Jake Dorst, CIO, Tahoe Forest District Hospital, Chapter 3

One of the most important characteristics for a strong leader is being able to stay calm when the organization hits rough waters. For Jake Dorst — who has survived tumultuous times during his career, including acquisitions and difficult go-lives — the ultimate test came less than a year into his tenure at Tahoe Forest Hospital District, when he was asked to serve as interim CEO. And although he learned quite a bit from the experience, he’s happy to be back in the CIO shoes that seem to fit him so well.

In this interview, Dorst talks about how his team is preparing for an Epic go-live (and why they chose to partner with Mercy Health’s IT services arm), why they’re focusing on “Population Wellness” rather than population health, the challenges of being located in a resort area, and why it’s essential to have a strong project manager. He also discusses why Tahoe Forest appealed to him, his “servant leadership” philosophy, and what it was like to move across the country with young children.

Chapter 1

Chapter 2

Chapter 3

• Challenges of a CAH – “The budget is smaller, but the prices are the same.”
• Attracting top IT talent
• Pros of being a smaller hospital
• Staff satisfaction & pride
• Project management – “The magic going on in the background”
• Interim CEO for 8 months: “It was a lot of learning.”
• Adopting servant leadership

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Bold Statements

I’m not averse to racking a server and helping out when I need to. I basically put together all the desks here for the training rooms on the weekends because it’s close to the house. Those are the types of things you do in smaller hospitals, and so you have to find people that can wear multiple hats.

We had great project managers there, but things ran so smoothly that I never really realized what magic was going on in the background until I didn’t have them. Now I know we’re lucky to have what we have here.

It was go-live, after go-live, after go-live when CHS was in acquisition mode. Crisis was the natural state, so you had to thrive in that environment or get out of it. I happen to be one of the people that was able to maintain semi-clear thinking through those types of situations, and that has helped me.

I started to think that maybe there just isn’t a written-down methodology of how I prescribe to things. But then I found the servant leadership model, and that really rang true with me.

Gamble:  In terms of being a critical access hospital, obviously there are differences on a lot of levels. But what are some of the unique challenges you face as a CIO of a critical access hospital? What have you found so far?

Dorst:  The budget is a little smaller, but the prices are still the same. And actually, when you’re not buying the volumes that I was typically buying in other positions I’ve held, you find that the squeaky wheel doesn’t get the grease as much. So that’s been a bit of a learning curve. Again, having VPS on our side has always helped us negotiate those waters. Having us really work and understand with partners that we are a critical access hospital and we don’t have deep pockets, but what we really need is going to be beneficial and helpful for the people that are our patients — I think that has gone a long way with certain companies. That’s one thing.

And just attracting talent is a challenge. You would think that living up here is ideal for folks that like mountain living, and mountain lakes, and skiing. But you’ve got to love winter to be here, and sometimes it’s hard to attract talent to stay in an area that’s basically a resort town. It’s not inexpensive to live here. We pay higher than usual rates, but it’s still a housing shortage here. So it’s hard to get high-quality candidates unless they just really love it here and are willing to make the sacrifice. Of course, you can probably name those same two challenges for everybody that’s in this industry.

Gamble:  Right. So to spin that a little bit, what skills do you think are most important when you’re CIO of that type of organization — a critical access hospital?

Dorst:  It’s been good for me. I came from the technical side; I didn’t grow up in management. I actually started as a network tech and moved my way up through Community Health Systems. So I’m not averse to racking a server and helping out when I need to. I basically put together all the desks here for the training rooms on the weekends because it’s close to the house. Those are the types of things you do in smaller hospitals, and so you have to find more generalist-type folks; people that can wear multiple hats.

Another thing is being able to work together. If you don’t have the one person that does the one job, you all have to pitch in and do it. You have to be able to have that camaraderie and be able to work well together. Those are things that I think help out in a smaller hospital. If you have the knowledge and you can get your hands dirty, and you’ve got a team that works well together and is not territorial, that’s always helpful.

