Leading Healthcare #221

Peter Chalke:

He taught me once, he said, you never want to retire someday and say, I wish I had.

Lois Skillings:

I think the biggest challenge is navigating during this time of such increasing complexity and also navigating during this time of such constant change.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to Love Maine radio show number 221, leading healthcare, airing for the first time on Sunday, December 13, 2015. Healthcare has undergone tremendous change in the past few decades and this transition is one that will likely continue for many years to come. Maine is fortunate to have strong leaders who are helping traverse this new landscape. Today we speak with Peter Chalk, President and CEO of Central Maine Healthcare, and Lois Skillings, President and CEO of Midcoast Parkview, about the challenges and opportunities they have been part of. Thank you for joining us.

Dr. Lisa Belisle:

You're in the studio with me today. I actually have an individual that I've met several times previously because technically he's my boss. Peter Chalk is the president and CEO of Central Maine Healthcare, the parent organization that oversees Central Maine Medical Center, Bridgeton Hospital, Rumford Hospital, Central Maine Medical Group, and the Maine College of Health Professions. Thanks so much for coming in and talking with me today.

Peter Chalke:

You're welcome.

Dr. Lisa Belisle:

Now, I should say you're my boss in that physician element of my life.

Peter Chalke:

Correct.

Dr. Lisa Belisle:

Since it's half of what I do.

Peter Chalke:

Correct.

Dr. Lisa Belisle:

You're not my boss of the radio show.

Peter Chalke:

You're my boss on the radio show.

Dr. Lisa Belisle:

That's right. That's right. We have to kind of go in my direction for a little while, but it's been great for me over the last two years now to work with Central Maine Healthcare because it's such an interesting. It's been an interesting evolution. It's been interesting to see where you've come from and where you're going. How long have you been with Fence from Maine?

Peter Chalke:

Amazingly, I've been there. This January will be 33 years. I came to Maine. I was going to come for three or four years, get a little more experience, and then move on. And 33 years later, here I am. So it's interesting.

Dr. Lisa Belisle:

Yeah. So where did you come from?

Peter Chalke:

I was working. I was born and raised in New York, actually. Born in New York City, grew up on Long island as a kid. My dad started working for the aetna Life Insurance Company after World War II. He worked on the island, and then we got transferred to Connecticut when I was in junior high and then Springfield, Mass. When I was in high school, and then went off to college in upstate New York at Ithaca College and found out about this field of health care and realized that to do that, I really needed a master's. So I went to George Washington University in D.C. and got my master's in business and healthcare administration. Had a residency, actually, at the Catholic Medical center in Manchester, N.H. and then took a job in Western Mass. For about, I want to say, seven or eight years, and then came to Maine. And since being in Maine, it seems like every time I have gotten a niche for more. I got more responsibility and different jobs. I can't even count how many I've had. But I have absolutely no regrets. My dad died, unfortunately. He was in the Marine Corps, colonel of the Marine Corps. But he kind of died young of heart disease unexpectedly. And he taught me once, he said, you never want to retire someday and say, I wish I had. And I don't feel that I had a great career. I love living in Maine and working in this environment, and it's been very rewarding.

Dr. Lisa Belisle:

What was it about healthcare Administration, specifically, that appealed to you?

Peter Chalke:

Yeah, it's a great question. So I was an economics major in college, and so very theoretical, business oriented. And, of course, I was in college in the crazy 60s where, you know, a lot of unrest on campuses. That was Kent State, a lot of things going on in Cornell at that time, and, you know, we were kind of lost, but I was really struggling. And my dad died when I was a senior, and I started struggling, you know, what am I going to do with my life? I was kind of on my own. And there was a program at Ithaca College that started after I arrived, but I knew some folks in. They were freshmen or sophomores, and it was healthcare admin. I didn't know what healthcare administration really was. I was on the assumption that if you had a hospital, maybe, probably a doctor ran it. I went to the local hospital, went to that program. It was too late for me to join it. And I said, wow, I have a business acumen. But I was concerned that whatever I did as a career in business, I had to believe in the company and the product, sincerely believe in it, or else I wouldn't enjoy myself. And I'm sure there are a lot of private businesses out there that make very interesting and rewarding things and help people. But I said, how can I lose in health care? I mean, everyone needs health care. So I did a lot of exploring, went to a bunch of hospitals, talked to a bunch of CEOs, and they said, you know, go out and get yourself a master's and see how you like it. And I did. And kind of the rest is history. I have no regrets. It's been a great career, and, you know, we've all helped a lot of people. He was a doctor. I mean, you can really point to what you've accomplished and said, we've done some good.

Dr. Lisa Belisle:

Well, it is an interesting point that you bring up, that we perhaps believe that doctors are in charge of administration in hospitals. And even though doctors and actually nurses and other healthcare professionals work as a team in the administration, there are people who are skilled at administration itself. Was there something about the administrative piece that specifically appealed to you?

