Welcome, and thank you for joining today's webinar on cardiovascular staffing in COVID, post-COVID world. This is part three of our webinar series, and we're going to focus today on leadership and culture. Prior to the COVID pandemic, healthcare has really struggled with some staffing shortages, and post-pandemic and during the pandemic, it really exacerbated the issue at hand. And today, we have the honor of having two fantastic guests that are going to dive into the importance of leadership, especially the diet leadership structure, and what leaders can do to extremely be effective in helping the retention of our team members during this post-COVID world that we now live in. So without further ado, I want to introduce our guests on hand. We have Dr. Arthur Breitman, Interventional Cardiologist, and also the Chief of Inpatient Cardiovascular Services at Wellstar Health System, and Tom Draper, Vice President, Wellstar Center for Cardiovascular Care. I want to welcome and thank you both for joining today. And if you can spend a couple of minutes, please, and Tom, if you can begin, just maybe give us an overall about your role, how long you've been at Wellstar, a little bit about your program, and then Dr. Breitman, if you can give us a little bit about yourself as well. Sure. Excellent. Thanks, Kevin. Thanks for having us. So my name is Tom Draper. I'm Vice President for the Wellstar Center for Cardiovascular Care at the Wellstar Health System. I've been here since August of 2020, was at the Sanger Heart and Vascular Institute for seven and a half years in the University of Michigan for 15 years prior to coming here all in cardiovascular care. So the Center for Cardiovascular Care really encompasses, we have over 90 employed physicians, about 85 employed advanced practice providers, 27 offices across the Georgia area. There's 11 hospitals within the Wellstar Health System. And we have, at the present time, eight PCI programs. So we do everything up really to heart transplant. We are full service, very integrated, very collaborative group that has built from a private practice group all the way into an employed integrated model that has really been a focus for years prior to me coming here with Rick Siegel, who's my predecessor, Kevin Mayer, who worked here several years ago. The culture here was something that was the foundation that I think allowed this group to get through COVID the way that it did and really come out, hopefully, on the other side, whenever that is, but on the other side, even stronger than what we were before. So pleasure to be here. Kevin, thank you. Thank you, Tom. Dr. Reitman. Kevin, thank you so much for having Tom and I. As you said, I'm Arthur Reitman. I'm an interventional cardiologist. I've been here in Marietta, been here in Marietta, Georgia, for the last 20 years. This is my first job out of fellowship. And I am merely sitting in a chair that was, that has been occupied by some phenomenal leaders before me. I've had the privilege of continuing, continuing and perpetuating their legacy. Some of the greatest leaders and mentorship that anybody could have ever had. So I was the eighth guy, and as Tom mentioned, there are now 90 of us. We started with one office and one hospital, and we are geographically diverse, to say the least, at this point in time, 20 years later. So I head the inpatient cardiovascular services for the service line, and one of my partners does the ambulatory side, and in a dyad fashion, we all report up to the head of our cardiovascular service line, Dr. Barry Minkler. So thank you again for having both of us. Thank you. Thank you. I think I did forget to mention my full name, Kevin Mayer, the VP of Care Transformation here at Manaxi. I've been here for nine months, and as Tom and Dr. Reitman mentioned, I had the privilege of working with the group back when they were private, actually, and it's fantastic to see the continued growth and sophistication that has continued with WellSTAR. So to jump into some quick housekeeping items, during the webinar, you're going to be able to ask some questions, and we hope to address those questions in the webinar at the end. So please take notice on the bottom right, there should be a Q&A option, and during you'll see me taking notes, and I will try to address any questions that are on the webinar today. So quickly, our agenda, we're going to go over governance and leadership, the importance of the dyad and the roles leaders play, and then we're going to really do an open interview session, and hopefully leave some room at the end to answer any questions for the people who have joined our webinar today. So this is a very popular slide that we use a lot in a lot of our engagements, and I give a lot of credit to Joel Sauer for putting this together, and I've mentioned this over and over, not only this slide, but also Joel's hairdo as well, we have the same haircut. With this slide, though, it really depicts high-performing CV programs, and it's become an edict here at MedAxian, and if you see at the bottom, the two foundational elements that we've found across all the groups that we visit is having a well-defined and articulated vision and a high-functioning governance and leadership structure in a world of constant change that we live in, without the high-functioning governance and leadership, it's really, really difficult to be able to really move things forward, and as Tom mentioned, to sustain the culture that you are trying to depict throughout your service lines. So again, this is another slide, we always say nothing else matters, culture is still absolutely everything, and we believe in the DyAD model and having physicians in leadership, I'm sorry, in leadership ability. So with that said, I'm going to open up with a couple questions, and again, love to depict the effective DyAD relationship, and would love for Tom, if you will, to start off with explaining