We’re learning to open up. It’s probably a good place to begin. This is our second podcast and it’s not quite tip of the tongue, so I think we use words like clunkiness and so no doubt, bear with us as we kind of go through this. We’re excited to kick off our podcast to tell the story about HnH impact and our fingerprints across the United States with our partners.

And so we’re blessed to be here with Neil and Steve and myself, Charles hall, and looking forward to a very productive one hour conversation. Absolutely. You know Stephen Hart’s Charles hall for HH Impact.

That’s one thing I learned from watching Josh actually introduce ourselves. I’m going to kind of talk a little bit about our guest today. It’s our very first guest, Neil Meltzer.

He’s the president and chief executive officer of LifeBridge Health out of Baltimore. Neil has been in healthcare for greater than 30 years. He’s led at all levels.

Former chair of the American Heart Association. I have that correct. Yes.

Yep. And so when we were thinking about people we might want to have to lead off, how do we start off? With a home run. Right.

Or a grand slam. And I thought Neil would be a great person to bring into the organization. And so, Neil, welcome.

No pressure here. None at all. We like to set high standards and we thought that’d be great having you here.

How is it to go with the heartbeat of healthcare? That’s a big one. I like that. I like that.

That’s good. I was sticking with a clunky, but I’ll go with. Yeah, I’ll get.

Go with it. Bring it. So, you know, with that we are again, this is our second podcast.

We’re learning to talk about it. And you know, one of the things that we’ve already been talking about today, before we even kicked off the podcast, is, you know, the effect of the government shutdown and in healthcare and you know, being in a large system like you are, and you’re a unique system in Maryland. Can you tell us a little bit about how Maryland is different than other states when it comes to healthcare and how that affects you all? Sure.

Maryland is one of the actually the only Medicare waivered state in this country. As such, our rates are set like a public utility, at least for the inpatient hospital rates. The physician rates are still negotiated with the payers, but we do not negotiate with the payers for the hospital rates.

And as a result of that, our focus is really trying to keep people healthy. And in the community, there is a Carter 5% above 5% below a baseline which is set at the beginning of each year regarding the number of admissions, the number of patients you should see. And if you pierce the 5% up with the number of patients, we do not get paid for those additional patients.

We give that care away for free. If you pierce the 5% below the benchmark, you start giving money back to the state government. As a result of this, the state enjoys just north of $4 billion additional from Medicare.

In an effort to address the social determinants of health. Our focus as a state is really keeping people healthy and in the community as opposed to keeping them in bed, in the hospital where other states potentially enjoy the benefits of readmissions. We get penalized for that.

We have a very rigid set of quality metrics that we have to meet the cost per Medicare enrolling needs to be below the rest of the nation in order to continue to enjoy these additional dollars, which are focused on community based care. So so much of what we’ve done, so much of what our peers do, is really address many of the social determinants of health. And we’ve got about 45 community based programs running today that focus on anything from congestive heart failure to domestic violence.
In fact, we actually employ ex offenders who go into the community to try to interrupt violence before it occurs, as every hospital does around this country. As part of the Affordable Care act, we’re required to do a community health needs assessment. And the number one issue that we hear every time we do it is violence in the community.

And so we decided to do something a little bit different and we created something called Stop the Iron Pipeline. When we were researching the issue of public health violence, we found that 80% of the violence in the state of Maryland, 80% of the gun violence in the state of Maryland was promulgated with guns that were trafficked in from the south. And the federal government was able to identify the actual location in Georgia where most of these guns were coming from.

So we began something called Stop the Iron Pipeline. And the result of that was the implementation of some legislation in the state which addressed gun ownership in a much more rigid way than they had in the past. We’ve done well north of 1,500 interventions in the city of Baltimore alone using these ex offenders.

And we’ve created something called the center for Hope, which takes all of our violence intervention programs and puts them under one umbrella. So it’s domestic violence, elder abuse, sexual child abuse, physical child abuse, and gun violence. Wow.

How are you this morning? That was awesome. What amazing work that you’re doing. I’m going to attempt to kind of break that down and simplify that just a little bit.

Absolutely. I got a little off track. No, no, no.

Actually, that was amazing. Because that’s innovative. Right.

And it’s political and it’s caring for your community. Let me. We try to keep it apolitical.

Yes, but it is political. There’s aspects of that there. So what I heard you say is the landscape of healthcare is changing.

It isn’t about being that hospital where we wait for people when they’re ill and injured. Correct. It is about caring for your community.