Gamble:  What are some of the things that the organization has done to try to either recruit the staff or hold on to them, being in a tougher place like that, like a resort area?

Dorst:  Pride is a big part of why people work here. It’s highly rated in terms of patient satisfaction. When you walk around town, you don’t have to take your badge off before you walk into the grocery store. People will say, ‘Oh, you work at the hospital. We had a great experience at the hospital.’ That leads to job satisfaction, because people hear those positives when they’re in town.

To help attract and recruit and maintain staffing, we have a very strong benefits package here. Like I said, the salary is very good. We pay our folks a good wage, and we have a game-sharing program that we just started last year, which I think is going to be a pleasant surprise for our employees. So it’s those types of things. We look at quality and pride at your place of work, as well as the compensation and benefits package we put together. That’s where we try to overcome the barriers that we have to recruiting.

Gamble:  Right. And when you look at things like experience in project management, I would think that that’s a skill set that’s be applicable at any level, but maybe even more so when you’re a critical access hospital.

Dorst:  Yes. I’ve got a strong project manager, Jeff Rosenfeld. He’s a good guy — hard worker, smart comes from a lean background. We’re lucky to have him. He works for IT, so that’s good, because we’re able to really leverage his experience. With the Mercy project we have going on now, he’s been hand in glove with their project management. Luckily, he loves to ski and he loves the mountains, so he’s here to stay.

For me, it was later in life and in my career that I realized how important project management was. When I was with CHS, we did go-lives all the time. We had great project managers there, but things ran so smoothly that I never really realized what magic was going on in the background until I didn’t have them. Now I know we’re lucky to have what we have here. Is really important.

Gamble:  I imagine crisis management and being able to lead when things go wrong is a really important quality for a CIO to have, with any rganization.

Dorst:  I think keeping cool in those types of situations is a big deal. If everybody’s losing their mind, there are no solutions coming up. Luckily — or maybe unluckily — I’ve had a lot of experience in crisis. When I was with Community Health Systems for so long, we had crises daily with all the go-lives. It was go-live, after go-live, after go-live when CHS was in acquisition mode. Crisis was the natural state, so you had to thrive in that environment or get out of it. I happen to be one of the people that was able to maintain semi-clear thinking through those types of situations, and that has helped me. Those situations are fewer far between than they were in those days, but I think that part of the DNA of a good CIO is to have a way to keep calm in those situations.

Gamble:  Yeah, not always easy.

Dorst:  No.

Gamble:  And you’ve been with Tahoe for about three years now?

Dorst:  Yes, about three years. I started as a CIO. Actually, we had a bit of a shake-up in our C-suite here, and I ended up being the interim CEO for eight months. We were looking at hiring in a temporary CEO, and then we looked at the bill of what it was going to cost, and I offered to keep the seat warm for the time it took us to find our permanent placement. So that was a fun ride. It gave me a taste of what that role is and what that’s all about, and then I moved into this CIO role once we hired our permanent CEO.

Gamble:  Yeah, I bet that was a pretty interesting experience. Is there anything that really stuck out for you or was it a lot of, ‘Okay, this is what CEOs go through.”

Dorst:  It was a lot of learning, and a lot of folks asking for money. That was most of my day. But it’s a lot of responsibility too, and it’s a tough job. I didn’t see my family basically for eight months. I was getting up before the sun was up and I was getting home after it was down. It was sad for me in that respect because I was missing some good portions of family time. I remember my son hadn’t seen me for so long, and my wife said, ‘You need to come home tonight because we’re carving pumpkins for Halloween.’ So I come in and pull the chef’s knife out of the butcher block and my boy comes around the corner and sees me holding this knife and just screams and runs off. And I was like, ‘I don’t think he recognized me.  He thought I was breaking into the house to carve up the pumpkin.’

Gamble:  Oh wow.