why you think your responsibilities on the admin side of the DyAD relationship, what part do you play in the DyAD? Yeah, you know, the DyAD relationship, to me, is the most fundamental aspect of leading in healthcare, and frankly, I don't see how we can function without it, and the reason is because too much and too often, we're asking our physician leaders to be physicians and leaders and do that all within, you know, 60, 80 hours a week, and we just can't move anything forward, so how I always look at it is physicians need to leverage us. We have different skill sets that we bring to the table, you know, mine may be more in the financial and, you know, perhaps in some of the business planning aspects in the strategy, but my physician partners will bring that clinical knowledge, that clinical vision that, you know, that patient care understanding, and where we intersect is in that strategy, in quality development, and what that allows us to do is allows us to move things forward in a much more robust fashion and in alignment, because too often, where I see things fail is when you don't have that DyAD relationship or a strong DyAD relationship, and you're either at odds or, you know, we hear all this time, you know, all the time, physicians and administration going, you know, going against one another, and then it just ends up becoming a brick wall, and it ends up slowing down progress, so to me, I truly believe in it not only just at my level, at the leadership level with Dr. Reitman and, you know, others, but every aspect where we have physician leaders, I try to pair them with an administrative leader, and administrators may have multiple physicians that they work with, because, again, we want to leverage our physicians where they're the greatest, and that's in clinical, that's in vision, that's in quality, obviously, that's in the, you know, patient experience and patient care, and to really pull from them how we can support them and how we can leverage them, and then if the DyAD relationship is good enough, the physicians are pulling from us, and, you know, really leveraging all of our strengths in trying to move different initiatives forward, so that's how I sort of view the world, and I think, to me, it's the most vital component to a functioning service line. Fantastic, fantastic answer. Dr. Reitman, could you chime in on what you feel from a physician leader standpoint? Absolutely. I mean, Kevin, look, this is incredibly complicated work. This is not the practice of medicine that many of us started with or a generation prior to us we may have witnessed. It's incredibly complicated to move initiatives and strategic goals and visions forward, and for that reason, the ability to articulate something that multiple people can buy into, that our DyAD partners are able to help us translate into whether it's an SBAR or a sort of strategic vision, it's so important to walk into a room together on the same page. I think that there are many times when we as physicians doing clinical work, we may not have the opportunity to be everywhere that we're being asked to be present, and as a consequence of that, to give 100 percent of ourselves where we are in the moment really demands a vision that is shared, that two people, that two DyAD leaders can interchange amongst each other, and when one is present, the other is not, the initiative still moves forward. It's the vision. It's the goal of all of this work that we must be moving forward in a progressive way. That takes not just one person being able to articulate a pathway, but it takes multiple people who have bought into a way of seeing the world, so that's why I think that the relationship is paramount towards anything that we do these days. Yeah, and Kevin, and you may ask this question, but I think that those last words that Dr. Reitman said, relationship, are absolutely critical, so before you can walk in the room on the same page, before you can develop a strategy, you have to work on that interpersonal relationship with your DyAD, and that is a very important thing as you're coming into a new role or new people are added that you, at an interpersonal level, that you build that trust, and you share that vulnerability that we both have coming from different points of view, and I think that is the key, because it sounds maybe easy on paper. Yeah, you get in a room, you figure it out, you go forward, but all this stuff is about trust, and all this stuff is about really having that relationship with that person across the table. One other thing to add that I should add, and most places may have a DyAD, some have a TriAD, and I think I just want to touch upon TriADs really quick, because I think that's a vital component as well, even though I have some clinical background, started my career in cardiac rehab, I'm not a bedside clinician, and so there's many times, and we sort of have a TriAD model here with Carrie Clark, who's our AVP over our practices, who's also a nurse, bringing her into to have that, she also started most of the cath labs here in the system, bringing her in that nursing expertise is always very critical as well, so if the administrator, the person in my role, or the administrator that is working with a physician leader doesn't necessarily have that clinical background, it's vital to get that administrative clinical background to partner with the administrator and the physician. Fantastic, so you know, clearly you guys have a level of sophistication in your DyAD role, and I love the fact that you also mentioned, DyADs could be at different levels too, it doesn't just have to stop with you and Dr. Reitman there at the top, but there's a different facets of the organization, you do have to have that pairing, which is important. For the people on the webinar too, and in the future, they're going to be at different levels, could you maybe describe a current situation or something that