In this edition, I speak with Thomas Carman, president and CEO of Samaritan Medical Center, located in Watertown. He has been Samaritan’s leader since April, 2004. The organization employs 2,220 people.

KNAUSS: Tell us a little about your background, Tom.

CARMAN: I’m a native of Maine and went to college in Boston at Massachusetts College of Pharmacy. I’m a pharmacist by training. I met my wife while we were going to pharmacy school. She’s also a pharmacist, originally from Syracuse. Upon graduation, I spent a couple of years in the public health service at a hospital on Staten Island in New York City. When I left the public health service, we moved to Central New York and settled in Cortland. I worked for Cortland Memorial Hospital (now known as Cortland Regional Medical Center) from 1981 until 2004. I then moved to Watertown to work for Samaritan.

I started at Cortland Memorial Hospital as a staff pharmacist and held several different positions over the years before I became the President and CEO the last seven years. We have four children, so it was important for us to stay near Syracuse because that’s where my wife’s family was living. They were aging, and we wanted to be close by, but I was looking for a different challenge. I was selected to take the role here at Samaritan in 2004, and I have been here ever since.

KNAUSS: That seems like quite the rise in the career from going from a pharmacist to a hospital president and CEO. What do you think some of the qualities that led you down that path?

CARMAN: I think some of the attributes that led me here come from my early work experience. When I was in high school, I started working in a corner drug store and that’s what really got me interested in pharmacy. Early on, I was also thinking that I would like to own my own store. When I went off to college and began to train as a pharmacist, I moved into hospital pharmacy and really fell in love with clinical pharmacy.

So, as you can see I am interested in business but have a passion for clinical. As my career progressed and I was able to move into managerial positions, it allowed me to combine that clinical background with the business background. That has really helped me over the years. To be in my position and understand patient care, to be able to understand the dialogue between physicians and administrators, physicians and nurses and other health-care professionals is very important. That background has been really valuable throughout my entire career.

KNAUSS:   If I were to ask your staff about your leadership style, what do you think they would say?

CARMAN: I think that they would note that I’m a very open leader, very transparent. I think they would also note that in my role, I have been focused on the future. I spend much of my time working strategically and am concerned more about where the organization has to go in the future. I don’t allow myself to get into the weeds, but I understand the operations very well, understand what’s going on, and my staff appreciates that. We’ve developed a strategic plan that has now been updated twice

KNAUSS:   Tell us about the strategic plan?

CARMAN: The initial plan was targeted inwardly. It was focused on strengthening the Samaritan brand. It included a goal to make sure we had the right facilities, a facility master plan. It considered the services that we offered, with a particular focus on the physicians who provided those services. We had an emphasis on physician recruitment and retention. We also developed a goal around performance improvement and the quality of our services. We began to compare ourselves to national best practices and national standards. At the same time, we invested in our workforce, with a goal around workforce development. Fort Drum is the only Army division post of 10 across the country that does not have a hospital. Because of this unique situation, we had a goal to support Fort Drum.

When the 10th Mountain Division was posted at Fort Drum back in 1985, they didn’t put a hospital on post. They didn’t put schools on post, and a lot of housing for soldiers and families was in the community. It’s one of the most integrated military communities that you’ll find, which is why one of our goals was to ensure that we were supporting Fort Drum with health-care services.

This organization was led well by that strategic plan. The board did a great job to put this together. That plan served us well until about 2011. We’ve since updated that plan to consider the needs of the Accountable Care Act and the transformation we are going through in health care today.

It will be interesting to see what happens to that in the future, but our current strategy is around being a highly reliable organization, focusing on the quality and safety of our services It’s focused on serving community needs, making sure we’ve got the right services to meet this community’s needs. It’s also focused on population health and insuring that an entire cohort of patients who may have a similar disease state are taken care of. As an example, we have about 10,000 diabetics in our region for which we’re responsible. How do we take care of them? How do we ensure that they are getting the care that they should receive?

We have specific organizational goals around population health, and we are a part of the North Country Initiative (NCI). NCI is a clinically integrated network that includes Samaritan and five other hospitals throughout the region. The board is made up of 23 individuals, 17 of which are physicians. It’s physician led and has obtained great participation from across the three counties — Jefferson, St. Lawrence, and Lewis. It’s beginning to put some things in place relative to population health.

I would also note that, in our current strategic plan, we continue to maintain goals related to Fort Drum, because that is such a unique relationship.

We’re also focused on our workforce. Much of our workforce efforts over the last seven or eight years has been around leadership development. In health care, we often take the best clinicians and make them a manager. That doesn’t make them the best leader, so we need to train and support them. A lot of our efforts have been around training our leaders to allow them to be comfortable to engage our staff. We have some wonderful staff and we need to make certain that they can help us with understanding the best way to provide for our patients.

