Jud Knox, CEO of York Hospital

Dr. Lisa Belisle:

Jed Knox has served as the President and CEO of York Hospital since 1982. Thanks for coming in today.

Jud Knox:

You're welcome. It's a pleasure to be here.

Dr. Lisa Belisle:

I'm really very interested in York Hospital and part of this came from going down to visit last I guess it was last fall now when your organization was doing a fundraiser and had started to do some more work in the area of I guess it was elderly care. But what I like about York Hospital is that you've been kind of innovative for quite some time. How did you get involved in this innovative organization?

Jud Knox:

Well, I started at York Hospital in 1982 and I think at the time that I arrived it was already a community hospital that was very patient focused and the staff concentrated very carefully on what's right for patients, families and the community. That was very good fortune for me. I think I was able to learn from the folks who were there and share some of my own values and hopes and aspirations with the folks who are there and the folks who are still there.

Dr. Lisa Belisle:

I'm looking at your name tag. It has your first name and then underneath the tagline is loving Kindness. It's kind of unusual for a healthcare organization, is it not?

Jud Knox:

It is a bit unusual. Loving kindness is a value set about non judgmental acceptance of people where they are and doing the best one can to enhance their lives and their well being. It is probably an unusual phrase or value set to use in a hospital setting, but I find it and I think others have found it very meaningful as a guideline as a foundation for trying to take care of other people and trying to improve the lives of others.

Dr. Lisa Belisle:

Your hospital is known for integrative care. You've been doing work in integrative medicine for really a few decades now, probably longer, but at least as long as I've been aware of it. And you are one of the leaders within our state. How did that happen?

Jud Knox:

Well, I think the foundation blocks are something like being open to what individuals need and want and perhaps providing care in a way that isn't dictated from a set of perceptions, but is more open to what people need. And whether it's integrative care or greater family inclusion or just embracing people as who they are and what they need, I think that's all part of what we try to do. We're not perfect by any stretch of the imagination, but I think that's the value set that we try to bring to take care of people. It's very similar to members of one's family. Members of one's family are all different, have different expectations, different wants and different needs. They're still members of the family, they're still embraceable, they're still engageable. And so it is with everyone I think we try to take care of.

Dr. Lisa Belisle:

At the same time, you still are responsible for budgets and numbers and quality metrics and meeting the needs of your of insurers and the government and regulatory agencies. So that's an interesting thing to have to balance.

Jud Knox:

As the CEO, you're so very right. It's a very interesting and often challenging set of opposing forces. In many ways. There's a lot in healthcare, there's a lot in medicine that's structured, regulated, defined. There's a lot of financial and regulatory restrictions that can very easily get one kind of restricted or defined by all those forces. And because of that, I think it takes some extra effort to take care of folks where they are in that context. And it probably takes a little bit of rebelliousness to say, okay, I know this is the form out there, this is the model, this is the template, if you will, but let's bring ourselves back to center. Let's bring ourselves back to our overriding purposes. It's more important than all of that. And that's the person, the people, the folks that we're trying to take care of. So it is a bit of a balance. And I'm not going to tell you that by any stretch of the imagination that we always stay exactly on the rails or perhaps exactly in the bounds as others might define them.

Dr. Lisa Belisle:

Having worked now over the course of 20 years of being a doctor, both with the Maine Health System and also with Central Maine Healthcare, and having done an article about Maine Health and interviewed Bill Karon and worked with Peter Chalk before he retired at Central Maine Healthcare. One of the things that is very clear is that you're dealing with the shifting sands of the landscape, and it seems as though medicine has made some dramatic leaps, but perhaps more challenging is that it's making subtle movements even as you're trying to deal with the dramatic leaps. Would you agree?

Jud Knox:

I would very definitely agree with you. I think there are leaps, there are big steps, there are tiptoes, there are stumbles, and they're all happening simultaneously. And I think one of the most interesting things for us to be attentive to those of us who are trying to provide health care and medical care is to be really cognizant of what's happening in the broader social context. We don't, in healthcare, live on an island. We cannot pretend or be effective, ignoring the rest of the social movements that are going on. And I think it's fascinating. I often talk to my leadership group about, interestingly enough, what's happening in retail, what are the lessons in retail that one can apply. They don't necessarily be. They aren't necessarily neatly analogous, but what can be applied by what's happening in retail. Because those same movements, those same changes, are going to change people's habits and conduct and going to very much reflect on what happens with people's wants and needs in medical care. And so some of our greatest challenges are, to me, not necessarily the steps that are going on within medicine and the changes that are going on within medicine. If anything, those changes may be more slowly occurring than the changes that are going on more broadly. And that's a little bit. I'm a very positive guy, but that's a little bit of a danger signal for medicine and those of us providing health care.