sticks out, where there was an issue, project, or an opportunity that you found it was better managed because of the DyAD structure? Sure, Tom, go ahead. Sure, I mean there's a million that I could lean on, but I think where I like to leverage it, where I think it's the most effective in just an ongoing basis, is in quality. So you know, physicians obviously are focused on quality, that's what they do, that's their DNA, but quality improvement, it's very difficult, and you know, too many times physicians try to improve quality, and they try to bring people around the room, and they attack it maybe at just one clinical aspect, but leveraging and having a DyAD partner there that can bring data, that can focus in and sort of lay out what the process is, that can bring other stakeholders around the table, that's where I've seen it be the most effective, all the way down the line, whether it's in interventional cardiology, or electrophysiology, or imaging, or whatever it might be. Quality is probably the one area where I see it most often used, and where I try to leverage it. The other area is just program development. Again, physicians have the expertise, and they have the vision, and they have, you know, the idea of what the strategy is, but program development then takes all the other aspects of proformas, and FTE counts, and all these other jargon stuff that physicians care about, but they don't need to get into the weeds until we're ready to move things forward. So leveraging that administrative partner in order to get all that detail, use the physician to sort of, you know, pressure test things, and then move things forward. Those are the two biggest areas where I see having the dyad be, you know, at every level, not just at the highest levels, but at every level within the organization really helps to move each aspect forward. Kevin, I have to say, and one of the most important things that I've realized over time is we are, as you well know, we're in the Atlanta market. It's incredibly competitive. You know, I trained in New York. These are a lot of markets are incredibly competitive these days. Anybody with whom we're competing is more than happy to see our strategic plan. None of this is a secret. The real magic of a dyad relationship belongs in the purview of execution. Being able to adequately execute your goals depends on the ability of physicians to get along with dyad partnerships within their service line, and then that translates into administration. For example, with what, as it pertains to quality, as Tom alliterated, the issue with quality had long been that physicians did not hold a lot of trust in the data that was being provided to them, and so when Tom brought to us a new way of looking at this, a transparent understanding of how the data was being collected, the groups that were responsible for collecting that data, all of a sudden there was much more buy-in. There was a bridge, if you will, between the folks who were doing the quality collection and the physicians making the statement, as Tom has said many times before, you know, people wake up trying to do the right thing every day, and you must give them the opportunity to show that. As physicians, we think fairly quickly. As cardiologists, sometimes we judge too prematurely, and we have a lot of responsibilities. We don't always afford every project the depth of time that we need to. I think there have been plenty of times when Tom has said to me, hold on a second, let's rethink this and look horizontally. The goals of the organization, the goals of any individual group with whom we interact, are all intentionally trying to elevate our program and elevate our group, and you must remember that in the back of your mind. Fantastic. You know, you guys have great synergy. I mean, you definitely just start working together, and I had to chuckle a little bit, too, hearing the word execution, too, from my great mentor Rick Siegel. I think I had a coffee cup on my desk, execution. So, you know, jumping into the team members right now, too, you guys brought us some great points. You know, there's heavy competition, as you stated, Dr. Reitman, from other industries. You know, I often make the joke about people being able to go to Target and make way more money and have less stress. And in healthcare, we've done a great job of really putting together some great mission vision and value statements. We put them on nice marble on the back of our ID cards. They're all over, but, you know, traveling to different sites and sometimes, you know, talking with frontline team members, there's some disconnect from what the C-suite might feel is their vision and values in the organization, but it doesn't resonate all the way to the frontline. Could you maybe share maybe some tactics and how do you promote a culture, again, both in a dyad fashion on how the mission vision and values resonates through the entire organization in cardiology? And I'll let Tom, if you will, if you can maybe start and Dr. Reitman chime in after. Yeah. So, I mean, that's an important question. It's important that our frontline team members understand, you know, where the organization is going and to be able to translate it and what it means to them at their level. That is in front of patients every single day. So, taking words that may be on slides or on a webpage and saying, what does that mean to you every single day? And how I utilize it is really leveraging the administrative team that we have. I try to make sure that our administrative team and by extension, our physician team, because, you know, this is, that type of thing is one of the things where Dr. Mangal and I, Dr. Reitman, Dr. Sachs, who's our ambulatory chief. We try to make sure that we're aligning with what the system's trying to do. So taking whatever, you know, direction the system is trying to do, and if we've been following any type of news, we've had some