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Becker’s Healthcare Podcast
Kofi A. Cash, DSc, FACHE, Director of Operations (COO-equivalent) at Bartow Regional Medical Center, BayCare Health
00:26:35
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- [00:00]
A
Welcome to the Becker's Healthcare Podcast. I'm Kelly Gooch, Senior editor and Enterprise Lead at Beckers and I'm thrilled to be joined today by Dr. Kofi Cash, Director of Operations at Barter Regional Medical center, part of BayCare Health. Dr. Cash recently stepped into this role where he's focused on operational performance, strategic growth and overseeing a significant capital expansion portfolio. He also brings experience from Mass General Brigham, giving him a perspective across different health system environments. Dr. Cash, thank you so much for joining me.
- [00:27]
B
It is a true pleasure. Thank you for having me. I look forward to having this brief discussion about a little bit about my career and where I am today.
- [00:38]
A
Absolutely. And before we dive in, would you mind telling us a little about yourself and your, your background so we know the perspective you bring today.
- [00:47]
B
Certainly. I, I come to this field which we call hospital administration, hospital operations from a non traditional background. I first cut my teeth in health care leadership on the quality side where often individuals pursuing chief operating officer and ultimately presidents of hospitals typically start from the ancillary services side. So have a non traditional background. I've been in acute care for over 20 years and I have learned a great deal because I have been throughout much of the major regions throughout the country and I've really enjoyed seeing and learning about different cultures throughout the country with respect to workforce engagement and diversity. But more importantly, I've learned a great deal with system ownership for profit, not for profit, community based and faith based organizations. And the mission statements are very different across the continuum. But nonetheless, operationally there are common threads that tie all of these systems and hospitals together which I have found to be rewarding with trying to solve very complicated problems. I've recently earned a doctorate degree in healthcare leadership from the highly regarded University of Alabama at Birmingham and that has really elevated my thinking about solving complex problems and bringing the empirical literature to bear when thinking about clinical and hospital difficulties and issues in the current marketplace. So I have enjoyed my career thus far. I continue, I look forward to continued movement and helping others, more importantly helping others achieve their dreams and aspirations.
- [03:03]
A
Thank you so much and congratulations on the most recent achievements there and also for just the of course wealth of perspective that you bring bring to the new position and everything you've accomplished there. I wanted to, I was curious what attracted you specifically to the opportunity at baycare and, and maybe what, what else excites you most about the work ahead?
- [03:25]
B
Yes, why I chose Bartow Regional here within the BayCare Health System there, there. There were several elements that really connected with me and I'll briefly go down those particular elements. First, daycare is relatively a young system established in 97, 1997 and so in no way, shape or form are they what we would call a seasoned health care system that's been around 75 or more years. They are young, they are in west central Florida which is really a fast growing, rapidly growing region within Florida. And therefore they're competing mightily against several major health care systems such as Orlando Health and Advent Health and also HCA towards the south part of the west central region. So it's, it's a competitive space, very competitive space, but it's fresh. Meaning I think BayCare has a terrific system. CEO Stephanie Connors who is really putting forth innovation, uplifting the visibility in presence within the market and just recently they have now baycare has, is now the largest academic health care system in west coast and I'm sorry west central Florida because of their recent partnership with Northwestern Medicine. And that's a very big deal with respect to competing in this marketplace, having a such a first tier, well renowned medical school and medical ecosystem like Northwestern to be part of the 16 hospitals and other ambulatory sites that BayCare offers to their various communities. So those were exciting elements and there are exciting elements. The other item that stuck out for me and really was attractive was the fact that Bartow Regional is undergoing a $100 million expansive expansion project. And this is a tremendous construction investment, capital investment which will provide additional capacity for a fast growing region and county, that being Polk County. The other items that were that stood out for me was that the, the ultimately the role, although they are, they are titled directors of operations, the function on a daily basis and the bandwidth of the role is very akin, highly akin to a chief operating officer. In fact it mirrors a chief operating officer very tightly. And so I was able to see and ultimately step into a role that gave me the full autonomy and bandwidth that comes with being a chief operating officer. It's a challenging role in today's healthcare space, but a much needed role at that. And then lastly the urgency around growing volume and developing and strengthening service lines for this particular hospital because of where it's located in Polk county, because of its distance away from the headquarters in Tampa, and also we do not currently have tightly aligned physician groups. So these physician groups have loyalties and referral patterns to a variety of healthcare systems in this particular county. And that also makes the work challenging. But because of those challenging, those challenges, it's also exciting and I felt that I could provide immediate value. So those are some of the elements towards this role, why I relocated with my wife from the Boston, greater Boston area down here to the greater Tampa region here in Florida.
