Maine Health: Andrea "Andy" Patstone

And I can't really think of a better person to do this with than Andy Pastone, who is the coastal region president of MaineHealth. You're going to enjoy our conversation about creativity and the human spirit because we both have intersections in healthcare and what's more creative than healthcare. So lots to talk about today. Thanks for coming in. Thanks for having me. I want to start with MaineHealth for people who are not aware. I mean, this is the state's largest healthcare system. It's been in existence for a couple decades now. About 30 years, Three-ish decades then. And how did you get to be involved with MaineHealth? Because you're from the Finger Lakes region of New York, right? It can be a long story or a short story. We have some time. I like a good story. You're here, so please do tell. The short of it is that my husband is from Rockport, Maine, and we met when I was working as the Chief Operating Officer for Health and Human Services for the state of Massachusetts. So I had been, I'd come in under the Romney administration right around the time when Massachusetts passed Universal Healthcare. And so I had this just fantastic opportunity to help implement that program in the state of Massachusetts. And then Deval Patrick followed Mitt Romney and I managed to weather the transition, which was, I think I might have been one of the only people left standing at the end of it all. But I absolutely loved my time under both administrations. And then it was interesting, lots of work around health reform, access to care, the intersection of social services and healthcare. And I was frankly more on the social services side over overseeing the operations of the child and youth services, mental health, public health. And so I had this relationship with healthcare where I was helping to implement the benefits part, access to WIC and TANF and Medicaid for people who were trying to get access to healthcare. And so Deval Patrick was elected for a second term, and I made it clear that I was about to get married and I was going to be moving to Maine. And they said, you know what? Well then we need to give your job to somebody else. So I was out, but it was the best thing that ever happened to me. I had this idea that Todd, my husband and I would move with him back to Maine, and I would have a job that I got home every day at five and I could have chickens. So you went into healthcare and then that didn't happen. Right. Okay. So I had this experience implementing health programs that involve health reform, and I went on this amazing informational interview circuit in All of my connections in Massachusetts knew someone, Maine is so small. So I got to meet Lisa Lano and Lori Lachance and amazing women who were willing to spend some time with me and help me figure out where Katie Longley, where I was going to land. And I landed at Lynn Lois Skillings office one day, who's a former president of Midcoast Parkview Health. And Lois said to me, you need to meet Bill Karen. And so one Saturday, Friday afternoon, I walked into Bill Karen's office, who's the former president of MaineHealth, and was a 30 minute meet and greet, but I walked out three hours later and we had just talked for the afternoon. And so then I landed at MaineHealth helping to implement. It was just after the passage of the Affordable Care Act. So Obamacare and Maine, Medicare was changing the way it pays for healthcare. And MaineHealth needed some help figuring out how to restructure a little bit in order to participate in some of those federal programs that were going to help us change the way we get reimbursed for healthcare. And so I spent 10 years, seven, well, I spent seven years working in the corporate office of MaineHealth first helping to figure out how to get us into these new payment programs that help us for the better, change the way we deliver care. And I know a lot about this, Lisa, but I also knew that I wanted to be closer to the point of care and to where the magic I think really happens. And so my role at MaineHealth gradually migrated to be more focused on operations. And then I found myself out at Stevens Memorial Hospital in Norway, Maine as the Chief operating Officer there, which is this tiny, wonderful place. It's just one of the most family-like teams of experts who are so good at what they do and so strongly love their patients and each other. So the ability to be there, COO. And then as president through the pandemic, I became the president of Stevens in January of 2020. And it was a really, really, really intense, amazing, fulfilling, wonderful leadership experience. And then Main Health restructured again, and we created these regions and the opportunity to lead a region was presented to me. And so I migrated back towards the coast, and now I work with four hospitals on the coast of Maine, Midcoast, Parkview Health in Brunswick, Lincoln Health and Dam Scaa, Penn Bay Regional Medical Center in Rockland and Waldo County General in Belfast. And it is just another amazing opportunity to help lead change and work with smart, dedicated, passionate people. So that's how I ended up where I am. There's so many connections, First I have to ask about the chickens. Does your job enable you to also raise chickens? It's really funny. I was 40 when we got married, and my husband said to me, Andy, do you want a baby or do you want chickens? And I chose the baby so we don't have chickens. Nathan is 11, and he too wants chickens. But I don't trust him to be responsible enough to actually help me take care of them. And my job doesn't really lend itself. I also want a goat. I am sure Nathan is very appreciative of the fact that you took that path. He then came into the world. He did. Yes. I chose him over chickens May become possible for Nathan in the future, Maybe, Which may become your possibility as well. Anything's possible. I agree. I agree. I mean, what you're describing to me is so interesting because first of all, a lot of the wonderful people you described are people that I've intersected with. And I love the fact that you had this listening tour and people, I mean, three hours with Bill Karen