crucial conversations we've had to have recently about the direction of where the organization is going. And I think it's important that first we understand that. We understand where our strategy and our vision is aligned to that, to the system strategy. And then it's important that we cascade it. We cascade it formally and formal conversations as strategy changes or mission statements change. And, you know, and we also rely on our leaders to be those cascaders of messages, but we also then do it via our actions as well. And that's based off of the strategies and the focus that we put on. So if our system vision is all about serving all, you know, we make that a priority and we make that a priority in how we take care of patients and the strategies that we put forward to make sure that we have access and we have health equity programs and all of that stuff. Obviously quality and making sure that we're aligned with what the quality, you know, focus areas are for the system. How does that translate to what we're doing in front of our patients every single day? So to me, the tactic is alignment with the system within our service line and then cascading and communicating via words and via actions to our frontline team members. Fantastic. Dr. Reitman? Well, I mean, I agree, I agree with Tom and Kevin, you're, you know, you're going to be very well aware of what I'm going to say. We are, as a physician, I come to the table with a certain skill set. There are 29,000 other team members within this organization that come to the table with the skill set as well. Being positively sort of respective of their perspective and understanding that what I might have done in the past when I really made some mistakes, there are, there's an organizational matrix that exists for a reason. And instead of calling the CEO, as Dr. Mangal has taught me many times over the years, allowing people to do their jobs and to advocate on my behalf and our behalf as a group of interventionalists, as a group of non-invasive imagers, as a group of heart failure doctors, allowing those people whose job it is to advocate on our behalf is really critical. And so I feel like understanding that everyone plays a role, again, everyone wakes up every day trying to do the right thing and to help us move forward. I think being able to communicate that from the bottom up is equally as effective. I read something the other day, which I found to be very useful and sort of disarming. Talk to the CEO as your very good friend. Talk to environmental services folks as if they are the CEO. And it's a poignant lesson and something that we try to do, I think the best leaders try to do every day. Love that, love that. So I'm going to push on that because I do want, Tom, for you to share some of your secrets there and Dr. Reitman's, but you know, engagement is everything and the term now that's being used a lot is quiet quitting, which I think is even more dangerous, in my opinion, to have someone who's disengaged but remains with the organization. But it's not only frontline team members, you know, you have physicians too who could be quiet quitters and don't want to be a part of anything. Could you maybe break down one, maybe how do you identify that before it's too late? And also how, what are some tactics or strategy you use to either course correct the quiet quitting? And we can begin from a physician standpoint, Dr. Reitman, if you can maybe explain a little bit about that. It's not a new phenomenon. I love that the verb is quiet quitting, but it's definitely the disengagement has been an issue for quite some time. I think culture is the most important thing that you can ever do within any organization. Culture is, it seems a wastebasket term, but it, the culture that we've developed has led to an extremely low turnover over the 20 years that I've been here. There are a handful of physicians that have left us for a variety of reasons, but my guess is it's no more than five. What I would say is that it's follow-up, it's communication, it's a constant reinforcement of a relationship that is not separated by boundaries. As Dr. Mangel always says, you know, when we sit at a board meeting, for example, within the boardroom, we're operating as a group trying to execute on a vision that works for the entire group. When we walk out of that room, we are one amongst the 90 or the 28,000, as I said. So communicating with people when there are issues, trying to understand. I had a physician in the office yesterday who was very concerned about feeling somewhat isolated in her role, and action steps, things that I can do actively to brainstorm and to help bring her to a better place is what I pledged, and a follow-up meeting is scheduled for a month from now. So actionable items that are within boundaries make sense, and allowing people to understand that you do care, that I am here to listen and nothing, there's really very little that cannot be solved with a conversation and with an open ear. I think as physicians, we're, you know, in some ways, especially when I was coming through, quietly quitting was not even a thing, but it was, you know, a lot of hours, a lot of sacrifices. I think what a newer generation of people have taught us is that you can live a life and provide wonderful, high-quality care for people concomitantly. I think that that is, the two are not mutually exclusive, as we may have been taught to believe early on. So in summary, what I would say, Kevin, is the culture is dictated by the ability to communicate in a way that does not demean either person, and it has to be one-on-one. Fantastic answer. Tom? Yeah, I mean, we're certainly, Kevin, we're not immune to what's going on around the country, and COVID certainly has made that worse. And so, you know, I think some of the strategies that our team has deployed has been exactly what Dr. Raymond said, has been that hands-on approach, meeting