KNAUSS: The first time I visited Samaritan Medical Center, I was greeted with a smile from everyone I walked by, which was at least 10 to 15 people. Talk a little bit about how you’ve developed that culture.

CARMAN: Clearly, it is all about culture, and culture is not something that changes overnight. Rather, it changes over time. Some have suggested it can take a good 10 to 12 years to change culture. For many years, we’ve been focused on the patient experience. That’s very important to us. But, let me step back and note that really, what we’re trying to provide is high value. When we think of value, we think of quality and experience, as well as the efficiency. With quality, we think of the clinical quality, which is obvious. But that’s often not what the patients can measure. What the patients can measure is the experience, and so we must be much more aware of what that experience means to them. We’ve also recognized that for the patient experience to be achieved, we’ve got to make sure that we have the engagement of our staff. The employee experience is also very important. When we combine the two of those together, that is the patient experience along with the employee experience, we refer to it as the “Samaritan Experience.”

To me, it is a journey. It has something that will never end and we want to continue to get better at. When you note the friendliness of the culture, I think that is a bit of a reflection of my own personal style as it reflects how I greet people not only in the organization but in the community. It maybe goes back to my days in retail, but I’ve also always been very warm and welcoming, and I think it’s important to create that relationship with our staff. I go to every single orientation. I provide an overview of the organization. I have all the new staff members introduce themselves, and I have a chance then to get to know the staff.

We have 2,200 employees who I try to get to know through an orientation process and ongoing rounding. What really made a difference for us was when we adopted patient-centered leadership about eight years ago. That allowed us to find a way to empower our staff through our leaders, and that’s when we started the training for the leaders to provide them with a background that they needed to engage our staff. Also at that time, we began to look at how we reward, how we recognize, and we adopted values. This is where we started to see a real change in the culture, which is what you witnessed.

We established a group of staff and leaders to look at standards of performance, and we began to adopt certain standards. What you noted is one of the standards that came out of this group. That group came across the best practice of the 10-5 rule. What that means is that when we see someone coming down the hallway within 10 feet, we will acknowledge him/her. We try to make eye to eye contact and smile and recognize them. When we get to within five feet, we’ll say hello and greet that individual. This has been extremely valuable since we moved into an expanded new facility in 2010, which is much larger and more complicated to navigate. It caused our staff to quickly recognize when people were lost or confused and not quite certain which way to go.

Our staff then recognized that it was not enough to greet and acknowledge, but also to say, “Can I help you?” It is not uncommon for a staff member to now say, “I’ll walk with you or show you where you need to go.” The staff has done a great job of being much warmer and welcoming to the people who come here whether they are patients, friends or family. This is because of the efforts that started about a decade ago.

KNAUSS: What do you do to recruit and retain top level talent?

CARMAN: Recruitment and retention is very important to us. First off, we have focused a great deal over the last decade around physician recruitment and retention because it can be very challenging recruiting physicians and very critical for our community. What we’ve done is to put a group together that includes physicians, members of our boards, along with leaders of the community. They work together to identify what specialties are needed. Then, we try to be much more proactive about the approach, because physician recruitment is not something you can react to. It often can take a year, two, or three to recruit a particular specialist.

We also recognize that we wanted to retain the great staff we had, as well as the new recruits. We not only focus on the front end of recruitment but we’ve also focused on the backend of retaining. We’ve had tremendous support here. As an example, our foundation coordinates a group that focuses on what we can we do better so that we not only help the recruited physician but the spouse of that physician. We often find that it’s not the physician who becomes disenchanted, but it’s the spouse. We have to make certain that the family is very satisfied with the environment. We focus on physicians because of the uniqueness and the challenges across the nation of finding the right physicians.

When it comes to our leaders, professionals and front line staff, we also go through similar process of trying to find the right people for our organization. Hiring for behavior, trying to get the right people knowing that we can train them for what we need them to do. We also started a formal staff retreat called “The Samaritan Experience” a year ago. We took all 2,200 of our staff through training between January and June. Now that we’ve trained the entire staff, new employee orientation begins with that formal retreat.

The Samaritan Experience Retreat is a way for us to try to translate our values into our day-to-day. This was not something that management decided to do. Rather, it was something our staff said “We want to do for our fellow staff members.” What they really wanted to accomplish with the retreat is to set the expectation for how we want to treat one another. That is how employees want to treat other employees, which will set the framework for how we want to treat our patients

About the author: Jeff Knauss is co-founder of the digital marketing agency, Digital Hyve, and has always had a passion for learning about successful executives and their stories. He also is a current board member of Byrne Dairy, the Food Bank of CNY, and Loretto Foundation. For more on Knauss, check out www.digitalhyve.com.