Leadership: Removing the Guess Work

Leadership Tradeoffs

INTRODUCTION:
You’re listening to Tiller-Hewitt’s Leadership Lens Podcast. If you’re a leader - or an aspiring leader - who wants to stay relevant and impactful… YOU’RE IN THE RIGHT PLACE.

At Tiller-Hewitt we believe it’s faster, smarter -- and less painful -- to learn from leaders who have walked before us. That’s why we invite top leaders to be our guests on the Leadership Lens.

Your host is Tammy Tiller-Hewitt – Founder of Tiller-Hewitt HealthCare Strategies. Let’s jump into the podcast.

TAMMY:
Today my guest is Dr. Chuck Callahan, Leader of Memorial Health System – a multi-hospital health system in Springfield Illinois. Chuck has the most diverse background which may be his secret leadership weapon.

Wait until you hear his answers to management trade-offs, what intel and healthcare have in common, or how the simplification and sequencing of their values pre-pandemic – actually took the guesswork out of decisions and successfully served as their compass through the pandemic.

And like most of you, I’m always curious about the factors that influence a leader’s hiring decision. That was a fun part for me hearing Chuck’s perspective and some of the biggest interview misses!

TAMMY:
Hi Chuck, welcome to the Leadership Lens Podcast. With your leadership background experience, there is literally an infinite amount of things we could talk about today.

CHUCK:
Well, Tammy, it's a pleasure to be here with you today.

TAMMY:
I've been in the business as long as you, but I've never met a health system CEO with your background. You earned a Doctorate of Philosophy and Clinical Psychology, you were the first Chief Quality Officer for your health system, you are a certified Lean Six Sigma Black Belt and an MBA with over 30 years of experience.

So, to say you’re well-rounded is an understatement. I want to start by just asking, out of curiosity, which part of those credentials or experience made the biggest impact, or has something outside of those credentials and experience made the biggest impact on your career?

CHUCK:
I've got to tell you, Tammy, I use every bit of it every day. I think of the situation we are in right now, every part of it contributed in some meaningful way. I guess I would have to say, as a healthcare executive coming from the floor - so to speak, my clinical training and having worked in the hospital setting alongside physicians and other clinicians, really is bedrock stuff. I think having that clinical background probably is a really useful part as you then transition to an administrative-type role.

TAMMY:
As you go to the dark side…

CHUCK:
I work with physicians, for example, who are contemplating coming into a physician executive type experience, and they ask, do I have to give up being a doctor? I said, you never will. The lens you approach things through you'll always be a physician. The plus side is, if you're doing human touch, you can see ten people a day, thirty people a day. But the system's, you design is an executive, informed by your clinical background, you can touch dozens or hundreds or even more. So on that side, impact, positive impact on patients and families is broader. I think that's an appealing thing for people as they want to evolve in their career.

TAMMY:
Wow, that is very good. Well said. Did you always know that you wanted a leadership role?

CHUCK:
I’ll answer this way, I never thought I wanted an executive or administrative role. That was not in my thinking. I knew I would lead you know as a clinical psychologist working in mostly rehabilitation settings, with people with strokes and spinal cord and head trauma injuries. I knew I would be helping lead them to better lives in some ways. I wanted to participate and help them come up with adaptations that would lead them in a better direction. But I didn't know that I'd be a leader in the sense that we used the term today, a healthcare leader executive. That was not in my plan.

TAMMY:
What would you say was the pivotal point in your career, maybe a defining moment, that felt like an epiphany or an affirmation of your chosen path?

CHUCK:
Rehabilitation is a team sport. I had the opportunity to work with teams and develop programs and partly based on my content knowledge, I'd be kind of became the leader of some small teams and learn that some of my psychology background (communication, analyzing kind of disparate information, trying to understand what people were saying when there was a conflict, kind of getting to the root) that felt very natural in the way that a psychotherapy approach would be and that you're kind of cajoling or helping people discover some ways of doing something different. So, that's a pretty natural evolution. Over time, I was asked to take on some management roles, but I was still mostly clinical.