them where they are, understanding what motivates them, understanding what it is that they have interest in. And I think, you know, it's that last part that I think is the key, is understanding, you know, what is it that maybe they want to grow and develop within themselves? And a little bit harder to do among 29,000 team members, but it's, you know, easier to do in a, you know, in a cath lab, in a singular cath lab, in that setting, and understand what that team is. You have interest in doing structural heart and growing to develop structural heart. We put in, we created a new tier program in order to give people that motivation to move up, you know, sonography, all these other areas, but we are certainly not immune to it and have struggled with it, like many are, you know, across the country with that staffing. But I think, you know, to piggyback on what Dr. Raymond said from a physician point of view, that's been the culture that has been reason why less than, you know, five physicians have left this practice. It's not Hotel California in a bad way. It's Hotel California in a good way. People just don't want to leave because Dr. Mangle, Dr. Reitman, and others, and, you know, Rick and Kerry and all the people that have been here before me, have done is they've fostered interest. So it's not, let's develop a PERT program. Okay, Dr. Reitman, you're the head of the inpatient cardiology or Dr. Menino, you're the head of interventional cardiology. You do it. We have physicians that express interest. A lot of the program growth since I've been here, and I know it has been before, has been because a specific physician has expressed interest and they've expressed interest in wanting to grow. And so what's been done then, that is fostered. And it may bring frontline team members along there with them because of different skill sets. They may bring frontline teammates along to develop that program in whatever capacity they have. So it is all about individuals. It is all about relationships and it's about communication. And I think that's the key. It's not, you know, it's not the silver bullet. It's not going to fix everything. But it's important that you understand what it is that motivates your team members and what it is that they may want to grow. And some may just say, you know what, I'm perfectly fine. That's where you're meeting them. And then you adjust whatever you need to adjust around them. So it's a tricky thing. It's a very tricky thing. It's all been what we've been able to do, I think, that's been so unique is the vast majority of it has been totally organic. It has not been, there are very few positions where we've had to go find someone to fill a particular need. And if there are, then we've spent a tremendous amount of time finding that individual to make sure first and foremost, yes, that they're well trained, but secondly, that they believe in patient care in a similar way to what we have always done, the way that we've always taken care of our folks. So. Fantastic answer. This is a great commercial for you guys. I imagine you get some phone calls now to fill some openings. And Kevin, I don't know if you can see the Q&A box, but there is a question. I was going to go about the Q&A box. Yeah, just a reminder about the Q&A box. And thank you, Tom. I was actually going to jump in and state the great questions. It's timely that that came across. But the question is asking if you can share what organizational resources are most critical to support a successful diet and whether that be data, leadership development, and what are the tools from an organizational resource perspective? I think, great question. Yeah, I'll just start because I really want Dr. Reitman to talk about the leadership development and some of the things that he's looking to do as we speak. And the one that I want to hit is data. I think data is absolutely critical. And Dr. Reitman alluded to it when we're talking about quality. But having the ability to tell our story, and I think that's a lot of what we have to do as diet leaders is tell our story, whether we're advocating for something or whether we're just trying to promote what we're trying to do or prior to advocating for something. I'm a big believer of continually tell your story of what your programs are doing, what your service line is doing. By the time you go and you ask for something, those senior leaders have a good understanding of what you're trying to do because they already have it. They already have a good awareness. And how to do that is via data. So whether it's a quality story, whether it's a financial story, whether it's a program growth story, whether it's a market opportunity, data is something that is vital. And it's always not easy to get either. And many systems are beyond complex in how their data is structured. So having those organizational resources at your elbow, which is something that I'm constantly fighting and fighting for, because I know if my diets have the right access to data and the right tools and the right person that can analyze and create informatics around that data, then they can really then support their physician leaders in whatever initiative, quality, strategy, or otherwise. But the leadership development thing, I think, is absolutely crucial. And Dr. Reitman has some really good visions on what he's trying to do with that. So I'll let him talk about that. And one second, before we jump into that, the data piece is absolutely critical. Could you speak to just timing something you mentioned before about including the team and sharing your vision to make sure there's not that disconnect? How do you break up that data so that it's pertinent to the individual at hand? So data you share in your C-suite, your exec community level, and then your ops team, and what data, and then the data shared at a front office. Sometimes I think we can lose people to where we're sharing data up