- [08:12]
A
Yeah, definitely a change there. But so many things. It sounds like that attracted you. Yeah, attracted you. And of course you mentioned the Northwestern Partnership and such a big capital construction portfolio, essentially being in the COO role in, in that regard. So I was curious too, in that role, you know, when you do step into this new organization, how do you really assess where the biggest operational opportunities are?
- [08:40]
B
Yes, and I really appreciate that question because it's probably a. The fundamental indicator of whether or not an operator is good or is going to be effective in their role. And I have been doing this quite a long time, not necessarily in the operations lane, but when you talk about quality, patient safety and add operations, different lens, but the same pace, the same type of tempo to the work. Wherever I've been, I've brought that same type of tempo to the work. So I go about understanding and evaluating opportunities, especially as an operator, really, really applying and using a structured assessment. And just like a physician diagnoses a patient, I diagnose an organization. And I can diagnose an organization, really regardless of the size, in less than three weeks. And it's because of a approach or a framework that I have been using and have finely tuned over the years. And so let me just highlight the elements to that framework for you and for your listeners. The first element is I. I'd like to review the governance structure, structures being plural within an organization, and the levels of engagement within those structures. So, for example, the medical executive committee, the board of directors or trustees, and then of course, the administrative team, what's the level of engagement, participation, attendance and energy in those respective governance structures? The second would be the visibility of administration. Is administration consistently as a collective unit, visible within the organization, accessible to the organization, especially to frontline workers and physicians? Third is a quantitative assessment regarding data content, but more importantly, data quality. What's the level there with respect to data quality? I think you'll find that in most acute care organizations they tend to be data rich without question, but the quality and the actionable portion of that data varies widely throughout the country. Next is the levels of workforce engagement. Workforce engagement, especially coming out of COVID has grown to be paramount and, and whether or not you're able to compete effectively in your respective market and your respective primary service area. Because what you really are trying to do is nurture, value and bring needed positive energy to your workforce. So that talent stays today more than any Other time talent is mobile, agile and able to leave an organization if they are not feeling a connection with their one up supervisor or not feeling valued within the organization. So where is the level or levels of workforce engagement throughout the institution or organization? Next is very important operationally is nursing operations and ancillary operations. And what I mean by ancillary is clinical departments such as pharmacy, lab, respiratory therapy, et cetera. It's very important to understand how these operations are complementing each other, engaging one another with synergy and ultimately depending on each other constructively as patients are handed off to various departments during their care. And then lastly, where does the hospital organization currently stand with their volume and market share in the primary service area? Where you would like to be as just a benchmark is anywhere between 55 and 65% of market share within your primary service area. If you want to compete in a meaningful way and continue to be autonomous and independent if that is the case, but definitely reduce and mitigate the risk of being bought or acquired, you have to have a strong market share or at least be pursuing a strong market share in your backyard. So I say this to outline and answer your question about how I go about in a deliberate way, an intentional way of assessing and identifying opportunities with respect to operations and more importantly strategy and strategic thinking that's needed within a healthcare environment.
- [14:22]
A
Yes, thank you so much for sharing those. I know that's going to be so helpful to others and looking at assessing those same opportunities there. So thank you so much for sharing your process. And I also just wanted to ask you Dr. Keshe, I know Bartow regional is a little really a smaller hospital within a larger system. And so I'm curious how you think about balancing the needs of the local community hospital while also aligning with the broader strategy of a system like baycare.
- [14:51]
B
Well, it's interesting and interesting from the standpoint of being a practitioner in the system. I think the literature would bear the empirical literature with regard to regionalization and systemness, especially where baycare currently is in their journey as a healthcare system, they're going through some natural growing pains. I think they're going through some storming and norming and this is all healthy and good. And more specifically, when you're talking about 16 hospitals, for example, in a within a healthcare system, it's interesting how your what your approach will be with management and leadership and matrix environments and dotted lines. So for example, specifically do you have a regional hospital president? Do you have a market chief operating officer? Do you have a regional chief nursing officer? And do you have regional leadership for laboratory, for imaging, for pharmacy, etc. And these models have been tried many times and some are effective and some are not so much. But I think it's important to allow a organization to go through that regionalization, if you will, not only just operationally, but from a leadership perspective as well, to begin to understand what works and what doesn't for the individual health care system. So for me, Bartow is the smallest hospital out of the 16 and it happens to be the most remote with respect to its distance from Tampa, where the headquarters are located. And so with that understanding with location, you really, as an operator or chief operating officer in that environment, you really need to prioritize and focus in on the local needs. It's very important to be independent with solving problems, coming up with solutions that is not necessarily codependent on what resources you're going to get from either the corporate office or the regional structure. And that's because when you're the outlying facility, it's really important to start building high reliability with day to day operations and relationships and processes because that at the end of the day is going to really be the denominator and the foundation for how the hospital is able to not only compete but to function day to day. So it's important to have that mindset, that entrepreneurial, independent mindset. When you're this far away, it's, and everything's relative, it's only about less than an hour drive, but nonetheless, within the system it's the most outlying facility. So I would say that if you're a chief operating officer in that particular ecosystem, I think it's very important to have a good pace, a good tempo and a mindset toward how can you strengthen and you strengthen the entity, but also maximize the regional resources so that the reliability of operations are strengthened over time. What you don't want to do is have processes that are overly dependent on regionalization, when regionalization by its very nature is dynamic and it will change and it pivots and it's agile. And so you don't want to be overly dependent on that. Rather you want to have a very strong foundation within the hospital itself.