There’s plenty of initiatives out there, some buzzwords like population health or clinically integrated network that leverages a group of providers to be proactive in the community’s life. When I think about that theme, that’s really what you’re talking about, is stepping outside of the bricks and mortars of the hospital to care for your community and those problems. Correct.

We just went through a fairly lengthy strategic planning process. And the upshot of that is that we aren’t into collect hospital beds. Our focus is to have improved access, improved convenience, go where the patients are and to be digital.

We don’t want to do digital. We don’t want to implement a software and check off a box that we implemented something. We see the use of digital being a backbone in terms of everything that we’re doing and offering going forward now.

At the same time, we worked with our employees to come up with a purpose statement. You know, every institution has a mission statement and a vision statement, and to be honest, they all sound kind of the same, but we wanted to come up with a purpose statement, sort of the filter through which we make decisions. And the employees came up with creating healthier communities together.

And when they talked about the word communities, they said the community could be a unit in a hospital, it could be a department, it could be a zip code, it can be an entire block, it can be anything we want it to be. But as we’re making decisions as an organization, that sort of becomes the filter. Are we helping create healthier communities? With everything that we’re doing going forward, it’s difficult to measure that, quite honestly.

One of the things we try to do is get a pulse from the patients themselves in the community. We do have a fairly rigid set of metrics that we look at when we’re talking about population health, chf, diabetes and things of that nature. We look at the violence and what’s happening in the city, and it has gone down as a result of the work that we’re doing.

But it’s very difficult to come up with an actual measurement. Some of this is intuitive. Some of this is a gut feel.

And unfortunately, not everything that counts can be measured in the way that you want to measure it. But to the extent that we can, we do. I think it’s interesting because a lot of what you guys are talking about is it’s outside the scope of what we would consider or most people would consider.

Just basic general healthcare, right? I go to a doc, I get some medicine, I get ibuprofen, I get something to help me with my cough or something like that, or I go in for a normal physical. But this is. This transcends that aspect of it.

And what’s unique about it is, you know, kind of something that we do a lot in our organizations is focus on the leadership. And so you really, as a leader yourself, having to get your team to buy into this, to look at the way we approach it, how do you hire and bring in the right team that understands this culture, your objectives, to get you guys where you’re trying to go? Because, again, it’s not normal. You add in the fact that you have probably one of the biggest players in healthcare in y
backyard, Johns Hopkins, eight miles away, right down the street from you.

That’s no competition, right? But you have all those challenges that you’re trying to face. So as a leader and leading your team to try to understand the mission, the vision, the values of what you’re trying to do, your purpose statement, how do you lead your team to understand that purpose? I try to have them lead. Believe it or not, I see myself to some degree as the orchestra leader.

I kind of need to know what’s just happened in the past, what music was just played, what are we focused on right at the moment, and where is the music going? Where do we need to go? And as I talk to my folks, when I talk to new employees in the organization, I say, if I’m doing my job right, I’m never making a decision. I’m sort of setting that true north. I set the baseline.

They understand what our values are, what our purpose is, But I let them take the path they feel is most appropriate to get to that true north. It may not be the path I take. It may not be the same route that I would want to go, but as long as they’re heading in the right direction and they’re achieving the goal that I set out, I actually feel really good about it.

And What I find is that when you empower the individuals in the organization to do that kind of work, to find their own path, they’re much more satisfied. We see. I think our employee engagement is in the top quartile in the country right now.

And I think that’s part of the reason it’s that high. But I find it to be very effective, at least in our organization, in our community. I think that’s awesome.

It kind of ties into something that Charles and I, we teach when we go into hospitals. As a leader, you want to be able to send what we call freedom within fences. Right.

You’re setting a fence line as a leader and saying, hey, I’m empowering you to work within this. And you know, even for your organization, your fence line is set by somebody higher than you, which is typically your board. But beyond that, it’s the regulatory.

It’s the compliance that the federal government sends. But that’s a great explanation on leadership. We’re setting the boundaries and giving them the tools and the.

And the ability to make those choices and decisions and supporting them in that. That’s perfect. And actually, I like the way you sort of envision that with sort of putting the fences up, setting the boundaries.

And the visual is terrific. There’s several. Right.

Journeys to a similar outcome. And so as you’ve rose through the ranks, you’ve had your philosophy, you’ve had your processes, and really what you’re saying is we need you to discover your philosophy, and the end result needs to resemble something like this. Correct.

And at the same time, if the end result, my true north, is inaccurate, I encourage the pushback, I encourage the debate. And that’s difficult for some leaders, and I know that. And I’m not always right.

And I think as a leader, I know. Astounding, isn’t it? Yes. But as a leader, you have to be able to admit your mistakes and you have to be willing to adjust your vision.