here and down. How do you connect that? Why, and is there any tactics or even a free tool you can explain to the team? And how do you break that data out so that you can explain the why to how that team member can affect the change that is needed in the organization? Yeah. So we believe in cascading scorecards. So we have an executive scorecard that ties sort of our true north, high-level metrics, and all our major categories of quality operations, growth, experience, et cetera. And that sort of ties to the system. Those are also roll-ups from all of our sites across the system. And that's what we look at as leaders to see if anything's going off the rails and to see if we need to start to lean in on things. But then we have site and sort of divisional-based data dashboards that's more relevant to what they're doing in their location or in their division. And that's an important piece because then that relates to, oh, this is what I do every single day. And it all cascades up. Now, do we have a good tool? Absolutely not. And it's something that we need to work towards and work to developing. It's something that we do a lot manually. But it was an important piece for us to develop for exactly what you're saying, Kevin, is our frontline team members and our frontline leaders need to have sort of how their business is running. I tell all my administrative leaders, so all of my team, all the CV directors in each of the different hospitals, you are an executive and you own your own business. So run it like a business, not in how you lead and how you demand and all that stuff, but in how you understand the functions of your business. So not just we did 25 PCIs last month, understand what that means, what that means in your growth trends, what it means for quality, what it means for strategy, what it means for your flow, your efficiencies, all of that stuff. So trying to get them the right information has been very critical. We're doing it in a pretty archaic way right now. Hopefully, as our new leadership within our system has come in and sort of transforming our data operations, we'll get a little bit better. But nonetheless, it doesn't change what we need to be doing, what we need to focus it on. Fantastic. I appreciate that, Tom. And Dr. Reitman, if you could jump into a little bit sharing the leadership development and the organizational resources around that. Sure. I mean, listen, Kevin, you know, you, Tom, a lot of people are very well aware. We have some phenomenal, phenomenal physicians who are some of the best trained people in the country. I think what we have not done well because we're not a, because academically we have never chosen to go down this route is we've not been great at telling our story. Tom's iterative approach to collecting a lot of this data has built on, has really been built on foundations that were laid previously, but a lot of incredibly creative work on Tom's part has led to dashboards that can be seen across the organization. And those dashboards we are coming to learn are the, really the currency, and Jeff Rose has told me this in the past, your currency is quality. And your ability to take that data and show it to the organization and demonstrate the work that you're doing is paramount. I think that it is also that data that emboldens leadership. There are 12 divisional leaders within our organization, within our service line, heart failure, electrophysiology, interventional cardiology, CCU, et cetera. So non-invasive, there are 12 divisional leaders. Those leaders, just like I, are physicians and have no sort of formal training in helping to elevate. So what we've done is we've asked the organization, many organizations have a physician leadership academy, and we have one too, but when we looked at it carefully and we broke it down into its components, what we're asking our physicians to do is to motivate other physicians, to elevate them, to share a vision, to help them to tell a story better. That requires something that's a little bit different. And so what we're doing currently is engaging in a pathway for executive coaching for all of our divisional leaders so that they are empowered to help those younger legacy folks grow. And so that when we walk out of the door, whether it's 10 years from now or 20 years from now, there's something incredibly powerful behind us, something that is self-perpetuating and based on this culture that is data-driven, that is transparent, and that works well within the organization. I want those 12 people to be empowered to make sound decisions with both the organization as well as their particular divisions and divisional physicians in mind. And that perspective really comes from someone who does executive coaching. And so that's the pathway that we're moving down. That's fantastic. And is that executive coaching an external firm or is that in-house talent that is- It is. This is coming from outside of our organization, somebody that we've asked to come in and do a combination of a virtual platform and an in-person platform, not an MBA or an MHA or anything like that, but questions and teaching us how to look at ourselves in a 360 degree manner and then be very deliberate with the people that we are tasked to lead. I think that's important because that was a financial commitment from the system too. So that's a huge resource. I love hearing that. And just on the development, something you mentioned, Tom, and I know where you're going with this. I love that approach. You said that you implemented some tiered, I guess, advancements so people know what their next step would look like. And I don't want to speak for you, but if you can speak into that, it might be beneficial for some of the people joining the webinar to hear what you're looking at implementing. Yeah, and simple. And many programs around the country probably have done this with mainly cath lab techs and sonographers. Because