Peter Chalke:

Well, I mean, healthcare is unique. There is no other business like it on earth. You know, there's very few businesses that, for example, we take care of all customers, regardless of their ability to pay. That's not how a bank works. It's not how a private business works. But that's our mission, and that's what we have to do. So we have some unique barriers that we have to overcome. But you know what I really enjoyed about it the most is I get to work with some very smart people. And I learned something every day, every day talking to our doctors, talking about a new procedure. How does that work? What's that? Do I get some very talented financial people and administrative folks? So I'm learning something daily. And I have been my entire career and that's been the fun part of

Dr. Lisa Belisle:

has seemed to me that having come from a business background, educational background, and me being a doctor and having basically very little business experience, except when I was a solo practitioner and ran my own small office, there's a very different mindset involved. There's a very different educational path. And to be able to communicate kind of across those, it's almost like speaking slightly different dialects. It seems to me that that might be one of the, I don't want to say challenges, maybe interesting aspects of your job.

Peter Chalke:

It is, and I've thought a lot about that over the years and I've tried to mentor a lot of our management staff and it is complex, but this is the way I've sort of made it a little simpler. We were built differently. Business administrators and physicians have a different mindset. Thank goodness we do. So a physician needs a lot of evidence before they're going to do something. Depending on what procedures, maybe upwards of 80, 90, 98% before they're going to do this procedure or put that stent in or fix that carotid artery. Thank goodness, because if they didn't, we'd be hurting patients. Business people need some evidence not quite to those proportions. They need a lot of common sense and they need a good gut. Now, we don't take risks where patient care is involved. We rely on the doctors to tell us what we can and cannot do. But we tend to take a little bit more risk on the business side. And so I always tell my folks, if you understand the physician's mind and how they operate, how they were trained to get a lot more done, if you want to work with them, give them the evidence and give them the data. If you give them the data, they will respond positively. And I've seen it for years. So that's the way UIs work. You're very data driven. So if we can run an institution or a practice or a department where we need the support of the doctors and we arm you with appropriate data, doctors make very, very good decisions. One way to bridge that gap, I think. And the rest is about relationships. It's about trust. It's about, I've been in my Institution a long time. I know majority of those doctors I consider, you know, some work for me, but many of them are my friends that I socialize with and you know, have some fun with. So, you know, it's really a team effort and you know, we all have to work together, whether we're nurses, administrators, doctors, to really solve the healthcare issues that we have to solve today. It's critically important.

Dr. Lisa Belisle:

You've been in medicine now long enough that you've seen pretty big changes not not only in medicine in general, but also for central Maine healthcare. There's been a lot of growth, there's been a lot of transition electronic medical records practices being bought and sold. And tell me what some of the biggest issues that you've dealt with.

Peter Chalke:

Well, first, you know, on your side of the spectrum, you know, I'm just amazed at the, the medical know how and things that have developed just in my career. I mean, when my dad died in 1971 of a heart attack, that was the dark ages of cardiac care. He probably needed a stent or a procedure. He didn't have a stent scent. He probably needed open heart surgery. And it was just ignored. And something horrible happened today, you know, just in that field, I mean, at central Maine and the other large hospitals in the state, you know, we can repair vessels of the heart, we can replace valves. We're now doing, you know, transaortic valve replacements. We can replace your aortic valve while your heart's still beating. I mean, it's just, you know, some of the developments in oncology and the drugs that are coming out today, it's just, and it's. I don't know how y' all keep up with it. And that's why, you know, we always have to sort of practice team based medicine because nobody can keep up with all these advances. So that's been exciting. The other thing, just on the medical side that I find interesting is how many ailments, procedures, I don't know what you want to call them, are so time sensitive where they perhaps weren't before. Now I know we started the trauma program in 93. Dr. Larry Hopperstead, who was our chief of trauma and just a terrific physician in man, taught me a lot and he taught me about the golden hour, which means if you have multi system trauma and we can get you on an operating table within an hour, the chance of survival increases dramatically. We realized a couple years later that doing that by ground was not always possible in a state like Maine. But since then we used to, Before 2000, we used to if you had a blocked vessel in your heart, you'd give thromboly, give TPA, you'd give a clot busting drug. And then around 2000, we started our program. There were a couple studies, I think one was at Stony Brook, one was at Albany Medical center that said, no, get them to a cath lab as fast as possible and open that vessel. Because the clot busting drugs are not that specific or accurate. So time became important, you know, get them there. Strokes, the same thing. Figure out what's going on. If the vessel's blocked, open the vessel. And interestingly now, because my involvement in life flight and I'm on the chair of the steering committee board, the seventh leading reason why patients are being transported from smaller hospitals is sepsis. Five years ago, 10 years, it wasn't even on the, it wasn't there. And as we look at that and talk to our clinicians, the issue is, you know, there's some very rapid infections that can do a lot of damage and you got to move quickly. And a lot of the rural hospitals obviously don't have ID specialists and don't have critical care docs. So they're pushing them to The Eastern Maine U.S. or Maine Med in great numbers. And that's a good thing. So speed is really important for so many diseases now because some of them are so rapid or devastating. And then, you know, on the other side, the administrative side, and then I'll go into some of the things we did, but you know, the payment system has been turned upside down and it's moving rapidly, but we've still got a foot in, you know, two canoes. So we're paid on a fee for service basis for some payers and we're paid on a fixed budget for some other payers. And we have the Medicare ACO. So 18,000 Medicare patients were responsible for. If we beat the budget that the federal government tells us what it is, we get to split that if we're over, you could lose some money. And we're seeing more of those kinds of arrangements on the private payer side. And it's predicted that that's where it's going to go, particularly on Medicare, because they really believe that's how they're going to reduce the Medicare spend over the next six or seven years. So that's a whole new challenge. I mean, I always thought, you know, when I got into this business that I always thought, like, why? Who came up with the term health care healthcare system? Because I didn't think it was a Healthcare system. I thought it was a sick care system. You don't go to the doctor if you're perfectly healthy. You go when you have something wrong with you. But we were healthcare, and we put that label on us. And I think the expectation folks had is, well, your job is to keep us well. And that may be true, but there's only so much time in the day, and most of our doctors are busy taking care of people who are sick. And, you know, we didn't get paid for keeping people well. You know, I don't mean that cynically, but that's the way it was structured. That's beginning to change. And now, you know, for you as a primary care physician, we're saying, no, you got to keep your patients out of the hospital. You got to do this and this, this, and it's a whole new thought process. And you have to develop an entirely different, you know, work plan to make that happen. And you got to do it with a lot of support, because you can't do it all yourself. So that's been a major, major, major change. And then locally, you know, I've been there so long now, you know, central Maine, you know, from its origins in 1891, you know, it was a primary care hospital until the 70s. And Bill Young came in the 70s and looked at a population of the central Maine area and greater than $220,000, 220,000 people, and you couldn't find a specialist anywhere in there. And so they either had to travel great distances to Portland or to Boston, because Portland was still in its developmental phase, or they did what Mainers were famous for. They just did nothing and kind of sucked it up, I guess is the word. So he helped the institution move more into a regional secondary referral center by recruiting specialists. They were all in private practice in those days, and a lot of those got well known in the region, did grand rounds in the smaller hospitals, started some specialty services that you couldn't support on Lewiston, Auburn, but for a greater geographic area, perhaps you could. So inpatient rehab, the cancer center with linear accelerators and all the equipment and medical oncology services, started doing diagnostic, cardiac, cast probably 35 years ago. Inpatient rehab unit we started. And then I came in 83, and that growth continued. So in 1990, we put critical care docs in our ICU. I think it was like 10 hours a day at that time, seven days a week. But I always looked back to that because as you know, that several years ago, the leapfrog group came out with a big report. They thought it was a good idea and we kind of thought it was a good idea. Fifteen years before that, we went to our critical care, our ICU referrers, and said, what happens if you are in an eight hour case and your patient crashes in the icu? And the answer was, it's not a lot of fun. So we did that in 90, and then 93, the trauma program, and then 97. As I said earlier, the golden hour required an air medicine program and fortunately we were interested in it. But Norman Ledman was a CEO at Eastern Main and Norm was just a super guy and had put programs together, I think in Pennsylvania and perhaps Ohio. So he knew the how to do it. And we just worked as a team between the leadership of Eastern Maine and Central Maine and just made it happen. And I'll never forget, we did our homework, we had a pretty slick presentation and we went to our board and said, this is going to be interesting. You know, this is not a CT scan, this is a helicopter. We're talking about 45 minutes to an hour of discussion and questions. Someone said, I make the motion, let's do it. And the rest is history. And it's just a great history. Probably over 16,000 trips. I would say people are walking around this state or this country that if it were not for that helicopter, would not. I've seen many of them, so that was a great addition. And our system continued to grow in 1990, even though back in the 70s when we recruited a lot of these specialists, they were in private practice. For US it was 1990 where that began to fall apart. And I remember primary care doctors coming to me. Friends of mine said, pete, practice of medicine is taking longer than practicing medicine. And what they meant was running the business was taking longer than seeing patients. And they went to medical school to be a doctor, a business person, and they just didn't have the expertise. If you took a large medical group, someone's got to know something about finance. Someone has to know about hr. Someone has to know what OSHA means. Someone has to, you know, and they just didn't have that expertise. And I think they were really getting nervous, burned out. And so we talked to a group of them, went on a couple conferences to say what these medical groups might look like. I went along and they said, tell you what, why don't we just work for you guys? You don't practice medicine. I said, you need not worry, I will not. And you know, don't go hiring a nurse unless we had involvement. Don't worry about it that's the way we operate. You take care of the business stuff, we'll take care of the medical stuff. And that was in 1990, and a couple internists, and I think in came the pediatricians and the obstetricians. And we never asked anyone to join the group because we thought they knew. And really one of the reasons we did it, by the way, besides taking care of our doctors, because we didn't, we were afraid they were going to leave was at that time, I forget the exact statistic, Lisa, but, you know, about 50% of the doctors coming out of residency wanted a large group. They didn't want solo practice, didn't want to own their practice. So we're saying, well, gosh, if we don't have an offering along those lines, then half the doctors coming out are not going to be interested in us. So we actually, in the early days, we said, we're looking for a family doc. These two private practices are looking, too. So why don't you interview there and you pick which one you want. And fortunately for us, some of them pick the private practice. So they knew we weren't playing games, we weren't paying more. All we wanted to bring doctors to our community now all those private practices are now with us. So then over the years, as we recruited specialists, it's tough in Maine. Payment systems are a little bit tough. A lot of Medicare, a lot of Medicaid, and physicians want a little bit more security. So they said, I think I would rather work for the hospital. So it's grown and grown, and I don't know, we're probably. I know we're over 400 providers. Some of them are nurse practitioners, what have you. But we're pretty close to 300 physicians. And as you know, we sort of span from the coast and Brunswick and Bath over to the western mountains of Rumford and Freiburg and Naples. And we set up a lot of practices in a lot of communities because we believed that access was important. That was long before the triple aim, by the way. But in Maine, it's hard to get places. It's hard for elderly patients to drive 40 miles in the middle of winter. So there's a lot of contact spots we have which are never really far from a practice. And, you know, if I look back, I'm probably rambling, but you say, well, you know, what's the most rewarding thing you ever did? You know, it's certainly not building buildings, but it's setting up programs. And I think one of them is our physician practice. I got More enjoyment from that than probably anything. And watching it continue to grow and evolve and, you know, just dreaming about what it could become.