Dr. Lisa Belisle:

The danger signal being make sure we

Jud Knox:

pay attention to what's going on outside our realm as well as what we're aware of and know about inside our service industry, if you will.

Dr. Lisa Belisle:

Well, having known many doctors and having been a doctor, I've had a bit of a sense that there's an ivory tower thing that has happened for many years, not unlike academia. It's understandable that if somebody gets a lot of education, they probably assume that they know a lot and they want to stay in that tower where things feel safe. It's not always been my experience that every single person, every single doctor, every Single health care provider wants to take a broader view. Some people would prefer to stay in that ivory tower, not all. I have plenty of doctor friends who are very open minded and very aware of social considerations. How do you deal with people who would really prefer just to stay where they're comfortable?

Jud Knox:

Well, it is a difficult thing because I respect the training, education, experience, skills that folks bring to take care of other people. Changing or impacting those folks attitude or approach to what they're doing is really a bit of a delicate piece. It's not to force them to change because they're wrong. It's not to impose something on them because they're going in the wrong direction. It's really tried to try to suggest that they have enormous heart and head to offer. But to be able to offer it effectively, we all need to recognize that we may have to offer it differently than we have in the past. So it doesn't make the skill set wrong, it doesn't make the delivery wrong, it doesn't make the approach wrong. But it may mean that who we're trying to help is in a different place than they were a number of years ago. And to be effective in helping them we need to do some changing. It's a bit of a challenge to stay away from. Not that you suggested it, but it's a bit of a challenge to stay away from the right and wrong piece. I often have discussions about whether walk in care is episodic, so it's not good. And primary care is longitudinal, so it is good. I really try to stay away from the good bad piece. If we're trying to take care of people, what are the vehicles that are going to be effective in embracing them?

Dr. Lisa Belisle:

I think that that's a very important point and that is that when we look at something like evidence based medicine, we tend to be very algorithmic. There's a good, there's a bad, there's a yes, there's a no. And that's really kind of a weird thing to try to impose upon the human organism which is multivariate. You know, we have different genetic structures, we have been raised in different social cultures. So it's a funny thing, we want to offer the best care. And I think that most doctors I have met have, want to offer the absolute best care. So if they need to be, if they need to say something is right in order to offer that care, that's where they're coming from, the very best place. But it's not, it's not a black and white situation.

Jud Knox:

Often I with You. It is a very, very valuable point. And the physicians, nurse practitioners, physician assistants that I know, all want to do the right thing to help other people. There is just no question about that. Not any. And we have built a lot of templates, we've built a lot of protocols, we've built a lot of, through professional associations and regulatory approaches, the right ways to do things. And we've in some ways constructed a bit of a trap for ourselves, even though we have to deal with that trap in the current. It's. We have to develop the ability to. We have to develop the ability to live in the present, but extend ourselves out to what might be in the possibilities in the future. Possibilities that we see and possibility that. Possibilities that the people that we are taking care of see. That's a difficult thing.

Dr. Lisa Belisle:

At one point, I think in my career I was very. I think I went from being an idealistic medical student and very excited about the possibilities of my career to being very disappointed because the reality of caring for people is very sobering. People are very complicated and their social situations are very complicated. And I so wanted to do things well that I was just destroyed when I realized I couldn't be perfect for them. I've come to the other side now and I really feel very optimistic about what we have to offer people within our system. And part of the reason I feel optimistic is that we are heading towards a time where we more appreciate teamwork, where we more appreciate working in an. In a structure where everybody has something to offer. We don't. As a doctor, I don't have to be perfect because I have other people that I work with who can do other things probably better than I can. And I think we're starting to educate our medical students this way now too. Have you noticed things like this playing out within your system?

Jud Knox:

I think as tumultuous as medical care and healthcare delivery is today, that we're making positive progress. And I think some of the confusion, if you will, contradiction and even dissatisfaction is helping us formulate a different set of expectations and deliverables than we have in the past. And I think that's making us, or allowing us to be more flexible and more individual oriented than perhaps the approach that we built in the past. I do believe that the team approach is freeing. I think the idea that none of us are perfect and none of us have all the answers and even the answers that we have aren't necessarily the right answers for everyone we're taking care of and being okay with that. I think we are evolving. I Think as caregivers, as carers, I think we are evolving in that way, and I think it's improving.

Dr. Lisa Belisle:

The other thing that I feel optimistic about is something that I heard somebody else who studies medical education speak about in a talk he gave to the first year main track students that work with Tufts and also Maine Medical Center. And he said, you are in a great time because we have high tech. We've made these advances in medicine that have helped a lot of people, and we are understanding how important relationships are again. So this next generation of students and practitioners can use both sides of their skill sets. They can be able to have high tech and high touch. They can use integrative care like massage or acupuncture, and they can use robotic medicine. And I think that's probably the. The most exciting thing that I have heard somebody talk about in medicine recently. And I think York Hospital is really attempting to do that.