I say, the epiphany probably came I was the Product Line Administrator for our Neuro and or Orth Service Lines. I was still 50% clinical doing a lot of kind of diagnostic work on an outpatient basis. I was asked if I take on the Emergency Trauma Service as well. That was kind of the epiphany where I said I've got to make a choice. I can't be good at all that simultaneously. We were seeing fifty thousand visits in one Trauma Center. That was a time where I had to make a choice. There’s a fork in the road and you’ve got to take it. For me at least, I thought there was enough of the skill-set I had devolved were required to do the job properly. People ask, oh, do you miss giving up? I don't think I gave up that much. I'm using all those skills every day.

TAMMY:
What do you think are the top leadership challenges today both professionally and organizationally

CHUCK:
Boy they’re significant! I have not experienced in my career as much simultaneous press on so many simultaneous fronts, as it seems like we're dealing with today. I am very much informed and believe in this VUCA Concept. And that's the one that's been out there for about twenty years out of the military strategy college or college VUCA world. The VUCA is a world of volatility, uncertainty, complexity and ambiguity. That's the VUCA acronym.

We've been talking about it for several years. It talks about the interconnectedness of things, the rapid pace of change, the lack of full knowledge that you'd like to have to make a decision. What's the path for? What we did before may not work. What I found is that idea was only reinforced by the pandemic. Everything that it told us to anticipate really came about as of the pandemic.

How disparate events across the globe can impact us. The impact on supply chain. The impact on people's motivation to stay in the healthcare space - all that. What I have been thinking about is that the solution to the VUCA problem. I think to combat the volatility, you have to have a strong set of values. To combat the uncertainty, you have to have methods of understanding the current environment. And that's some blend of formal data but also just management by walking around and getting on the floor.

I think the answer to complexity is really understanding that there's a few key constraints. We can talk about that more. But if you use a theory of constraints, I think, frankly, it really outlines very well, the challenges that managers are facing today. The answer to ambiguity is action. I think there's too much of a risk of being paralyzed in the passivity, just wait for it to blow on by. It's an adaptive response to take some purposeful action. And as leaders, we have to say, guys, here's what we are going to try to do. It may not work, and if it doesn't, we'll fail it fast. I think that kind of VUCA solution, honestly, that's how I'm thinking about how we move forward.

TAMMY:
That's powerful. That alone is worth the price of admission. I'm sure our listeners are taking copious notes right now, that's good. What do you think the warning signs are that an organization is getting close to running off the track?

CHUCK:
Boy, it's a great question. When things aren't working, as well as they used to, you gotta pay attention. And I think, though we mentioned constraints, I do want to highlight that because these are some of the signs. That fear of constraints is that every system is held back or limited by usually one predominant constraint. And if you can identify it, you can kind of pick it off or address it. And the key constraints out of, you know, this is my black belt kind of background, but there's several versions of this. They call them the 5 M’s or the 6 M’s, I like this version of the 6 M's. It's Manpower, or I would properly more call it Human Power now, Materials, Machine, Methods, Management and Milieu. And one of those 6 usually is your predominant problem.

So, for two years, the milieu of the pandemic was the predominant problem. Everything we did was his response to that pandemic milieu. Within that when the resurgence and then relaxations, it manifested, the next constraint would pop up.

For a while was materials: no masks, no gowns, no vaccine, no test supplies. And so, you attack those.

Now the predominant constraint is the workforce, the human power element. That is such a feature of everything we’re doing. I could serve a lot more patients if I could just find the staff. And it's putting a lot of pressure on the operational metrics. The cost of the staff because of supply and demand. The travelers were relying upon. It is really flipping upside down the business model of healthcare.

TAMMY:
I do know that resources and manpower or human power is a very hot topic, really across all industries. What kind of innovative solutions have you come up with?

CHUCK:
It is a significant problem. I mean, in the short run like a lot of places, we are now more reliant upon traveler or agency staff solutions than we ever have been before. It's a very challenging thing when some of your staff decided to go off and travel elsewhere because they see a short-term, pretty significant economic opportunity. Even people say I love the culture, I love my team here, but I got kids going to college. Am I stupid not to go away and bang some cash real fast. And that's a hard one to answer, you know. So, we've got our teams going over to other places and their teams come down here and we're all paying exorbitant prices to do it. That bubble is going to burst at some point, but it's probably going to take a while to work through it. So, we're overly reliant on travelers, and many of them are very good. But they don't necessarily know your culture. They don't know your operation as well and they're transient. So, it's not a good solution. There's this element of the great resignation where the impacts of the pandemic over time, emotionally and every other way, people are just saying, you know, I'm ready for a change. I'm going to retire early. I’m going to change my career path. I'm going to go do something else because guess what, sometimes there's not extra time and I'm just going to do it now. We've seen that impact medical staff, regular staff, etc. You see it in the CEO data around the country of the churn that's going on. People are just tired.