Dr. Lisa Belisle:

You know, I'm glad that you talked about Life Flight because this was one of the articles that we thought was really important to write for Maine Magaz. And we had the Life Flight crew in and, you know, it's been multiple times that we've been out in the community and talked to people who were really impacted by Life Flight. Another organization that I know has touched a lot of people is the Dempsey Center. And this is an organization that falls under the wing of Central Maine Healthcare.

Peter Chalke:

Right.

Dr. Lisa Belisle:

Talk to me about that.

Peter Chalke:

It's a great story and try to make it as brief as I can, but. So Patrick's mom had cancer for about 17 years, ovarian cancer. So, you know, survived a long time with that particular diagnosis. So in some of the early stages, Patrick was in Los Angeles filming Greys and what have you. And he was calling his sister, who works at our hospital and has worked there for about 36 years, Mary. And she's not a clinician, but she's had various jobs and she knows a lot of people. And he'd say, go find out about this, go find out about this. Go talk to that doctor. And it occurred to him one day that, you know, God, if I my sister, I'd be so lost or other people lost. So he came out and I didn't even know he was there. And he met with his sister and met with one of our oncology social workers. And he asked them, are there enough support services for cancer patients and their families? And the answer was no. Or they're fragmented, difficult to access. And then finally he came to me with this concept of putting together a center that doesn't do the medicine. The medicine's in the hospital, oncology, radiation therapy, surgery, but provides support for the cancer, support for the cancer patients and their families while they're going through the cancer journey. That's how I describe it and how he describes it. He wanted a couple things. He wanted a world class website. I think we have that now because I haven't heard him complain about it lately. And he's been very involved. He wanted information either on the Internet that we've screened so it's accurate, or brochures or books or what have you. He wanted integrative medicine. He wanted massage, acupuncture, all the things that we can do to make those patients more comfortable. And he wanted a space. And so we started, and we started in a physician's Office, which wasn't particularly, you know, but we didn't know how fast it was going to grow. And then they got the next office and they got the next office from me. And, you know, it's kind of a hodgepodge, you know, treatment rooms, exam rooms, you know what it looks like. And it really wasn't conducive, but it was really beginning to grow. And so finally I showed him the top floor of Lowell Square, which is one of the mill buildings at Lewiston that we had. We have a lot of our back room services on the lower floors, but it's beautiful. It's brick and there's big windows and it's beams. And he kind of lit up when he saw that and saw the possibilities. So we built the new Dempsey Center a couple years ago in that space and get a lot of comments from the patients that they see enough white and they see enough bright lights, and it's nice to see bricks and wood. We have a healing garden in there that he wanted to put in. We have space for kitchen, demonstration kitchen, meeting rooms, some of the integrative medicine rooms. The Dempsey challenges up there. And we take care of, as I said, patients and families. But one of the unique things that I always like to talk about, because even as long as I've been in this business, for some reason, I never thought of it, we have a gal, Tookie, who is a pediatric social worker. Just a wonderful woman. At any given time, she probably has 130 kids on her service. Kids could be, mom has cancer and they're scared to death. Dad has cancer and they're scared to death, Their sibling might have cancer and they're being ignored or vice versa. And when you think about young kids and you know, the impact that could have on them for the rest of her life if it went untreated or wasn't helped, it's pretty dramatic. So the Dempsey center has been able to fill these holes where we found them, Whether it's counseling, support groups, and what he said to us, find out what the cancer patient needs and do it. And we have about 16, 17 employees. And I think last year we saw over 16,000 patient contacts. Some actually visiting, some maybe phone some other way, but everyone. So many people have reached out to the Dempsey center statewide, and it's been really rewarding. Then, of course, we have the challenge that every year that he is very instrumental in, because he knows the pro cyclists. We have that group. And of course, this year we had Joan London, and we got about three and a half, four minutes on today's show. And. And we had. Katherine Kelly Lang, who was on the Bold and the beautiful for 25 years, and she was great. So we're getting a lot of different people coming up, and it's just a lot. It's a lot of fun. Great sponsorships, great time. Very emotional. Very emotional. I spent a lot of time with Patrick on the weekend, and at the end, we both. As I'm saying goodbye, we both say the same thing. It's about the stories. Some are tragic, some are sad, some are happy, some. It's the stories. It's the stories that make the event, so they're very rewarding. I've enjoyed it immensely, and I'm so appreciative of Patrick and what he's done for the community and for cancer patients, both in our area and further out. His mom, as you know, passed away, and she was just a wonderful woman. She's like my. I don't have a mom and dad. She's like my adopted mother straightened me out every once in a while. But she's just a wonderful, wonderful woman, and we miss her. The Chinese connection is, I think, what you asked, and that one's going to help you a little bit. Not as detailed, but through a whole series of events in Lewis and Auburn over the past year. This concept developed, it had something to do with a Bates College professor who had a brother who did a lot of development work in Beijing, and some people in Beijing that were concerned about the health of the population of China, and they came up with this concept. What if we could send Chinese nationals that are very sick and are unable to get the care they need in China? Can we send them to the States where a hospital like ours can take care of those patients? And can we build a facility where they can recuperate and recreate? And that's basically. So it's medical tourism coming over here. I was in China two weeks ago. Wonderful people I met. I was at a conference. They asked me to speak. I was there the weekend the governor was there. So he spoke before me and then had a nice video about the state of Maine there. And many of them came up to me with illnesses that either they had or their loved ones have. Of course, you got to deal with the language barrier, so everything's through translations. But, you know, I know what this means. That means a karate. So some sign language helps, I guess. But. So we're developing the program, and I'm working very closely with the folks from Beijing, and. And they're continuing to put this building Together. And we're optimistic that we'll be seeing some patients. I think we'll see patients before the building is complete. But particularly in cities like Beijing, I mean, I was fortunate. The six days I was there, five days had a nice breeze, and it was blue skies, crystal clear. The sixth day I was there, you could cut the air with a knife. I mean, it was pretty bad. And you could. You breathe it in. It bothered me. Bothered. You know, and sometimes that hangs around for weeks, months on end, particularly in the winter as the power plants gear up, because it gets colder. And so, you know, according to one of the people in Beijing, they said, you know, unfortunately, we're systematically killing the population through air pollution. Water is not particularly good. You can't drink the water. Food is, I think, generally good. Interesting. But a lot of cancer, a lot of diabetes, a lot of people. Beijing alone, I think, is 12 million. I don't know. It's millions and millions of people live there. So I think it's an exciting project. You know, it has a lot of. Not for us. I'm sure it has a lot of political, you know, aspects to it. But as I work with my people over there, I basically say, you know, there could be a lot of noise around this, but it's basically people taking care of people. And whether you're from China, whether you're from Somalia or whether you're from Lewiston, if you're ill and we can help you, we feel an obligation to do that. And I think that's what we're going to find, and I think it's going to be. We're going to have more diversity. We're going to have some Chinese kids running schools, and, you know, what a great thing. So it's a work in progress, though, and we're not there yet, but we're very optimistic that we can make it happen.