And the world, as we’re sitting here today, with the government shutdown, the world is changing and constantly in flux, and you’ve got to continue to weave and bob whenever necessary in order to make sure that you’re still focused on that purpose, that vision, that mission. In many ways, you talked about power dynamics there. And so creating a team, we can paint a picture that says we want a team that feels safe and comfortable in raising their hand.

We can label things like just culture and so forth, but the reality is a good leadership team banters. Right. Exactly right.

And then come out unified. And we don’t always get that right. No, no, that’s true.

You know, I, I, I look down my, my, my leadership table some days, and it’s, some days it feels like Snoopy’s ball team. You know, you’ve got the, the boisterous aunt and the crazy uncle and, and, you know, pig Pen. And, you know, they’re all, they all serve their own roles, yet they’re, they’re my team, and I love them, and they love each other, and we work together really well.

We’re not afraid as a family to disagree with each other and call out each other on our foibles, but it works. And it’s tough to assemble a team that works that way. And, you know, one, one.

I think that the lessons I’ve learned over my now close to 45 years in health care is that sometimes you got to follow your gut. You know, we were talking about this last night that, you know, in hiring, I’ve learned a couple of things. One, follow your gut.

The one time I did not follow my gut and my gut was telling me it was going to be a bad hire, it was a bad hire. The other thing is a yes is a yes. You know it immediately.

A no is a no, and you know that immediately, usually three minutes into an interview. But a maybe is a no. And until you get to that yes, don’t settle.

And I think, you know, through trial and error, we’ve created a really strong, effective team, but it takes time to assemble that. You talk about the gut. Yeah, that’s experienced leader.

That’s in our previous discussions, we were talking about leadership in the fire or the storm that we have to go through. That gut, I’ll call that wisdom. That’s.

Then they’re done that. And let’s not go that direction because there’s too many landmines to navigate here. Right.

Can you talk about how that sense of wisdom came in over the years as where you were from and why you went into healthcare and how you evolved to be a boy? I know that’s a bigger moment, but the reality is it defines the man behind the leader. Well, you know, I think back to my original beginnings in healthcare. My father, I grew up in Boston.

My father had a number of small community pharmacies, and there were pharmacies in not always the most affluent areas. And I saw him really, through public health, trading medication for anything anyone would give him. So he would have women making lasagnas for him and providing food in an effort to gain their medications, whatever they needed.

And it was watching that I think. Which began to. And not.

Not thinking about it that early, but really began to create sort of who I was and why I wanted to move in that direction. My very first job was cleaning rat cages. Oh, the research rat cages.

There we are. Yeah. Followed by.

I think my job after that in the hospital was purging X ray films. Yes, X rays were on films. Once upon a time in a basement in a.

In a. In a old building in a area. It was actually Framingham Union Hospital in Framingham, Massachusetts.

Was that in the basement? It was in the basement, absolutely. Because all radiology was in the basement back then. Keep it dark.

Yeah, keep it dark. Then counting pills when you had to actually count pills by hand, you know, once I was trusted enough to count pills. Was that for your dad? No, this was, this was in the same hospital.

And I used to meet with the hospital president and he used to sit on the steps of the hospital eating a lunch out of a brown bag. And I’d eat my lunch and he’d eat his lunch and we’d talk and we did that. I think I worked there for four summers.

And you know, through that, through those conversations, not thinking about it at the time, he was really beginning to guide me in terms of my future and my career. And you know, I respect that a lot. The hospital’s still around.

It’s since been acquired by Tenet, but it’s, you know, it’s, it’s, it’s there and serving the community. And that’s really where I began. Nice.

That’s some great roots. Yeah, we somehow all follow in our parents footsteps, right? In one way or another, either characteristics or within the field itself. And that’s probably that exposure.

It’s what you knew, it’s what you lived every day growing up. Sure. I don’t know if there was ever a different direction for you.

Well, you know, it’s interesting. My. My undergraduate degree is in health physics or nuclear physics.

I was studying the impact of nuclear power on the environment. I was a bit of a tree hugger. Green armband for Earth Day 501s, which I still have my Birkenstocks, which I finally got rid of, but they’re back in style, by the way.

They last forever. They do last forever. They do last forever.

But you know, at the time, and this was the 70s, you know, there were not a whole lot of jobs for world savers at the time. And I was offered a public health scholarship by Tulane University and I ended up getting my master’s in public health and My master’s in health administration from Tulane, went back to Massachusetts, did my administrative residency at Leahy Clinic when it was moving from Boston to Burlington, Massachusetts, then worked as a vice president at a. Actually, I was the COO of a very small hospital in Ayer, Massachusetts, Neshoba Community Hospital.

