generation of healthcare leaders? You know, I think that The hope is that they can bring their own lens to things.

I think every- call it a generation, and then there are those that are kind of on the fringes of generations of leaders. But, you know, much like when we pass a baton in the military to the next person who- your succession plan, um, in the military, that’s one thing the military does actually better than most of the civilian world is succession planning. But, um, the I think that, I think would be to put your own lens on it and don’t feel constrained by everything you’ve been told, what’s been done before. You know, you should learn from history, always learn from history, take it into consideration, but put your own lens on it and decide how your unique qualities as a leader, your uniqueness, and that you bring to the table is going to elevate anything you touch. So I think the hope is that, you know, put your own fingerprints on things and that someday when they’re done as leaders, everybody’s hope, including ours, is that you leave things better than you found it.

You always leave an organization, a team, whatever it is, in a better place than what you found it. And I think the, you know, from a hope standpoint, It’s that they have the opportunity, you know, similar to some of my opportunities and your opportunities to learn, to- their hope would be to have the mentors and the opportunities to become that very best version of themselves possible, to bring that to any job they have. And that my hope for them is that they pass that on, is that then they pay that forward. So my hope is that they can be the kind of leader that people look up to and that they want to be. And my hope for this generation of leaders is that they can inspire the followership that will then allow them to leave their fingerprints on another generation.

And they can look back and say, I helped. I made a difference. And I helped people. And I helped organizations become a better place and a better version of themselves. Than they were, and that you opened a door and gave people opportunity that wouldn’t have otherwise had that.

So my hope for them is that they leave their fingerprints and that when they look back, that they can say them- say these things about themselves as a leader. Charles. Love it. I, I think, um, the next generation, it’s hard to think that way because it is passing the baton on. As either succession planning and you’re moving to the next phase in your professional career, or it’s really that bigger thing of we’ve been leading this generation.

Now it’s their turn to lead the industry itself. Pamela Miller, I want to thank you for the time that you spent and definitely for the, the peer and friendship that we’ve developed over time. And I’m looking forward to continuing to work with you. In healthcare with our leaders across the country and the things that we’ve been doing. And I’m blessed to have met you and to be able to work with you.

And I’m grateful for your time today and what you’ve contributed. Well, thanks, Charles. It’s been a real honor and a privilege of, you know, meeting you, learning from you, and getting to work side by side. We do seem to be like two peas in a pod in many ways. And so It’s, it’s less like work when it’s fun and you really enjoy and you admire the people that you work with.

And that’s, it’s absolutely true for, for me when I’m working with you. So I appreciate the opportunity. I look forward to our future and more opportunities for us to work together as we go from here to there across the country. And, and for this opportunity today, thanks so much, Charles. I appreciate it very much.

Admiral, thank you so much for your time.