Dr. Lisa Belisle:

Peter, how can people find out about Central Maine Healthcare and the innovative programs that you're offering, and primary care, all of the things that you're doing for.

Peter Chalke:

We have a pretty active website, so I'd suggest they go on, you know, central healthcare.com I think, is what it is, and that'll source all our programs, our physician directories, some of the things we're doing. We're pretty innovative on our website now, and you get a lot of information from that, and that seems what people are looking for today. It's this thing, click away.

Dr. Lisa Belisle:

People can also read about Lifelite and the Dempsey center in Maine magazine and on the website, and we thank you

Peter Chalke:

for that we thank you very much for that.

Dr. Lisa Belisle:

And they can also hear the interviews that are all past podcasts. Actually, we talked to Tukey Bright from the Dempsey center. So we had the Dempsey center well represented. We had Life Flight well represented. And I encourage people to go back and listen to some of those podcasts and see what they think.

Peter Chalke:

We got a great staff. We're doing some great things. We're very fortunate, but it's been fun.

Dr. Lisa Belisle:

Well, it's really been very enjoyable and enlightening actually, for me to speak with you. We've been speaking with Peter Chalk. He's the president and CEO of Central Maine Healthcare, the parent organization that oversees Central Maine Medical Center, Bridgeton Hospital, Rumford Hospital, Central Maine Medical Group, and the Maine College of Health Professions. Thank you for all the work you've done in Maine over the past 33 years.

Peter Chalke:

Thank you. Appreciate it.

Dr. Lisa Belisle:

Often an interesting thing for me to hear the name of an individual and then many years later, have the opportunity to meet this individual in person. Because that's just the way that Life works sometimes. We know that sometime our path is going to cross. And this individual, Lois Gillings, is the president and CEO of Midcoast Parkview Health Services. Your reputation precedes you. You are doing a great job up in the Mid coast region. So I thank you for that and thank you for coming in today.

Lois Skillings:

Well, thank you for having me here, Lisa.

Dr. Lisa Belisle:

Your background is in nursing?

Lois Skillings:

Yes, I'm a nurse. I've been a nurse for 36 years.

Dr. Lisa Belisle:

So tell me how you started that.

Lois Skillings:

Well, I was always very interested in science and definitely a people person and a great combination of science and being a people person. Nursing is a great career. And so I started off as a staff nurse in medical, surgical nursing and emergency nursing, and then moved into leadership roles in health care.

Dr. Lisa Belisle:

I've worked with a lot of nurses. I've been very fortunate. And I think you can't replace a good nurse because they're such an integral part of the healthcare team. Actually, everybody on the healthcare team is extremely important. But I'm interested in talking to someone like yourself who has gone from a very clinical role to a very administrative role, because those are very different kind of parts of the brain, parts of the social interaction. Tell me about that.