back in the day. I mean, that is a miracle. And it was intense. Yeah. I learned so much from working for Bill Karen. He wasn't always easy, right? Good things and important things, but wow, what a mind and what a leader. And yeah, the fact that I had three hours on a Friday afternoon is pretty special. I wrote an article for Main Magazine about him at one point, and I had a chance to interview him, not for three hours. That was not in the cards, but I mean, yes, you could tell that this is an individual just incredibly deep thinker and also so connected with people and understanding the community when, I mean, he really brought MaineHealth forward from a very different kind of state of organization to closer to what it is now. Very, very much so. I remember when I joined MaineHealth, we have these glass walled offices, and I would often walk by Bill's office and I'd see him, he would just sitting there looking out the window, and he was thinking, and you could see him thinking. And I learned so much about the importance of stopping and thinking about sequencing. If you want to make a big change that a lot of people are going to have trouble with, who do you need to talk to first? And then who needs to know next? And the other thing I learned from Bill is what's the right combination of people to put at a table to strike that balance of getting input and having real conversation, but getting out with a decision that we need to get out with. And there's unreal art to that. And I took that from my time working with him. It was an absolute privilege. I think that's really such a important thing. It's such a formative thing as a leader that you had that experience. But also the fact that, I mean, Lori Lachance and Lisa Lano, women, I mean, are you kidding me? These are the rock stars. I mean, I'm still close with Lisa Lano today from a relationship I built when we built together when I was at MaineHealth, Maine Med a long, long time ago now. But I mean, Lori Lachance, she was the president of Thomas College for such a long time. I mean, you're talking about people who have given so much of themselves to the Maine community. I think I haven't maintained my relationship as much with Lori Lisa. I'm going on a kayaking trip with Lisa in July. And to have, even there were women who I met with who I didn't even name, who we all know. What I think I learned from that experience is how, not just how small MaineHealth is, but MaineHealth is full of people who could be carrying out their careers anywhere in the world. Just brilliant, strong, thoughtful leaders. And we all choose to be here because of what the state and this community offers us. And that's beyond precious. So that was an amazing experience to get to meet all those women. And frankly, they still are people. I remember being a new mom back at work, sitting in the lactation room at MaineHealth attached to a breast pump crying and calling Lois and saying, I don't think I can do this. I mean, how many people can reach out and call the president of a hospital when they're early in their pregnancy to help me. And she was, there was no one better than Lois for that kind of a thing. So those relationships are still ones that I turned to today. I had a chance to interact with Lois as well. And I mean, just what a great individual. I mean, also, I believe her background in nursing. And she was one of the early women leaders at the upper levels in the medical, clinical healthcare field in Maine. And also so personable, such a caring individual, Everything, all of that. And I think when you, and And brilliant and frankly Really savvy, Yes, She's one of those people who you don't realize that she's getting exactly what she wanted out of the conversation. And it's the right thing, and she just brings you along. She's amazing. I want to back up a little bit because I think it is easy to say, oh yeah, you're a woman in medicine or a woman in healthcare and you're caring. That becomes such an interesting stereotype. And of course that is true of Lois in particular. But you're absolutely right. I mean that it was everything that was sort of additive to that. And I think she just retired within the last few years. She did, and she did. And that organization landed the most gifted successor for Lois and Dr. Chris Bovie, Who's also wonderful, You may know, I learned so much every day from working with the three hospital presidents who I have the privilege of working with. They're all clinicians. I'm the only non-clinician. And that's an interesting dynamic in leadership. There's the gender dynamic. Are you a clinician or not? How old are you? Where did you come from? Are you from away or here? And all of those dynamics are there. But Chris, who succeeded, Lois at Midcoast is really one of the most gifted communicators I've ever worked with. Cindy Wade, who is the president of LincolnHealth, born and bred in Maine in that area. That's her community. She grew up there. She's started her career as a nurse there, and then went into the Navy and came back. And then Denise Needham is a pharmacist leading Pen Bay and Waldo together, and just an incredible executor, very strategic in how she thinks. Wonderful motivator and connector of people. Sometimes I pinch myself think, how did I get so lucky to work with all these people? Yeah, it's amazing. It's just amazing. I love that you have these really great relationships with these very qualified individuals, and I love that they are offering care. And let's lump in Stevens also, because I mean, this is actually how we need to take care of these communities, is we need to have, I mean, an overarching system I think is very important. But then to have people who are actually making sure that things are done very well in the communities that they're caring for, and that is really the only way we're going to be able to figure out access to health in rural regions, because you have to have people who really want to make these things work because it is not easy at all. No. It's not easy. And I think that's one of the things that's made MaineHealth so special in comparison to a lot of other large integrated healthcare systems, is that connection