It was me, the CEO and the cno. And we pretty much did everything in that organization, including unlocking the doors in the morning and locking them at night. And from there I was recruited away to Baltimore for what was going to be 5 years.

Drove down Route 95 with a 2 year old in the backseat of my Plymouth station wagon with a fake wood paneling, listening to Baby Beluga by Rafi. Anyone remember Raffi by me. The backseat.

The backseat of that station wagon flipped backwards, of course. Of course. Yeah.

A little car seat back there. Yes. You remember those? Yes.

And I’ve been in Baltimore now for 38 years. I started as a vice president of miscellaneous. I have run every.

In a hospital except for patient finance. I’ve run physician billing, but the only hospital department I’ve not run is patient finance. Well, you know, with that kind of experience, that’ll lead me into a great question, Neil, as you get into this coming year, you know we’re currently in the government shutdown, right.

You know, lots of changes going on in healthcare. Conversations about telemedicine, population health, mobile integrated health, community paramedicine. What do you see as the top three things coming in healthcare in the future that we really need to be focusing on? I think several things.

Number one, I think artificial intelligence. I think it’s going to be changing the way we function. It’s going to be changing the way people perceive healthcare.

When you think about it, the source of truth is beginning to change. We have five generations of people working in our organization. We’ve got traditionalists who are now probably in their 80s at this point, still working there.

And we’ve got, I’m trying to remember the new term, the alpha gen alpha gen alpha gen alpha. And when I talk to my kids who are in their early to mid-30s, they look at AI as a source of truth. And when you talk to our physicians, our physicians will admit that they can’t keep up with the evidence, but AI can keep up with the evidence.

So oftentimes AI is more accurate than a physician potentially. So I think AI is one thing. Number one with that, Neil, I was just going to say, I have an example of that myself is so like, I just did my blood work and my physician couldn’t get back in touch with me for three or four days.

So I took my results and I put it in chat GPT and said, what is this really telling me in layman’s terms? And it was like, it was incredible to give a breakdown of like, hey, this is what the normal range is. These are the possible things that are causing this to go up or down. Here are some recommendations that you can do to affect it.

It said. It said broccoli. Yeah, it’s what it said, is it said broccoli, eat more green vegetables, like less red meat.

All the things that I did not want to hear, but I found that that as just as simple as a layman who doesn’t have a health degree or understand medicine, but to have that simple understanding of like, I want to know, because today we all want to know now. Like, I want today, I want it right now. That’s our culture.

That has become our culture. And I think that’s an aspect of AI that is positive, but it could also be a negative connotation because if it says you have an issue and you’re like, but I can’t see my doctor for a week, this is telling me I’m having cancer or something like that. And it doesn’t necessarily always mean it’s true.

So I appreciate that, that AI, and we’re seeing that with our hospitals and our systems is like, how do we integrate AI? Is it in the rev cycle? Is it in selection of people? We had an individual we were meeting yesterday, a gentleman named Edison. He’s from Columbia. He’s the CEO of a hospital down there.

And his number one question is, how do we get CEOs to embrace AI in the culture of healthcare? And I thought that it just resonated with me when he said that. No. And I don’t think it’s going to be up to the CEO at some point.

I think they’re going to be pushed into it if they don’t embrace themselves because everyone is using it. The one thing we’ve got to be careful about is making sure you have the governance around it to assure that you’re. You’re not relying on it solely to make decisions.

Because then there’s this liability associated with that. Absolutely. I think it’s transformational and very much the early adopters are already there.

Right. So it’s now the mainstream. And unfortunately, in that philosophy about early adopters, mainstream and laggers or no nos, right.

There are going to be people who suffer, who are late to the game, and unfortunately, it will have consequences on our industry, absolutely tangential to that is technology and wearables and how that information is going to be used. I do believe predictive analytics is going to be incredibly important. Because when you think about it, Steve, I can take your charge card information and find out when you go to Nordstrom or Macy’s, are you buying running shoes or are you buying a tie? When you go t
the supermarket, are you buying cookies or are you buying broccoli? Yep.

I was going to say something else, but we’ll go with broccoli. Yeah, I think it’s broccoli. We have all your health information.

So when you think about it, if you’re able to harness all that information in advance in our kids generation, you think about it, it’s going to be barbaric to think that you have to wait for someone to get sick before you begin to intervene. And with predictive analytics, with all that information that’s out there, if we’re able to harness that, we will be able to affect someone’s health before they even suffer a health consequence. So I think that’s, that’s a component that will be out there i
the future.