Lois Skillings:

Well, I think it's actually an emerging trend in healthcare today and at just the right time. And healthcare is undergoing the biggest transformation that I've seen in my career in this decade. And more and more clinicians who have innate leadership skills or can develop leadership skills are taking on more leadership roles in healthcare because we have a deep understanding and passion for the mission of what we do, a great understanding of operations and how things work and how to make them better. And it's an emerging trend, as I said, for more and more clinicians to step into leadership roles. Nurses, doctors and other members of the healthcare team.

Dr. Lisa Belisle:

So what did you have to learn in order to make that transition? What types of skills and how did your mindset change?

Lois Skillings:

Well, I would say that it's definitely been a life journey to continue a leadership practice. Just as in clinical practice practice, we're always learning how to improve, how to advance our skills. That's the same for any leader as well. And it really started when I was 23 years old and I was asked to be a head nurse. And looking back, I think to myself, how did that ever happen? But my passion for wanting to make things better and continuously learning how to improve systems, how to improve staff morale, how to improve how we serve our patients and their families, and how we improve our financial performance, it's A great reward to see success in those arenas. So progressively I've had the real privilege and opportunity to gain more and more leadership experience through both on the job training, but also official education as well.

Dr. Lisa Belisle:

And where are you originally from?

Lois Skillings:

I grew up in Pownall, Maine, and went to Freeport High School and went to Northeastern University in Boston for nursing. And that's the longest time I've been away from Maine, is the years that I was in college.

Dr. Lisa Belisle:

Well, I love hearing that because this is something that comes up a lot, the idea of the brain drain and people moving away and never returning. But you're a main girl. I mean, and you're practically in your backyard. You know, Bath, Brunswick, that's just the other side of Freeport. Really.

Lois Skillings:

It really is. This is the community that I grew up in that I get to serve now and provide the care and services that really are meeting the needs of my friends and families and neighbors.

Dr. Lisa Belisle:

Well, that's what, as you know, having a practice up in the Brunswick area, that's what I've found so interesting. And also practicing in the Portland and Yarmouth areas is the same thing. It's not that, you know, there's me over here as the doctor and them over there as the patient. It really is. These are people that I interact with on a regular basis in the community. These are friends and family.

Lois Skillings:

It's not a job, is it? It's personal.

Dr. Lisa Belisle:

It's very personal, yes. I worked for Maine Health for 10 years, and as part of the time that I spent at Maine Health, I worked in employee wellness. And we touched a lot of different community hospitals. And there is an affiliation between Midcoast and MaineHealth. Describe that for me.

Lois Skillings:

Yes, we're really proud to be part of the MaineHealth team as a clinical affiliate. We are an independent organization that's owned by our community. So we're not technically owned by MaineHealth, but we partner with them on clinical pathways for the care of patients and for improving the health of the communities that we serve.

Dr. Lisa Belisle:

And you have a new hospital?

Lois Skillings:

We do. Midcoast Hospital actually was born when the Bath Memorial Hospital and the Regional Memorial Hospital came together in the mid-80s. And then in the early 2000s, we built a new regional hospital, Midcoast Hospital. And just this past summer, Parkview Hospital, Parkview Adventist Medical center, joined with Midcoast to be a regional service delivery of healthcare for our region.

Dr. Lisa Belisle:

One of the things that I noticed about the hospitals in the Midcoast region is, and now that Parkview and Midcoast have merged Is that there is this very strong sense of community. There is this strong sense of small hospital doing good work. Tell me about some of the major initiatives that Midcoast and Midcoast Parkview are trying to move forward with.

Lois Skillings:

Well, the first thing we did, recognizing that we truly are undergoing the biggest transformation in healthcare that I've seen in my generation, is that we reached out to the community about three years ago and asked over 1,000 people. Doctors, nurses, patients and families, community leaders, clergy. It's the year 2020, and what should healthcare look like in our community? And what emerged from those listening sessions is a set of five things that we call our 2020 vision that really talks about transforming our healthcare system to be really focused on health. We recognize that hospitals are necessary. Boy, anyone who's ever had a croupy child in the middle of the night or broken ankle or heart attack realizes that hospitals need to be there 24,7 when the community needs them and they need to be regionally located in rational places that are easy to get to. But when you have too many hospitals, the focus is on how to make those hospitals survive and that duplication and competitiveness can take away resources from the mission, which is to improve the health of the community. So what we've done through this 2020 vision was really changed our mindset to being a health care delivery system that's coordinated and integrated and really focused with a foundation of primary care. Really the relationship between a primary care provider, a doctor, nurse, practition and the patient. That's where most healthcare happens in the community. So a very strong foundation of primary care advancements in health promotion and wellness. What can we do to create a healthier community so we can prevent illness from happening in the first place? And how can we continue to meet the needs of our community? Really focus toward the triple aim to improve health care. Better health, better care, lower costs.

Dr. Lisa Belisle:

The triple aim is actually something that has been embraced in a much larger way. It's something that midcoast is a part of. But you didn't initiate that.