- [19:10]
A
Yes, and I know, I also wanted to ask you just kind of a more forward looking question as well, really the next phase of your career in healthcare operations leadership, what lessons from your experience so far are shaping how you approach leadership and building strong teams?
- [19:32]
B
Well, I've thought about that particular question, that topic most deeply over the years and there are a few things that stick out with respect to lessons and the first lesson may not be intuitive, but I think nonetheless it's very important. I think we've all been on the all taken flights and before you take off, they say in case of an emergency, make sure you have the oxygen before you share the oxygen with anyone next to you. I think it's very important to abide by self care and what I mean by self care and these roles, these roles are difficult, these roles can be lonely, these roles are required. But nonetheless it does take a toll on the individual and also the individual's family. When you are a chief operating officer for an acute care hospital, a complex organization. So self care, whether that is making sure you unplug on the weekends, whether you're, whether you are active, whether you work out, whether you hydrate, make healthy choices during the lunch and dinner times as you pass through each day. But self care is very important because it gives you the strength and the rejuvenation to lead others during very complex times. So I would say that was the first lesson is take care, take good care and make healthy decisions about your own personal well being. The second deals with trust and psychological safety. I think it's very important for leaders to think about how to build trust, how to establish spaces of psychological safety so that folks feel comfortable speaking, communicating and talking. More importantly, communicating in a way where you can understand and have a better insight into day to day work, to where work is being performed and more importantly, feeling safe to come forward with mistakes and errors, which is, I think a hallmark of psychological safety is when individuals feel safe to communicate clinical error or operational error, knowing that the environment is going to focus on improvement and not on any personal retribution. Communicating a vision is very important. Effectively communicating a vision and being agile enough to pivot that communication depending on the audience that's in front of you. I think it's very important to be able to change the communication style, change your communication lexicon, change your communication tone when you have physicians or nurses or food and nutrition or physical therapy in front of you. These are all very different audiences and I think it's important to be able to turn and tune in that signal differently depending on the audience before you. Another lesson is urgently execute rather than passively execute or hope and pray that outcomes will come your way. I think it's important to take a urgent attitude to the work, using data to inform you. It's very important and this is not necessarily intuitive, but again, I think it's necessary to leadership and that is silence is required. Too often I Think leaders, especially in the C suite, want to be, want to demonstrate their intellectual acumen, their expertise, by sometimes over talking or over dominating the room. I think it's important for a secure leader to be quiet and to listen far more than they talk, especially when you're listening to your direct reports, when you're listening in the boardroom, when you're listening to stakeholders, physicians or board of directors, silence is required far more than talking. When you reach the higher levels of healthcare leadership and then the one thing my parents taught me growing up, and I think we all have been told this, what we learn in kindergarten, but it matters so much today. It's a simple, simple lesson, but not applied effectively or consistently. And that is simply being kind to others. Healthcare, healthcare leadership, hospital administration is very difficult work that never stops, never has a vacation and is continuous all throughout the year, every single day of the year. And so being kind is something that I think is, should be part of the formula, needs to be part of the formula. And it makes not only the individual feel good, it makes others feel good. And so when you have the ability to provide kindness and demonstrate kindness, I think it creates a space where people can show up in their best selves. So optimism and kindness, I think is important. Those are some of the lessons. They're not all of the lessons, but I think they are the lessons that are top of mind. And those lessons have come through over two decades of being a leader in the acute care healthcare space.
- [25:46]
A
Thank you so much. I think those are great lessons and what you said about kindness, just having that silence and listening, I think just very valuable no matter what position the leader's in. So I really appreciate you sharing those lessons learned along the way. And thank you so much, Dr. Keshe, for joining this just fun and interesting conversation today and taking the time to talk. I really appreciate your time and I look forward to working with you again soon.
- [26:14]
B
Thank you so much. I enjoyed this very much and I hope you and Beckers continue to have a great 2020.