So I’ll dive into that. So we’ve kind of been, Charles and I have been going on this journey, this healthcare journey, and. Right.

One of the things we looked at was we both have taken a genetic methylation test. Okay. To really understand your genetics and how your genetics affect your health in advance.

So no longer are you just taking and going by natural supplements and taking like B12, B6 or whatever. Right. The supplements are geared specifically towards our genetics.

So for instance, I need a pre methylated B6 vitamin. Right. You know, things of that nature.

And it’s interesting because to me, that’s exactly it. If I know in advance that my body doesn’t do really well with red meat. Right.

Then I can kind of control my own. Now I have to change my behaviors. Right.

Right. But at least I have roadmap of what good looks like and what success would be perfectly for my genetics. And I think that’s interesting in healthcare because everything in most part has been reactive.

Now you’re trying to be more proactive. Exactly. And our goal is to be able to live that life as we get older, to still be able to do the things we want to do, feel healthy, have energy.

And so it resonated with me when you’re talking about that predictive analysis and being able to take those aspects of what we do to kind of figure out how well you’re going to be able to live and how we can handle your issues in the future. I think one of our challenges as a healthcare industry and possibly as society is trying to figure out how you impact behavior change. I know the things that I shouldn’t be doing, yet I do them anyhow.

You know, you look at people, I say, you know, my weakness is carbs. Give me bread. Give me, you know, pasta.

Bring it. Oh, my gosh. All good.

All good. But, you know, I know I can’t overdo that. People know they shouldn’t smoke, yet they smoke.

People know they should eat healthy, yet they don’t eat healthy. So how do you take that information and get folks to change their behavior? I think that’s still a change challenging for us. We’re talking blue zone stuff.

Yeah, yeah. It’s how do you create a community who the environment is set up for? Good choices. Correct.

And. And that’s difficult. You’re in Baltimore.

That’s difficult. Listen, we tried to do this in our own cafeteria in one of our hospitals, where we cut out. We eliminated french fries and.

And, you know, greasy food and pizza and all. We almost had a revolt. Yeah.

You know, people working hard, they want their french fries at lunch. So, you know, the Navy tried to do that many years ago on ships. Right.

And I will tell you, the most popular day on a ship for meal is poker and slider day, which is pokers or hot dogs, sliders or hamburgers. And when they try to take away the french fries. Oh, man.

And. And you’re on a ship mutiny. And, yeah, you’re about to have a mutiny because you’re.

You’re out to sea for six months, and you only have certain things you’re looking forward to, and one of them is that day, and the other spaghetti. If you take away either one of those, it was just not going to work. But you talk about your behaviors.

I think that’s a big thing. Also, we were kind of talking about this last night is, you know, we talk about cultural change in an organization, and one of our board advisors, Admiral Vitaly, made a great point to me is, you know, you guys talk about your culture change, but culture change takes so long, and with average leadership in healthcare being 18 to 24 months, it’s very hard to affect culture change. And he’s like, what you’re really going after is that behavioral change.
Right. You know, and we’ve seen it in a couple of our clients where we get in there and we ask them, how do you know your business? Do you know what good Looks like, what is the industry standard? And you get varying degrees of answers or questions to follow that. And then you start implementing minor changes, just small little changes.

And it comes to doing the little things right every day, right. And that’s their behavior. And now we’re what, 180 days? A little over 180 days with that one client.

And it has transformed them. Now their culture is shifting into what we expected them to be or what we would want them to be. But it is.

It does take time. You can’t push too hard. A lot of people don’t like change.

You know, that’s so true. I had a bad hire replaced that individual, brought someone else in and had to rebuild the culture. And she started with something very simple.

She called it the 510 rule rule. If you’re within 10ft, you smile. If you’re within 5ft, you say hello.

That’s it. That’s it. That’s the only thing.

You implement one thing, basics, and repeat it over and over and over again. Hold each other accountable. And it works.

And it begins to change the culture of the organization. And all of a sudden, people are smiling. People seem happier, but it is.

You’re exactly right. You’ve got to do it consistently every single day, for every encounter. It is.

I think it’s. Those are great statements. You know, we preach all the time.

You know, you can have all the goals strateg. Those are just dreams. Unless you can bring consistency and persistence into your organization to help follow through.

It’s same, you know, whether you’re on a weight loss journey or on trying to save money to buy a house. If you’re not consistent and persistent, you’re never going to get there. And you’re right.

And so much of that’s in healthcare, too. You know, working with Charles to see when he goes into an organization is, you know, going in on the advisory side. And he’s working on a 12, 18, 24 months.