Lois Skillings:

No, the triple aim was really coined by ihi, the Institute for Healthcare Improvement. But it's been a movement that is really fueling this focus of healthcare toward being mission and improvement oriented, rather than market and business oriented. I mean, we recognize that we have to run big health care systems to small physician offices in a financially prudent way and to run our organizations in a way that makes good business sense. But we don't exist to be in business. We exist to deliver outstanding health care and improve the health of our community. So the triple aim helps us all to recognize that we can accomplish all of these three things together. And there's never been more important time. Health care costs in our country cost twice as much as they do in other industrialized nations, and yet we rank 39th in the world in our overall health outcomes. Our children have higher obesity rates and asthma rates. We have higher cancer cardiovascular disease rates. And we also don't live as long as other industrialized nations. And so this crossroads that we're at truly is about how to turn that around and transform healthcare from the old way to the new way. And that doesn't mean that things that we were doing in the past haven't been helpful. I mean, obviously there's so many great advancements in technology and disease treatment and cures that we didn't have even a decade ago, or definitely not a century ago. But it is definitely time to take the best of what we've learned from the past century and say, how can we now put our efforts toward making healthcare cost less and make health better in our communities?

Dr. Lisa Belisle:

Midcoast was named one of two main hospitals, U.S. news and World Report's best regional hospitals. How do you think that came to be?

Lois Skillings:

Well, I think it came to be for probably many reasons and many people. We just have a fabulous team of doctors, nurses, leaders, and support staff who just work their hard every day toward a culture of continuous improvement. And you can't fix things and make them better and keep them the same at the same time. I know that's kind of an oxymoron or a yogi bearism, God rest his soul, but truly, I think our culture is about how to continuously make things better and also have a culture of caring and compassion. And those things in combination with being in a beautiful part of Maine where people love to come and live and work, and our gorgeous new facility and an expanding system, it's all coming together, but it's not new. This is something that has been building on over decades of success and growth.

Dr. Lisa Belisle:

What do you think that your healthcare providers and also your patients, what would you think they would consider to be the biggest challenges faced by Midcoast Parkview?

Lois Skillings:

I think the biggest challenge is navigating during this time of such increasing complexity, and also navigating during this time of such constant change and building resilience and how we can help adapt new systems and support the people who are going through change. We've just asked a lot of people just in the last few months, bringing together two organizations that were beloved in our community. And the outpouring of support from the community has been phenomenal. Are there certain folks who are disappointed on both sides of the of the aisle? Probably. But for the most part, there's been such a great, overwhelming support for what we've done. And at the same time, it's a lot of change. We're bringing together two groups of people learning new ways of working together, changing where and how care is delivered. It's a lot of changes.

Dr. Lisa Belisle:

It's interesting as you're talking about building resilience, One of the things that obviously, you know, we talk about the stress on an organism and stress is typically thought to be bad, but really you actually need stress or change for growth. That's just a necessity because if you don't have stress on an organism, it stagnates.

Lois Skillings:

It is very true. So I think this adaptability is really part of midcoach long term success and where we've gotten to this point in time where we are considered to be one of the highest quality, lowest cost community health systems in the state of Maine. And it's now our goal to take that energy and create the healthiest community in Maine. How can we create a culture of health where we work with our tiniest new infants who are born in our community, to our folks who are elder and everybody in between local employers to create a culture of health where we can achieve a higher health status, lower overall obesity rates, prevent diabetes, heart disease, etc.

Dr. Lisa Belisle:

So how will you do that?

Lois Skillings:

Well, I think we will do that in many different ways. I definitely don't have a. We don't have a plan, but we have a vision. And one of the things is by the alignment of Midcoast and Parfum coming together, Parfum has decades of being a statewide leader in promoting health and wellness. And so we're continuing to preserve that mission and add on top of that the support and resources that Midcoast has been bringing by partnering with our Healthy Maine Partnerships. Access Health in our community is the name of our local Healthy Maine partnership, local physician groups, other community groups, the Y, the local Y and come together to see what is the best way to enhance a culture of health. And so we'll be beginning that conversation in the coming year.

Dr. Lisa Belisle:

One of the things that I know my patients who go to Midcoast have brought back to me is they really enjoy the aesthetic of the hospital. They really enjoy the building itself. They enjoy, they like the people, they like the services, but they like the fact that the art, the building it seems to be a space that promotes health and healing. Was this something you took into consideration when you were building that new building?

Lois Skillings:

It was definitely. That is the vision and credit to our former CEO Herb Paris, who, together with a healing environment committee of physicians, nurses and artists and other people from the community came together to say, how can we create a space that does just. That brings nature inside and promotes a sense of hope and healing for the community? And it is beautiful. People tease that there are two art museums in Brunswick, one at Bowdoin College and one at Midcoast Hospital.

Dr. Lisa Belisle:

It's interesting though, because even though intuitively I think we all know that this is true, that the space promotes that. A space is important one way or the other. It can send you in a direction away from or toward healing. It costs money. It's something that not everybody is willing to put resources behind. Why was this so important to Midcoast?

Lois Skillings:

I think because we were starting from a brand new space. And so it was important to say, since we have a blank palette, what can we do to create a place of hope and healing? And really, health is about body, mind and spirit. And the spaces that we provide health care in should be attuned to those, to the senses and to body, mind and spirit.

Dr. Lisa Belisle:

You've had the opportunity to grow up in Maine, be educated elsewhere, come back and work in Maine for most of your professional career. What are some of the major changes that you've seen and what are the changes that you hope to see in the future?