And so, this is a big problem. Where do you find this next wave of staff? And honestly, when you can make $18 or $20 an hour at the Chick-fil-A that really starts to pick off a certain segment of your entry level workforce that used to be some of the engine for getting into health care.

You know, the people who would work in the floors is doing different jobs, maybe then go on with help to get nursing degrees or other laboratory degrees. And so that was the input pathway and that's been picked off. The innovation is, ideally, we can redesign the things to maybe be more efficient and really let people work up to the max of their training. But designs like that are often slower. And so, in the short run you're going to see a lot of reliance on these various international or domestic type traveling people as we try to figure out how to develop these resources for staffing.

TAMMY:
What are you guys doing in terms of automation to maybe replace some people, whether it's online scheduling, online registration, check-in - anything and everything that you can automate?

CHUCK:
We are trying to do each and every of those things. It's pretty informative when you go to the McDonald's now, and no one at the front counter unless you call for them. But they have two big kiosk things you order your own burger. Of course, it takes me 10 minutes to figure out how to make my order versus walking up to the counter and saying give me a Quarter Pounder, a Diet Coke. In a sense, they put the burden on the customer. Frankly, all they do is bring it out when it's done. Healthcare is a pretty human touch kind of business and so I think the challenge, that's the constraint of the method. How do we continue to make people feel like we've got their human interest at heart versus I'm just here managing my own way through an environment I don't understand. I think that's going to be a hard one to figure out.

We're doing some of the self-scheduling. As you get a large Integrated Health Systems, pulling these things together, it's very costly. It's a little bit challenging. We're trying to do that. I think a lot of the work is going to be giving tools to - people want to self-manage to a certain degree. I want to be able to get on late and order my stuff and do my stuff and they’re somewhat comfortable with that. I think is going to have to be a lot of different solutions for different customer needs.

TAMMY:
Let's talk about growth. I mean we still have to have volume to cover the cost. We work with leaders who want to consistently deliver strategic growth and measurable results. So what are your leadership secrets or success strategies around strategic growth? You know, not all business is good business and then measurable results.

CHUCK:
You'd be a better decide, what is good business? It's somewhat different. I'm in a not-for-profit healthcare space, that doesn't mean I don't need to make a margin. But there's some roles that my organizations are in where we're the last ones standing. For example, Behavioral Health.

In some of my markets, I'm the only hospital system offering inpatient Behavioral Health Services. Others have gotten out of it. And so, there's a certain community responsibility to those people even though that segment might not be your most profitable choice if that was your only motivation. Your value system drives some of these decisions. And then there's going to be hard choices about what is stainable growth, what's good business, what's profitable, what’s sustainable, what's worthwhile? That's going to be an individual decision based on your local marketplace and what your community’s need. Our values are we’re serving both individuals and communities to increase the overall level of health. If I bail on a key service, it might be profitable, but I don't know that it's consistent with my mission. That's the compass I have to use and leaders have to use about making hard choices. Leadership is always about managing trade-offs and I would say right now, the trade-offs are challenging.

TAMMY:
Well said. I like your last man standing. The question is, if you become the last man standing for the key service lines that don't support your financial mission.

CHUCK:
There's some hard choices. And so then maybe you need to segment down within those. Are there segments that are the most vital, the most unique? How can you do some things a little bit more efficiently? Asking the customer to be actively involved in their own healthcare is actually not a bad thing. To say, well, I'm just moving the burden onto them, actually, that might help them manage their health more prudently over time.

So, I think behaviorally if we can engage that kind of dialogue and engage people say by taking on this element of the care yourself, here's how you learn to care for yourself. I'm kind of teaching you how to fish. That actually can be a positive move for overall health and consistent with our mission. But we have to be very thoughtful about it.