that we have to our local communities through the community institution of a hospital or a local health system as we call them, because they're much more than hospitals in each community that we serve. So one of the things in doing some background work that you brought up was this idea of adaptive leadership. And I just finished my doctorate in leadership studies. Oh, interesting. I didn't know that. So I'm a little bit of a leadership theories kind of, I don't want to call it geek, that sounds pejorative. But I love this kind of thing because in adaptive leadership, it actually speaks to what we really kind of all need to go to anyway, which is that we can't bring our one leadership self to every single situation. That does not work at all. I mean, when you're describing Lois, I mean, I'm guessing part of her success was the ability to read a situation or you're describing Chris Movey, and it's the ability to communicate in a way that translates information across and then motivates Persuades and motivates It persuades. Exactly. The idea of influence and leadership. So tell me how you came to this idea that adaptive leadership was so important. The way I think of it, there's a couple of different elements of it. One is being aware of yourself and the impact that you have on people and how that impact is different depending on what that person is bringing to the table so that it all starts with that. And that's a lifelong journey, quest endeavor. And some days we get it right, and boy, some days we don't. So that for me is really part to be hyper aware of how I show up. But then the second part is how the way you show up, how other people are showing up and how they need you to show up given who they are. And so sometimes you build that. I think, and I'd be interested in your thoughts on this over time, the duration of our relationship with the highs and lows and the ins and outs and what we learn about each other as we go along. And then sometimes you have to do it by reading a room and seeing who's reacting to what and how and responding accordingly. And again, sometimes we hit that right, and sometimes we don't, but I think we are always thinking about it. You have a better chance of getting there. I don't know. Does that resonate with you? Oh, absolutely. Yeah. And I think it's interesting, you also mentioned this idea of being a non-clinician in a largely clinical field. So for someone like you, you're coming at it from your perspective and you're dealing with other people who have, especially nursing and medicine in particular, very strong cultural backgrounds and trainings can be very positive. And also anything that can be strongly positive can also potentially have a negative. As you're the person who's coming at it and you're like, Ooh, I've got representatives all around here. And then you have the operations people, you have the finance people, and you've got all the people in the mix. That element of emotional intelligence, that element of reading the room and understanding not just how to read it, but how to utilize that information in a way that things get done, that you influence things. And I think all of that is encapsulated also in the concept of empathy. Healthcare is really hard, this, and it's getting harder. And I think we're asking clinicians, providers, physicians or advanced practice professionals or nurses to do things in different ways. Nurses too, that push us out of our comfort zone, and frankly, sometimes might not be what we imagined we'd be doing with our career. So how do you have those conversations with physicians who have made a choice to work in a community looking for a deep connection? Let's say they're a primary care physician, they went into primary care to connect with people and be part of the human existence on a plane. That's something that I think we can only think about the magic of being a physician or a nurse just beyond. There's something just so priceless that you can't even put into words. But then someone like me comes along and says, well, how many patients are you seeing in a day? You see 12. Can you see more? I mean, how awful must that feel? So it's important to try to understand who that person is, help make sure that you're being accountable for explaining why you're asking them to work harder, faster, and maybe give some time to adjust. Or maybe we say, let's try this for two months and we'll stop and see what we can learn, and then maybe we'll go back again. But that conversation is hard. And I think being aware and being, having a sense of humor about the fact that here's the suit I come in. I have deep, deep, deep, deep respect for what we do in healthcare, but I don't touch patients. It's a good thing. I don't, but then here I am. And how do you creating an environment that directly impacts the way that someone who's dedicated their life to touching patients, it impacts them and maybe not always ways that they want, and how do we navigate that together? That's the question. And it keeps me up at night, but it also fulfills me when we get it right. I think as you're talking, I'm thinking about, I mean, I've worked with a lot of physician leaders at all the levels and all the areas. You know what I'm talking about. I definitely do. And one of the things that I am struck by is that I think we are very early on in even providing people who are physicians. It just happens to be the group that I work with, but maybe even clinicians with even leadership skills and understanding and ability. And I actually think nursing is probably ahead of us in this because they actually do have a strong historical background in leadership. I think doctors, I mean, we know this, it's always just been like, well, you have the terminal degree, ding, you're a leader. And let's just assume that because you have the set of letters behind your name and that you know how to do something very, very well, that you'll know how to do all the stuff very, very well. And I think that whole set of leadership skills and behaviors and mindset is something that we're so early on in trying to do well. Yeah. And do you think that if you look at the physicians with whom you work, some