Lois Skillings:

I think one of the biggest changes that I've seen has been the consolidation and coordination of care within regions to align and realign healthcare, to preserve and protect and strengthen that for the future. And by that, I mean you can see it happening all across the state where the old way of delivering health care in a hospital centric, duplicative way is no longer sustainable. It's unaffordable. These financial challenges that are facing hospitals today are very real. Reimbursement is down. Uncompensated care is. Our uncompensated care has tripled only in the last six years at Midcoast. And so if you multiply that across every hospital in the state of Maine, there's a growing recognition that we can continue the status quo of working against each other or come together in regions that makes the most common sense to preserve an outstanding healthcare delivery system for every patient in that region. So I think that what we're seeing is more and more consolidation so that we can reduce unnecessary and duplicative infrastructure While still preserving access. That's been one of the biggest changes, and we've seen it just in our community this past summer with the coming together of Midcoast and Parkview, that is happening in other small regions of the state, all across the state.

Dr. Lisa Belisle:

One of the things that I know my patients worry about in our small practice where we've been affiliated with Central Maine Healthcare, is they worry about in losing a smaller practice to a bigger system, they lose that small practice, feel that intimacy, that staff knowing their name, staff knowing who their children are. I'm sure that you're experiencing something similar as you're working with Parkview. How do you work with that? How do you dispel the fears of this absorption of the smaller by the larger?

Lois Skillings:

Well, I think to me, it all comes down to culture and being focused on the mission and the support of the people at the front line. So it is our hope in actual design that by having primary care centric models for the basis of all healthcare, that in that primary care small office, that that team approach to care called the patient centered medical home, where the patient knows they have not only a provider, but they have a nurse and an MA and a nurse practitioner or a physician assistant who will work with them to help maintain their health and promote their health. And so I think at the front line, that's where healthcare is delivered. It's not delivered by the big corporate offices or by the CEO of a health system. It's really delivered at the place where the public and the patient and their families interact with that doctor, that nurse. And so I think it all boils down to culture. Is there a culture of leadership that promotes and supports that, or is it more of a corporate kind of environment? And I know at Midcoast, we really strive to recognize that everyone is focused on our mission and that frontline care of the patient.

Dr. Lisa Belisle:

You've had the opportunity to witness healthcare delivery as a nurse and as an administrator. You've also had the opportunity, I'm sure, over the course of your life to experience healthcare delivery as a person, as an individual. What are the things that you believe makes healthcare delivery most successful?

Lois Skillings:

Well, the first thing is it's all about relationships. Does that provider, the doctor, the nurse, have time to spend in relationship and to truly listen and engage the patient and their family into what their goals and hopes are? I know this past year, my family, my primary care provider, when I met with her for my annual physical, she asked me one of the most important questions I've ever been asked as a patient, as A consumer of healthcare. She said, lois, where do you see your health in 10 years and what do you think you want to do and how can I help you to achieve that goal? And so more and more today, we're recognizing in health care that patient centric is the most important thing. And I think, secondly, evidence based, are we excellent at the science? Yes, you want healthcare professionals who are nice and compassionate, but you also want them to be smart, really smart. You want them to be well educated. You want them to be well trained and up to date on the most recent research and evidence that help them to guide the care that they're giving for you. Third, I always trust an organization that invites a third party in to look under the hood from an accreditation perspective. I'm proud to work in an organization that's joint commission accredited and has a magnet designation and these symbols of quality. It isn't just to be able to for bragging rights. It's not for me, it's not about the bragging rights. It's about being able to say that we've invited experts to come in and look under the hood, kick the tires, snoop around, make sure that we are what we say we are. And those are the things that I look for. And I think the last thing is that more and more patients, and especially the people who are paying for health care, the employers that we work with and our taxpayers want to know, are they getting value for the care that they're receiving and is this a low cost, high quality interaction? Because more and more cost is playing a role in health care because again, the status quo is unsustainable. This rising cost in Maine, our costs are 22% above the state of Maine average of about the country's average. And our country is twice what it does in other countries. That puts us at an economic disadvantage when it comes to thriving in a global marketplace. And it distracts us from paying for other things in our society, like educating our children, other infrastructure and technology advancements. So I'm really passionate about driving down costs of health care as well.

Dr. Lisa Belisle:

What is the website for Midcoast for those of us who are interested in Learning more?

Lois Skillings:

It's www.midcoasthealth.com.

Dr. Lisa Belisle:

we've been speaking with Lois Gillings, who is the president and CEO of Midcoast Parkview Health Services and also a nurse. Thank you for all of the work that you have done and all of the various arenas that you've worked in. I appreciate your coming in today.

Lois Skillings:

Thank you. Dr. Lisa it was an honor to be here today.

Dr. Lisa Belisle:

have been listening to Love Maine radio show number 221 leading health care. Our guests have included Peter Chalk and Lois Gillings. We love to hear from you, so please let us know what you think of lovemain Radio. We welcome your suggestions for future shows. Also let our sponsors know that you have heard about them here. We are privileged that they enable us to bring love Maine Radio to you each week. This is Dr. Lisa Bellaio. I hope that you have enjoyed our leading health care show. If you like what you've heard, please subscribe to our podcast and take a moment to give us feedback on itunes. Thank you for allowing me to be a part of your day. May you have a bountiful life.