our system has grown by addition of hospitals, we had what's called here legacy, sort of the four original hospitals, and then there were acquisitions made. There really wasn't a lot of consistency across the board, and there really wasn't a clear pathway that for a cath or an EP tech, one could be working at Kennistone, which is our main hospital that does everything, everything under the sun. And then one of our smaller community hospitals, there was no differentiation between the two with regards to progression of skillsets. So someone in structural heart, that has done a lot of training, done a lot of on the job work to get to that skillset, was at the same level as someone, and not to diminish it, but someone doing diagnostic caths all day long. So that was, I say, relatively simple. It wasn't simple to get approved and through the system, but it was a simple concept in let's create tiers based off of education experience and the type of work that you're doing, and then to create this new tier that is really for those people that are looking to do those highest complex procedures, and now replicating that in a cardiac stenographer world. So it's a recruitment, it's retention tool, but it's also, again, meeting those team members where they're at and what interests them and giving them an opportunity to develop within their own team, within their own organization. That's fantastic. I just wanna quickly remind everyone too, in the webinar too, that the question and answers, if you would like to submit questions, to use the Q&A box, not the chat tool. The chat tool is disabled. It's the Q&A box if you want to ask questions. So, Dr. Reitman, other than what I've taught you, what has the COVID pandemic taught you as a physician leader? What has strengthened as a result post-pandemic? I think that I have to be very honest about this, and I love being able to interact this way, but I have to tell you that for me, there's great value in human relationships and I struggle somewhat with the virtual nature of visits sometimes. People, you don't get a chance to hug people. I struggle a little bit, your patience. I mean, you don't get the opportunity to interact with your peers in a way that fosters trust. I think that the screen is an incredibly useful tool for bringing people together, but what COVID has, I think, taught me and a lot of people that I work with is the value of the interaction, sitting down face-to-face with somebody, reading their face, shaking their hand, there's nothing that replaces that. And as I watched my children have to sort of retreat into their schoolwork with their computers and continue to push higher, it's a very difficult ask. And so for me, I would reiterate so much of the information that's out there about the value of, whether it's one-on-one or with an audience, being able to read people's faces, to see them, to understand what they're really saying and really feeling, and then to be able to share that with them. And really feeling, I think that that's an art form that really can be lost if you use the screen as a substitute. I don't think it does nearly justice to the level of interaction that we used to have. Well said, Tom. And I think, to that end, everything Dr. Wrightman said is absolutely spot on. And I think I have a lot of those same personality traits and that human connection and that interest to be right in front of people. So to say what we've learned, we've learned how to lead in a different way because we haven't been able to do that. So learning how to build relationships over a screen, learning how to understand, how to get a point across without all the body language, because yes, we may be on camera now, but I would say 80% of our meetings, most people don't even get on camera. It's just like having a phone conversation, but through a computer. So it's learning how to articulate a message clearly and concisely when you can't read that body connection piece of it. And it's about building relationships in a different way. I mean, still this day, I've been here over two years, there are still people that I talk to on almost a daily basis I've never met in person. And when I do, most of them say like, wow, you're a lot taller than what I thought. But it's like, then you're like, oh, now we have this a little bit more connection. It's a consistent message, Tom. No, I have met you a million times. I'm still amazed. So it's taught us this different skillset. The other thing that it's taught us, and again, the virtual piece of it is honoring flexibility and honoring, it's harder, obviously, for your direct patient care where they need to be in and they need to be treating patients at the bedside or in the lab or in the office. But even then, in our offices, how we've been able to be flexible with our staff members, whether it's front office staff that are working from home or whether it's nursing that's working from home that are able to do the same amount of work, but still being able to do it at home. But for leadership positions, it has been about flexibility. Those 7 a.m. and those 5 and 6 and 7 p.m. haven't gone away, but what's gone away in a lot of cases is that we're doing those virtually. And yes, it may not be the best environment, but there's also some conversations that, you know what? Yes, I want the human interaction, but it's not gonna be any added value. When it's our board meetings and it's leadership meetings and difficult conversations, 100%, but when it's talking about what we're gonna do with our PET scanner, which was my 7 a.m. meeting this morning, that is, I don't need to be in a room. I don't need to be here at 7 a.m. in order to do that. I can do that from the comfort of my house or in most cases, as I'm driving into work. It just gives me more flexibility and more time with my family and, you know, all that stuff. That's the other thing that I've learned to be able to be adaptable