I think if you're managing your value system, I mean my values in my organization, let me put it this way, they are in this order:

• Safety - First do no harm.
• Integrity - which is courtesy and the management relationships which also includes equity and diversity type of understandings
• Quality - which is outcome you know, evidence-based care
• Stewardship - I have to manage my finite resources prudently because I want to be here for another hundred years or more to serve the community.

But honestly, stewardship is not the first value. Other organizations may have a different system where maximizing profit is the first value. I'm not going to comment whether it's good or bad. I'm just saying, if that's not our organizational posture. I can't ignore the stewardship value, but I will tell you, I have purchased equipment and done things and the name of safety that frankly I had to find other dollars to pay for that.

TAMMY:
You did the right thing.

CHUCK:
But that's our system and, honestly, that served us well during the pandemic.

TAMMY:
Awesome. Does your team know your values and the values of your organization?

CHUCK:
I'm pretty proud of that work. We had a more complicated statement of value that had been in our organization for twenty-five years before that, that everybody agreed, you couldn't articulate it. Everybody could articulate a couple of pieces of it, and it all read beautifully on the wall map, but you couldn't rattle it off in the way that I just did. And so, we did some purposeful work to review our statement values as part of a strategic plan, kind of refresh: Mission Vision Values. And these values, it got simplified to those four in that very particular cadence. And honestly, I'm pretty proud of that because, “A” it worked during the pandemic, it helped guide personal and organizational decisions. And I think it's simple enough that most people can articulate it.

TAMMY:
You're right. It's just so complicated. I see people grab their badge and flip it around so they can tell me. What did Einstein say, if you can't explain it simply, you don't understand it.

CHUCK:
That's exactly right. I get worried about the staff members, trying to do the right thing, but they get in to bind. What if what I think to do is safe but it's also cost more money? How do I decide? I think the value of having a value system that is in a particular cadence if you have that decision, safety always wins.

A lot of clinicians say, I get safety first, that's pretty common in healthcare. Shouldn't quality be next? Save your life and then get you to health, isn’t that what we do? We argue that integrity is second because if I don't give you the courtesy and the respect, you will never give me the opportunity to show the quality I can offer you.

If I'm rude you on the phone and keep you waiting for 20 minutes, you'll go somewhere else for that surgery. If I can convey successfully to the community at large, I am a place that has integrative relationships and I respect you, giving your diversity, your lifestyle, who you are, if I can be a safe place for you to come and grow your career and have fellowship and really evolve, I ultimately should be able to attract more good workers to my place than someone they see is not safe for that. That's why integrity second for us.

TAMMY:
One of my favorite questions to ask is, what factors influence your hiring decisions?

CHUCK:
Well, certainly the traditional ones in the sense of you know, are they a good fit for the job. That gets you in the door.

Your resume, your pedigree, so to speak. If somebody said well how do I do a successful interview? Frankly, interview behaviors start when you get off the plane for the interview until the time you leave town, that's the interview. Don't say well I wasn't in the formal interview so I dressed sloppily. Guess what the minute, I see you the interview started. I'm data collecting from the minute, you walk up to my office and I shake your hand. You better be prepared. You have done your homework. If it's obvious to me that you're not quite sure if you're in Springfield, Illinois, or Springfield Missouri. And you say, tell me about your hospital, I'm like, okay, you know, that's unimpressive. Do your homework.

Thirdly, we'll do the thing and we'll tell each other who we are, and we'll have some conversation. At some point, I'm selling the organization, so I'm telling you about us. At some point I’ll say, hey, what questions do you have of me to help you appraise this opportunity for yourself? I don't have any questions, I've met other people already. I think all my questions are answered. That is a stupid answer.

Because, honestly, I don't know what you've talked about in those other sessions. Maybe you have only three questions you’re asking of everybody, I won't know that. But that shows me that you've got curiosity of mind. Even if they're canned questions, then if nothing else that can take can compare my answer with others to see if, hey are these people on the same page? But if you I have had more than you can count, even bright people say no, I don't have any questions. Frankly, that is a big miss because I just think you have no intellectual curiosity, then you're not on your feet.