Dorst:  It’s a sacrifice that CEOs make, especially in health care where you have physicians that want to meet either early in the morning or late at night. And so you’re up early to meet them, then you have a full day, and then you’re usually in meetings or recruiting or going out to dinners, or there’s some event where you need to be present. So it’s a fun job, but there are definitely some tradeoffs.

Gamble:  I’m sure it was really interesting to walk in those shoes for a while. Eight months is a lot of time; that’s not a couple of weeks.

Dorst:  It was a while. There was some turmoil going on with the board particularly too at that time, so that was another thing that would take a lot of time, a lot of strategy, a lot of talking to people, and working things out. So that was just really good experience.

Gamble:  Okay. And before that, you were with Meritus Health, correct?

Dorst:  Right. There was a spinoff there where we worked to get the Trivergent MSO set up and in place. I saw it coming down. I had left CHS because of what I’ll call ‘red tape-ish things’ where there are a lot of decision-makers and board levels and things that you had to go through. Those were the things I moved to Meritus for to get away from; I wanted to actually make quick, timely agile decisions, and I felt with Trivergent, even though it’s a great idea to pool your resources and share in the savings, it was going to be top heavy. So that’s when we started looking around for a new job, and luckily, this one came up.

Gamble:  And it did involve a big move.

Dorst:  Oh yeah. We drove across the country, and at that time I had a 5-year-old, a 3-year-old, and a 1-year-old in the minivan. I swear, when we got here, we opened the door and about two inches of Cheerios fell out of the minivan.

Gamble:  I’m sure.

Dorst:  We didn’t try to do it in three days. We took a full week driving out, and I tried to not drive more than six or so hours a day, and I always made sure we stayed in a hotel with a pool. We basically threw the kids in the pool once we got out and let them swim for a couple of hours to tire them out, and that seemed to work. So I told them when they grow up they can tell people they swam across America.

Gamble:  Before the call, you and I talked about how parenthood sometimes seeps into your leadership style. I think that’s true for a lot of people because there are similarities — not to compare the people you work with to children, of course, but there are some similarities in terms of the approaches you take. Would you agree with that?

Dorst:  I searched for a while for a prescribed leadership style. A lot of them didn’t fit my way, and I started to think that maybe there just isn’t a written-down methodology of how I prescribe to things. But then I found the servant leadership model, and that really rang true with me. In that model, it talks about love — not the romantic type of love but a familial love you have for a team or an organization that you work with. My kids will be at each other’s throats all day long, but when the neighbor kid pushes one of them, it becomes, ‘hey, don’t touch my sister or don’t touch my brother. It’s okay for me to do it, but not for you.’

I equate that back to my team, because we’ll say, ‘We can have arguments and we can disagree, but when it comes down to it, we’re all on the same team and we’re all pulling in the same direction.’ And that’s where that love of the team comes in, where you can have arguments and disagreements with people, but if you have that love for your team, you don’t want anything to happen to that. So that’s where that protection comes in, and once you start parenting and seeing those parallels in life and leadership, it’s eye-opening and helpful.

Gamble:  The other thing is that if you have people who disagree, the good part is that they feel comfortable enough to be honest. Obviously you don’t want it to go too far, but it is better to have that than people who are holding things in.

Dorst:  Right, when it’s not for personal gain, but you’re arguing passionately on your belief that it’s going to be the best for the organization because of that love, that familial love that you have for the organization. If you can get there, it’s magical.

Gamble:  Yeah, I know my kids don’t hold anything in. Okay, well I could definitely speak to you more, and I’m sure we’ll speak again, but for now, I should let you go. But thanks so much, it’s been really interesting hearing about the work you guys are doing there.

Dorst:  I appreciate it. We’re really proud of the work we do here. We’re proud of our organization and its ability to embrace innovation and be agile. If we can help other people with too, we want to reach out and help others. So any chance that we have to tell our story, we’re happy to do it. I appreciate you reaching out to me again and taking the time to talk to us.

Gamble:  Sure thing. Good luck with the implementation — I’m sure we’ll have more to talk about once that’s done.

Dorst:  Sounds good, I appreciate it.