You know, you see their eyes wide, Huge, wide eyes, like we’re never going to get there. This is ridiculous. Eyes wide and then crossed.

Yeah, yeah, crossed. But, you know, it’s the gentle hand on the back. It’s the teaching them like, you don’t have to do it all the time.

One of our staff, Chris, retired force master chief in the Navy, we use a lot of Navy terms. We’re mostly Navy guys. And he gives the explanation, you know, if you’re an aircraft carrier, everybody’s seen Top Gun, the greatest movie of all time.

So the aircraft carrier, if you turn 30 degrees at 1 time to really go over there quickly. Everything on top of that aircraft carrier will fall into the ocean, right? And everybody’s going to get upset. Their coffee’s all over the floor.

But hospital is the same way. If you turn too quick, you’re going to lose people. You’re right.

But if you turn 2, 3 degrees at a time, you’re slow change. It’s easy, it’s manageable. May not be comfortable, but it’s possible.

Right? And I think that’s a huge aspect of it. And, you know, it sounds like your. Your hospital has been well on that journey for many years.

But it didn’t happen overnight. No, it did not happen overnight. And we’ve had false starts and things.

You know, we’ve tried things and they didn’t work. I love pilots because a pilot, you start and stop. So we try things, we try to learn from each other.

We’ve got, you know, 135 sites of care across pretty much three states. And it’s not easy. And I think one of the, One of the challenges we face, and I think a lot of health systems now face, is communication.

And, you know, we’re sitting here doing a podcast, right? As I said, we’ve got five generations of people working for us. Some people want to read a memo still, some people will only look for 45 seconds at a little video. So we are trying to use every mode of communication possible and constantly repeating it.

So whoever the audience is is constantly getting the kind of message in the way they want to receive it. But, and, you know, we find that with patients too, you know, one of the challenges we, you know, you think about communication to patients, health equ Surrounds is it is a result of the kind of communication, the ability for someone to receive that information. And, you know, a good example of this, we had.

We had a patient, cardiac patient from South America and didn’t speak English, only spoke Spanish. We had a translator in the room. Cardiologist would tell the patient what was going on and what the patient needed to do.

And the translator would say, do you understand? And she’d nod her head up and down. Yes, she understood. And they said, are you going to follow the directions? And she’d say, no, she’d.

She nod her head back and forth because she wasn’t going to follow it. So physician leaves, translator sits and talks to her. She says, I don’t understand.

And she said, in my country, physicians have gray hair. They’re male. And this was a young female, very brilliant cardiologist, but she was not going to follow the directions of someone she didn’t respect.

She wasn’t going to follow the directions. That’s health equity. And one of the things we’re realizing now is that we’ve got to use technology in a way to allow the communication to be received in the way the person wants to receive it.

So whether it’s the five generations of employees or it’s the patient from South America that will only listen to an older male physician, we’ve got to accommodate them. Well, I think what you said was these are barriers I’m going to categorize more leadership barriers that we have to overcome to reach a patient. They may not receive information this leader is attempting to provide.

Correct. And so that’s the challenge. Very much so.

And you know, in. In Maryland, where we have probably 43 different dialects and languages spoken, it becomes exceedingly challenging. So we’re trying to use technology now through the use of tele nursing to provide discharge instructions.

I’ve been talking to two companies about the idea of creating avatars. So rather than an actual live nurse on the other end of the camera, you know, it could be an elderly Chinese woman. It could be, you know, a, you know, older male physician who speaks Spanish.

It could be whoever that patient needs in order to relay that information. And we’re finding that when we do it properly, the rate of readmission goes down and the patient satisfaction goes up and it does work. And now, granted, our studies are very, very small right now with a small population of patients, but I think we’re onto something.

And I think it’s not brilliant by any means. It’s just if you think about how people receive information and you provide it in a way that it is effective for that individual, it works. It’s no different than what ads ad agencies are doing or marketing folks are doing in the rest of the country.

It’s much more scientific, probably from their standpoint, but we’ve got to learn from them. Yeah, I hear the journey and the mountain that you have to climb, and obviously a thousand things come to mind, like who is your care team? Your care team is your health system. But that’s not a true statement.

No. Your care team is post acute. It’s ems.

It’s how do you get those in the community? It’s the community together on the same page. So in caring for your community, how do you get these independent groups of people pre hospital, post hospital, post acute healthcare system, primary care specialty? How do you get them all on the same page when they’re not under Your umbrella. I wish I could say we had an answer to that.

We don’t. I, I think we try to work with them when we can. We, we’re finding that more and more we’re having to actually run those organizations post hospitalization.