TAMMY:
Wow, listeners. That was a powerful answer because we're talking about hiring leaders now. He's not talking about hiring a front office person, but a leadership role, that's good. I've heard of organizations who mystery travel with candidates, where they will have a seat either in the same row or very close on the airplane, they watch them at the gate, they watch how they interact with people all the way through. Have you ever done anything like that?

CHUCK:
I cannot say, it's interesting, it makes me smile, kind of like, wow, that's clever - mystery shopper. I will say, here's the proxy. We’ll take you out to dinner. I watch your table manners.

That's the closest proxy. And on the one hand you're doing a courtesy, we’ll feed you since you spent the whole day interviewing. But I think beyond that, it’s like how do you act in an unstructured setting. Your “table manners”. What do you say when your guard is down and we're not in that formal interview setting? It can be quite revealing. Even on a subtle level, did I enjoy that hour and half or two hours? Because if I didn't, why would I want to work for you for the next number of years?

TAMMY:
I had a friend that was interviewed for an engineering job and she got the job, but later, she was told by HR that they critique a lot of things during dinner. Much of what you just said. Also, things like do they salt their food without tasting it. So fascinating to hear about that. I love hearing about interviews and I think there are so important but, you know, everyone is on their best behavior. Getting them out of that environment, I agree is an awesome idea. What are the three takeaways you learn from managing through a pandemic?

CHUCK:
I would say kind of the importance of your values. If you've not really thought about it, I guess there's personal values as well, but your organization values. If you haven't looked at them in a while, and if they didn't play out prominently in some way during your experience, they're probably not very useful. And so you ought to look at it because I I found again that sequence that we described a few minutes ago, Boy, we returned to that all the time. We had hard choices and the path wasn't clear either way and for us, that was a very helpful compass. It validated that the work we had done two years ago was good work. You’ve gotta look at your values. Maybe they’ve evolved over time. I think for people in the workforce, for some of them their values have been changed by the pandemic, less trust in certain authority figures. Maybe my priorities have changed because people I know didn't make it. So, that was a big one for me.

The other one is leadership, visible leadership. We really stepped in, we did a lot of what I call innovative things in the early days of the pandemic, like a lot of people did. We built outside triage stations in the ambulance bay of our Emergency Department, to do quick triage for people who are peppered up before to keep them out of the organization, if they were contagious, etc. We did a lot of things like that kind of nimble but I think that when you're doing that stuff, I think the visibility, the MBWA (management by walking around) was pretty important to kind of reinforce what you think is going on and also send people the message that you're there with them. I think that's important.

The other one is our systems are so complex, maybe overly complex. I think the pandemic kind of showed that. When have we ever been in conflict with visitors? Usually, we're open armed, right? It's the rare exception where you have to tell somebody to leave because they're not behaving properly, but I gotta say, unfortunately, the front line staff who do the check-in, and the temperature screening, they took a lot of heat this last couple of years. I mean decorum is at an all-time low. And so I think that, you know, when was the last time we were in conflict with visitors?

TAMMY:
That's a good point. My parents are at an age where they're in and out of the hospital with, you know, total this and total that. And nurses would always say you're part of the care team. Well, I'm a bean-counter, so that was always hard for me, but we never left a parent behind. Everyone would always spend the night and we really did participate in the care. I would think that with no visitors, no family, that added another layer of burden on the nursing staff to just keep a closer eye, more frequency, and while they're having sicker patients. So, it was like a double whammy to the nursing team as well, not having the family and the visitors.

CHUCK:
It did because many times, they're able to keep no mama, you know, hey sit down, let's call for the nurse I mean there was a certain safety feature. There's a certain comfort feature for the patient. They're doing emotional support in the room. You're doing teaching with the family which facilitates the discharge. All those are very positive. Now during the pandemic it was a mixed bag because if I have a lot of family there and do I know that they’re adhering to, the nurses sometimes got to the level of I'm the cop to make sure, you know, put on a mask. They said, I almost got too many things to watch now. So, I think it has changed the posture of how you think about these things. I think just you have to have a lot of appreciation of the demands we put on staff and on managers frankly and just acknowledge this is hard work. I don't have all the answers, but I need to talk to you, to understand the perspective to help formulate the best answers I can.