Jud Knox:

The most important thing any of us have are relationships. The most important things we can have. And relationships are a connection of compassion and love, and whether it's in medical care or any other part of our life. So anything we do in a really meaningful way, in my opinion, has to be based on relationships. And relationships are one to one, constantly dynamic, and always work. Not necessarily bad work, but always work. So if we're going to help people, if we're going to deliver care, the foundation is the relationship. And recognizing that, I think, is probably one of the most important things we can do moving forward.

Dr. Lisa Belisle:

As far as relationships are concerned. One of the things that I noticed when I was at the fundraiser, and I don't even think it was just a fundraiser, I think it was also, it was on the announcement of a grant that was being given by a family to advance care for older people. But I was impressed with the community. I was impressed with the people who had shown up to celebrate this work. I was impressed with, and I have been consistently impressed with the people who remain committed to York Hospital who want to see it furthered. I mean, you have had some beautiful new structures put in place, so your physical plant is obviously evolving and lovely. But more importantly, I think the community support is so strong. And that's something that, as we've evolved into health systems, doesn't always maintain its importance.

Jud Knox:

I'm a very strong believer in the connection with community, which is, to me, about relationships. So for York Hospital to be valuable, no less sustainable, the organization and the folks in the organization have to work on those relationships all the time. Communities aren't stagnant. They Change their characters, change. How do we change as an organization to keep that relationship in a valuable place for the community? And again, I'm not professing perfection or awesome achievement, but it is the, it is the piece that I feel is extremely important. For community medicine. The development of systems and expansions of major, major providers of care. We're in a very interesting market in York. Portsmouth Hospital is owned by Hospital Corporation of America which is 180 hospitals around the country. Another hospital on the seacoast has now been purchased by Mass General, happens to be one of the larger providers in New England and Nearshore hospitals of 55 independent hospital sitting in a number of relatively small communities. I'm not boasting about that position. I'm merely saying that I think the relationship piece, our work on relationships with the communities is why we still have good relationships with those folks. I don't know longer term the answer to your question, and it's a wonderful question, a bit perplexing, how are those relationships maintained as organizations cover states and regions, not community or groups of communities? I'm not sure.

Dr. Lisa Belisle:

Can you give me an example of a change that you have seen in the time that you've been in York hospital starting in 1982 that has surprised you? Whether it's a change of attitude, whether it's a change of circumstance, maybe it's a person's change of mind?

Jud Knox:

Well, I think the change that's. Been the greatest in my years at York Hospital is the movement of physicians from private practice to employment. So decades ago as a hospital executive I worked with physicians in relationships where they were in private practice and worked at the hospital. And there was an interesting and for the most part pretty comfortable set of relationships, mutually respective relationships developed. Today we have probably 160 providers employed at York Hospital. And employment, when we talk about physicians is not necessarily a positive word. But most importantly it's a totally new relationship with providers. And I'm not sure anybody's really comfortable with it yet. And there have been people, there are organizations who have been in these sort of structures, employment structures long before we were. Long, long before we were. So perhaps those with that experience are. But it's still I think, and awkward relationship. So that's kind of interesting for me to say that after talking so much about the importance of relationships and positive relationships. So that's the biggest change. Is it a good change, one might ask. And I think it can be and is transitioning us to. A good set of positive relationships. But I'll just speak for ourselves we're not there yet. We're still trying to figure out what that new relationship is. You know, it's as if we formed it, the relationship, the employment relationship, without sitting down and going, okay, doctor, what would you like this relationship to be for you and hospital? What would you like? What are your expectations out of this relationship? Interestingly enough, at least in my experience, we never had those discussions. We had the I'd like to be employed. Here's our contract. And that's not a great way to develop relationships. Are we learning? Yes, we're learning, and we've moved some significant distance, but I still think we've got a ways to go.

Dr. Lisa Belisle:

What is your hope for the future?

Jud Knox:

My hope for the future is that there are no barriers to great medical care. I'm sort of a universalist from that perspective. I'm open access. Everybody deserves the best medical care that we can bring about to folks, that we can bring to folks. That's what I hope. We're really lucky in our corner of the world. We provide care. Everybody comes to our doors regardless of their ability to pay. And I'm very proud of that. But we're a little microcosm compared to the broader picture. And open access, that would be my dream.

Dr. Lisa Belisle:

Well, I hope that you see your dream.

Jud Knox:

Thank you very much.

Dr. Lisa Belisle:

I've been speaking with Judd Knox, who has served as the president, president and CEO of York Hospital since 1982. I really appreciate your having the time to come in and talk with me today. Thank you. I appreciate the work you're doing.

Jud Knox:

Thank you. My pleasure. Very happy to be here.