to that. I appreciate it. That was the admin side, helping us not being sued by Zoom. I appreciate the shout out there, Tom. Yeah. So, you know, people, team members, you know, they contribute on different levels. And, you know, sometimes people get caught up in title and only feel like they can move the cheese or affect change based on title. You know, how do you foster that contribution from your team members when they are arranging titles? Because as you know, there's a lot of silent leaders out there. There's that strong nurse that is able to get that difficult doc to move through the office a little faster or the naysayer front office person who's able to rattle the team. So what are some things, how do you foster the contribution of all team members, not just based on the title? I think a very difficult question. I think that within our organization, what I would say is we work with individuals. There are individuals who have skillsets that we go to because of those skillsets and to lend value and credibility to a project, to a goal, to the care of a patient. I think that if you are always remembering and repeating to yourself on an ongoing basis, my goal is X, Y, or Z. I need to be taking care of a patient with these complicated issues. It prevents egos from getting in the way. And I think that understanding that there's so many people who have the ability to participate in very complicated conversations that will generate ownership. Ownership is paramount when you're trying to do something across an entire service line. No one person can ultimately or should ultimately be responsible for all of that. Getting the input of multiple people, making sure that they understand how critical they are, that is, and reaching out. Just to ask a quick question. It's so easy to do today, whether it's via text or calls, whatever it is, there is no traditional boundary the way that there once was in terms of the office and the phones and methods of communication. It's so easy to get so many people, their input in terms of what you're doing. Titles really sort of melt away when people feel invested and feel like they are participating in something that's making care for their patients, care for their community better. Fantastic answer. Tom? Yeah, Dr. Edmund, spot on. I mean, it's about listening and it's about understanding or helping those team members understand their role in the bigger organization. And I think the way that I approach it, one, with my leaders, I don't try to look at things at all in a hierarchy way. And I try not to look at whose title is who. I'm gonna go to this person only if they have this title. I'll go to the frontline team member who's taking care of the patient at the bedside if they have an invested interest and they have a great solution. So what I try to do, probably not as much as what I should be, is as I round with our teams and our team members, I try to get them to see me as just a person, not a title. And I'm not sitting there grilling them about X, Y, or Z. I'm listening to what they're doing every single day. I'm listening to what struggles they may have. And my approach to them is how can I advocate for you? How can I support you? What is it that you need in order to take better care of your patients? And to me, I try to just to eliminate any titles. I don't come walking in and say, hey, I'm Tom Draper, I'm the vice president. And everyone stand up and add attention. That just then fosters a whole title environment. And what I try to do is just be with them in their environment and understand them at the bedside or at the administrative table, whoever that team member is. And then my job is just to advocate. I had a great boss. My first boss at Sanger said, would always take, he's like, we should take the org chart and flip it upside down. Where the patient's at the very top. And it's the frontline team members, it's the nurses, it's the cath lab techs, then it's the manager, then it's the director. And I'm all the way down here at the bottom and my job is to make sure that everything that happens above me is done as well as possible. And that's my sole job is to make sure what they all need in order to take care of that individual, that individual patient is the most important thing. So that's just the way that I approach it. And I think Dr. Reitman sort of spelled it out perfectly how we look at it. I think what you said, Tom, is the most important thing in terms of never about not worrying about titles and not getting caught up in that. Meet people where they are, not where you are. When you said that earlier, it just strikes me that that is, that's my goal and that's my job is to understand where other people are in order to gain their buy-in for the initiatives that we're trying to execute for the vision of the service line and the healthcare system. Gentlemen, it has been an absolute pleasure around that one minute mark. I sincerely, sincerely appreciate the words of wisdom. The culture was absolutely displayed and the effective dyad partnership that you guys had was absolutely displayed throughout this entire webinar. I wanna thank you really from the bottom of my heart of taking the time today and sharing your stories. Thank you. So I learned so much from you, Tom, as a mentor. Dr. Reitman has always been a mentor life on print and shout out to some of my other prior dyads, Dr. Simone and Manuel and Dr. Alsheikh, who we always joke that we weren't the smartest dyad, but we were the best looking dyad is what we would always say. So I hope you appreciated our webinar today. Thank you all for taking time to view this webinar, part three, have a beautiful day. And thank you again to the WellSTAR team. You were amazing. Thanks, Kevin.

cardiovascular staffing

COVID and post-COVID world

leadership

culture

dyad leadership structure

retaining team members

effective communication

trust

data

positive culture