TAMMY:
If you were talking to someone outside of healthcare, what is one or two things you would say from an insider’s perspective, describing the current state of the health system, the healthcare industry?

CHUCK:
I think it's in a time of change, it has been in times of change before. I don't think we can just say, well because I have low staff, you're going to have crummy service. I don't think we can become complacent. It's easy to say, well yeah, I know the call light was slow and I know it's harder to get you in for your test, but I'm short-staffed. We can't become complacent. We've got to user our various resources and creativity to try and figure out customer-centered solutions and it won't be easy. A little bit of acknowledgment but also dedication to change some of our standing processes that really are customer centered and be less aggravating to people.

TAMMY:
The last thing you want to see when you go to a restaurant or anywhere is like, please be patient, we're short-staffed. I mean that's basically announcing you're going to have a really crappy experience ahead.

CHUCK:
It's hard. How do we get some relief for staff? We're doing some things, like a lot of people are. Hey, standing orders. Are there certain things we do that we don't even maybe remember why we do them that just churn extra burden?

We've gone to a lot of automated standing orders. Maybe all those elements don't make as much sense today as they did when they were first put in order. So, sometimes in healthcare systems are pretty good about adding stuff but not so good about retiring them.

TAMMY:
Yeah. Is that your “lean” brain talking?

CHUCK:
In the “lean” Six Sigma world, we got really good at the Six Sigma part and probably could enhance our “LEAN” part. And I'm trying to think that way now.

TAMMY:
We know that leaders are readers. What are a couple of two or three books that you would recommend that leaders either listen to or pick up and read?

CHUCK:
I tell you and I'm pretty well read. I like to read. I've got a clinical background, I've got a technical business background. I read certain things for pleasure that you would call goofy things I guess. In this space for healthcare leaders, honestly, there are two books that I found that I now think are good reads. They both come from a guy named Andy Grove. He was the former CEO of Intel, the chip company. And he has a very fascinating background. He grew up in what was then Post World War II Eastern Europe, under the Communist regimes and his mother basically decided to save her family by escaping to America. He arrived I think right about the time he's in high school and getting ready for college. He didn't even speak English. He somehow got himself through. He could became basically an engineer. That's an inspiring story. He was the first employee hired by the company that became Intel. The two founding leaders hired him as an engineer to help build this company when they had like three staff.

He has two books, ones called High Output Management, which is now in a paperback form. And basically, it comes from a number of lectures he gave at Stanford Business School when he talks about, how do you manage? And it's got nuts and bolts stuff how do you set a meeting? Why do you have a meeting? How do you do a performance appraisal? How do you set some key management priorities? Basically what's a manager do? They get output. He’s very practical and that's a great management book.

His other book is called, Only The Paranoid Survive which is on strategy, leadership. That book really introduces the idea that every business goes through, what he’ll call a strategic inflection point, a SIP. He talks and the book pretty articulately plain talk about how, in his career, Intel was doing great as a memory chip company, that's all they were. This was in the late 70s, early 80s and that business went into decline because Japan developed a very cheap, high-quality memory chip product. Intel was about ready to go out of business, almost overnight. And so they had one of these kind of “Come to Jesus” meetings you might say. He basically said we're going to do something new and it's called an integrated circuit. It's not a memory chip. We're going to become an integrated circuit company. The first integrated circuit they designed became the chip that ran the brand new IBM PC in 1984.

They basically said we're going to move all production out of memory chips, which was their bread and butter. It’s like Coca-Cola saying, we're not going to make cola anymore. We're going to go into water. They bet the farm and basically IBM selected their chip to be the brains of what was this stupid idea called a PC.

People don't even remember the computers used to be mainframe. There was no personal computer until 1984. And Apple had come out with their little machine about the same time. Intel made the integrated chip, the process microprocessor chip, they became the brains and now multiple iterations of PCs, now cell phones, that was the boom of their business. That moment with was a strategic inflection point (SIP), where the things you are doing no longer work, and you have to make a choice, and that to me is the element of strategy. So those two books, kind of cover the nuts and bolts of management and strategy leadership in a pretty useful way.

TAMMY:
That's awesome. Have you found some of the things that you read in there helpful in your job?