So historically we were a hospital system. We’re now an integrated financing delivery system where we’re providing insurance and we’re providing all sorts of post acute community services. There’s a group out of the UK called Health Shared and what they’re trying to do are put together communities of like patients who support each other.

So they are trying to put together a group of diabetic patients who understand what they’re going through and share each other, share the challenges and share the successes. Same with congestive heart failure. And I think people are trying to experiment with different ways of getting the kind of community support necessary.

Particularly as one of the other challenges we face is a shortage of caregivers. Certainly primary care is changing a lot. My view is that.

But we’re going to see primary care go the way of anesthesia, where you’ll have one MD and they would be managing or overseeing a group of NPs or PAs. And as we do that, I think we’ve got to figure out a better way to assure that the care is being provided in the most efficacious way. And we’ve got to use the community more deliberately and more effectively than we have in the past.

And I think it’s somewhat scattered right now. So what we’re trying to do as an organization is provide many of those services directly. But a lot of this isn’t reimbursed and that’s a challenge.

You know, one of the things, Neil, that I heard you say in this, which resonated with me, is we talk leadership all the time. And this was another great example of leadership. Is one of the greatest things a leader can say is I don’t have the answer, I don’t know.

As we try to figure out our challenges, as we try to work through this together, leaders don’t always have to, to have every answer. You know, you, you leverage your, your relationships, your communities, other industries to try to figure out how to solve a problem. And when you think about where we are often missing, and I think that’s a, especially with new leaders, new leaders feel that they have to have all the answers all the time.

They got to be able to tell their people where to go, what to do, and, and I don’t know is perfectly acceptable. And so I, I appreciate you Pointing that out. I don’t think you necessarily knew what you were doing.

But I’m sitting here, I’m like, I don’t know. That’s a great. What I was doing.

Yeah, that’s exactly what. Yeah. What he said.

What he said. Yes, we’ll buy into that. But, yeah, that’s awesome.

And, Neil, I’d ask you, if you had to pick the three top tenants of leadership, three things that you think that leaders really need to understand and know. What do you think those three things are? Boy number one is you got to be vulnerable. You got to be human.

A leader can lead anyone. If you don’t have followers, and no one’s going to follow you if you’re not relatable. Number one.

Number two is honesty, Making sure that, as you indicated before, if you don’t have the answer, you don’t have the answer, it’s okay not to have the answer. And I think number three is integrity. Making sure that you’re doing the right thing for the right reasons all the time.

Awesome. That resonates with me. I think those are things that we preach to leaders all the time, is to look at that.

You have to be relatable. Absolutely. You have to be honest.

And then integrity. If you don’t build trust, you can’t have a relationship. Exactly.

And relationships are essential when you’re a leader. That’s true. Then the reverse question is, what is the three pitfalls in leadership? I mean, it goes from one to the other.

And so knowing that our goal here is to provide lessons with expertise to our audience. Yeah, there’s pitfalls. Yeah.

I think, you know, one of the pitfalls and we sort of reverse some of this is. Is thinking you know all the answers. Thinking that you have all the answers.

Probably. Number two is not listening. What? Not listening? Not.

Yeah, but not only listening with your ears, but sort of listening with your gut, with your heart, and absorbing what’s around you. I think that’s. That’s.

That’s key. And boy number three is not being humble. Honestly recognizing that you are human and how important that is for the organization and for the communities, frankly, that you serve.

Wow. Those are hard lessons because I think we’ve all stepped on it a few times, and it brings us to our knees of going, reflection, what just happened. The reality is leadership will humble you if you take that journey.

And so if you don’t listen, you’re called out, you know, with your eyes, with your body, with your tones. Totally resonate with that philosophy. And longer you’re in it, those are the lessons you we should learn.

It’s funny, I talk to new employees about failure and I didn’t coin this, but someone once told me, failure is first attempt in learning. And I said, remember, failure isn’t fatal, it’s a lesson. And you take that lesson and you go forward and you’ll learn a few more lessons along the way, I guarantee it.

But it’s important to remember that it’s okay to fail. I want to hit on one last thing with regards to leadership. When you look at leaders and being a good leader and all that goes into it, I think there’s also a misconception that leadership is always fun.

It’s always great to just have the title. And man, once I’m a leader, I won’t have to work all those extra hours. No weekends, yeah, no weekends.

And I’m not going to be taking the phone call from the boss all the time. And I think that is a true misconception. You have people that’ll sit there and say, leaders, man, they make so much more money, it’s ridiculous how much they make.