CHUCK:
Absolutely. What's the purpose of a meeting? Hey, take a look at what he has to say about it. And that strategic inflection point, I think we're in one right now. How do you run a hospital when you got no staff, or the staff you can get are too expensive to own?

TAMMY:
Right. Wow.

CHUCK:
That's a strategic inflection point.

TAMMY:
That's good.

CHUCK:
And how we get through that, what choices we make that's probably going to set the story for the next twenty years of healthcare in America.

TAMMY:
Is there anything right now that we're facing decisions that we are going to have to bet the farm on to do a radical shift.

CHUCK:
What happens when healthcare gets expensive for your own employees to afford. How do you think through that?

TAMMY:
What do you think, is the government ever going to get involved and prohibit some of this activity that's happening because we're all paying? And I don't blame the nurses either for going and stashing a bunch of cash because today is an opportunity for them. But it's hurting all of us in the long run. Do you see any intervention?

CHUCK:
Well, there is some intervention going on. It's probably a mixed bag because you have to be pretty smart about this. There is some in Illinois, there is some legislation that was attempting to put some caps on this. What's extraordinary cost in this? But you have to be careful because there's some discussion about what is the impact on some of the international traveling resources? There are some pockets of new staff that come internationally and these contracts are a little different. These are people who don't travel for 13-week contracts, some of them come over for a three-year commitment to your community and they're well-trained, and depending on the country they come from, many times the language is not a barrier and they fit in well with culture. And then again they have very high levels of training experience and so for some of those people to come to America to work is a good thing for their family. They actually move their families here ultimately. About 60% of them decide to stay on permanently after a three-year commitment because they've become ingrained in the community and they like the workplace. Honestly, that to me feels like a melting pot idea that seems very American, right? The idea of people seeking their fortune but helping and enriching what we can do. That may be a great new source. But some of the attempts to manage the expense of travelers, could put a chill on that, which may be counterproductive. So, how do we manage that?

TAMMY:
That's good. Well, Chuck, this has been an awesome interview, again that we could go on and on, but we're going to have to wrap it up. But I do have what we call the rapid, five wrap-up questions.

What are you currently reading that you would highly recommend to a colleague?

CHUCK:
To be honest, I bought a boat I now live on a lake, and I'm scared to death to drive it. So I'm reading about how to pilot a boat better. How’s that?

TAMMY:
That's good! See more examples of how well-rounded you are. What word or mantra do you live by?

CHUCK:
Integrity. I have to be able to look at myself in the mirror and I have to be able to look at you and I think that boils down to Integrity.

TAMMY:
Awesome. And how do you start your day?

CHUCK:
I'm going to answer this different now than I may answer before. We're now kind of empty-nesters. Our youngest is away at college, getting ready to go to graduate school, two dogs. So when we wake up, we're getting dressed my wife and we found that, we've been married a long time, you focus a lot on your family, do things, but hey, this next wave, it's important that we kind of reinvest, because we gotta do things differently, right? Your kids go off to college. You have a new social circle. We can't be passive. We have to actively manage that. So, do you know what we do while I'm tying my tie, or we're talking at the coffee? We do that Wordle thing. She does that. She says okay, we need a word with a middle letter that's an “I” and the third space. We do Wordle together, and then we do Quordle, which is It's like Wordle on steroids with four of them. And so every morning we kind of interact and do those and see what we can solve a puzzle before we ship off to do whatever we're doing.

TAMMY:
I love it. Okay. In one or two words, what is the most important characteristic of a leader?

CHUCK:
Probably to serve others.

TAMMY:
One piece of advice, that you would give your younger self.

CHUCK:
Keep growing. Don't stop. Because things change around you and you change. And so if you can kind of keep having some level of forward growth, you're going to stay more motivated, you’re going to be more interesting to other people around you, and I think you'll be able to serve others better if you grow.

TAMMY:
That's awesome. Well, thank you so much again for being a guest on the Leadership Lens Podcast, Chuck.

CHUCK:
It’s been my pleasure, I've enjoyed it. You've asked me some interesting questions that I’m going to be thinking about themmore after we hang up.

TAMMY:
Oh, wonderful!

CLOSING:
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