And you start to sit there and be like, but do you realize that it’s not a 40 hour a week job Monday through Friday, it’s a 24 hour day, seven day a week job. It’s dealing with things oftentimes outside your organization, the political side, all the other organizations and things you have to be a part of. Because as a leader, the expectation is you’re not just leading here, but we want you to lead there and there and there.

Can you talk about that a little bit? Sure. When I talk to young administrators, they ask me about life balance and I tell them I wish I could have. Is that such a thing? Yeah.

No. I don’t think I’ve ever had my marriage, my work life and my personal life all, all in balance at once. One is always being shortchanged in one way or another.

And you know, once you rise up in leadership, you are, you are a community face. You are expected to be in multiple places, sometimes at the same time. You’re expected to be the face of the organization.

People are boss watchers. So everything you do or don’t do, you will be judged. As I’m rolling towards retirement, I tell folks that I’m going to be blamed for things I did.

I’m going to be blamed for things I didn’t do. I said, I know it. I said, every boss is, when they leave an organization, they’re a target.

They are a target, but it is Very difficult at times. This is a 247 job. It’s all encompassing.

I would say that greater than 50% of my social life is work. Whether you’re attending the Disease of the Month gala or you’re attending a political event, you’re always out there. And, you know, to the extent that you do have a partner, this is.

It is a. It is a team. It is a team effort.

And, you know, I’ve learned that my wife of now almost 43 years has learned that. That’s, that’s, you know, she plays a role when she’s out there, too. She knows it.

And, you know, I have an expectation of her, she has an expectation of me. We meet at dinner oftentimes because we’re working the room separately. But it is a team sport and leadership is a team sport.

Generally, you know, I’ll bring up the wise because, you know, Charles and I are both married. Our wives are on this journey with us. And not that they’re in the room with us.

Yeah, not that they’re in the room. So we have some dynamics here. We have Neil here with the misses, not with us.

And so this is going to be great by Steve. But it’s true, you know, when your spouses are involved and stuff and, you know, we’re getting paid for the work we’re doing, you know, oftentimes they’re expected to be there. And it was very similar in the Navy is your spouses are expected to be at the events, they’re expected to be at all the engagements, the expectations there.

But there’s no compensation. There’s no aspect of that. And that’s.

That’s a challenge. And you think you’re watched. They’re watched even more.

Oh, yes, absolutely. They’re watched even more, you know, and it’s. But that is.

It is that unsung hero. And not only that, but then taking care of the home and all the stuff and the kids and all the events. Yeah, it’s a challenge, but, you know, it’s an opportunity as a parent also, we’ve brought our kids to galas for years and I think they’ve grown up sort of becoming somewhat bleeding heart a little bit as well.

I’ve got a daughter that went into social work and now she’s running a foundation. I’ve got a son who’s an attorney who wanted to go into human rights law till he realized he couldn’t do human rights law and make a living. So he’s doing corporate law, but he actually runs.

Did you say pro bono? Is that what I heard you say? He actually runs an organization called the Community Law center in his part Time for Fun, which is all a group of his buddies that are offering services to the community for free legal services. But, you know, I think part of it is because of the way we enculturated them. Yeah, I guess, to some degree.

And bringing them to these kind of events so they learned the importance of giving back to the community. I think we. We’re starting that.

We’ve had our kids attend golf tournaments and some internships. Internships, perfect. I think those things are important, but it is, it is.

It’s an ever evolving process to stay involved, to stay. To be there, to do all those type of things. But, you know, you.

You talk about your son and wanting to go to Human rights salon, realizing there’s not a lot of money there. That’s the fun part of growing up where you’re like, man, I want to be an artist. And it’s like, but you gotta eat, you know, or, you know, well, I’m an artist and a bartender.

Just be clear. Yeah, it works. I want to be a philosopher.

And you’re gonna think deep thoughts about being poor. You know, it’s like, you know, all the things that kind of go into that aspect. Well, awesome.

Well, we’re coming near the end of our time. You know, I want to tell you, Neil, thank you very much for being here, for. For being engaged with us on this and our.

Our second podcast. Really enjoy talking to you. I think it’s.

It’s great. And so I appreciate that. Likewise.

And, you know, I’m proud to be on the journey with you, and I appreciate everything you’re doing to help make healthcare better in this country. We’re. We’re blessed to have you on the team.

Thank you. I know that your changing chapters in the next, we’re going to say 8 to 12 months. I say that because it’s the flex on this part, but your contribution to healthcare.

I’m looking forward to the next chapter of what you’re going to do for our industry. Appreciate your time. No, I’m calling it chapter two.

And I appreciate being here. Thank you. Thank you for the opportunity.

Thank you. Wonderful. Thank you.