seem to just have it, the ability to connect and motivate other people, and some want it very badly and are working to get it, and then some, just like anybody, not everybody has it. What do you think the best thing, I know you're supposed to be interviewing, but let me ask you a question. Turn the tables. How can people like me reach the physicians who want to be leaders and need a little bit of coaching and help or guidance? What's the best thing that we can do for that cohort of leaders in your mind? I think it's so contextual, I mean, this would take such a long time to answer that question, but I think the first answer that immediately comes to my mind is to understand where they're coming from and what they want to achieve. But I love that you've divided it out into sort of the 80% in the middle and the 10% at one end, who get it, who get it, and then the 10% on the other end that aren't ever going to get it. But it kind of all circles back to adaptive leadership that you're not going to get the same answer for every group. I mean, I work with mid and early career physicians, and then I work with leader career physicians. Their understanding of leadership and interacting, even just interacting at a clinical level is so different one group to the next. And so what those two groups need is so different. So unfortunately, it's not an easy answer. You know what I notice in the journey of when you earn someone's trust enough, so they'll talk to you, kind of learn the other side of the story. And what I think is really hard for a lot of people who are going through a leadership transition, but particularly is this, am I an advocate for the people I'm leading? Or am I really supposed to adopt a new mindset and lead them somewhere different that I might myself be uncomfortable with? And the richness of conversations that I've had with physician leaders who are in that transition stage where you really need to move a group, a practice group along, but it's a hard change and there's lots of real reasons why it's hard. Does the leader fall back on trying to and focusing their time on making sure that the voices of their constituents, it's almost like a constituent representative model are heard, or do they have the awareness and the self, the presence to know that I need to step apart a little bit and stepping apart doesn't mean that I don't have empathy and that I still can't expect and build trust, but I'm not one of the pack anymore and I need to pull the pack along. That's a very different way of showing up. And I struggle with, I think we all struggle with that, all of the change that we're trying to lead, but I see that particularly in younger leaders and many physician leaders. Oh, I think that's so true. Does it make sense? Yeah. And I think when I talk with the younger leaders, one of the things that they will notice about mid-career or just for their experience is they will talk about a lack of authenticity. So these are people that they expect to be fully authentic. And I think what you're describing is this lack of ability to integrate the different aspects of self that are involved in exactly what you're describing. Because in order to advance along the path, you actually have to simultaneously be authentic, but also hold so many different ideas, Many of which you're uncomfortable with yourself. Right. Yes. I think we all struggle with that. Yes. I mean, I think so much of it is about the shift in where you are in the ecosystem and you're still in the same place. You're still with all the other frogs in the pond, but you might be sitting on the banks of the pond. You know what you're talking about there. It was something I think about a lot is the power of the seat you sit in. So when I was at MaineHealth in the corporate office, so we have this really neat place that everyone works in at one 10 Free Street in downtown Portland, and we all are there in support of care delivery sites all throughout southern Maine. And I was one of the people, I fancied myself this way, and I think some would've agreed, but maybe not everybody, that I kind of got it. I understood that we were in the corporate office not really experiencing day-to-day, what was going on on the ground. And I was often trying to translate and navigate across. And then one day I found sitting out at Stevens in Norway and looking back at some of the programs that MaineHealth was trying to support the rollout of or the development of, and I was like, what? That's not relevant to what I have to do today. Wait, I was used to push that program and now I'm realizing that. So I think that your perspective, and that's the value of sitting in different places and being aware of that over the course of a career, but everyone was right, but what's important to you changes. So as you go along that leadership path recognizing, wow, I was in private or clinical practice and all of these things felt irrelevant to me, that's an overstatement. But they felt like something that was being done to me and I was being pulled along, and now I'm sitting in a seat where I'm trying to implement some of those things and don't forget how it felt to be there, but at the same time, you have to pull people forward. Yes. I think there's a little bit of a mind meld going on here with what you're describing. I didn't know this would be the much fun today. So that's good. Well, I'm glad. Fun is important. I think one of the things that you were talking about was this idea that you end up kind of translating. And one of the things I wonder about in understanding your background is that one of the reasons you went into healthcare is that you had a very personal family-oriented reason for deciding that this was the choice we were going to make. And I wonder if that didn't give you more empathy because this was something that your family was navigating in a different way. What you're referring to is that I have an older sister who, she's three and a half years older than I am, and she was born with a very severe hearing, deficit hearing loss. And so she was born in 1969. I was born in 72, so this was in the seventies. And to fast forward, I don't think I realized until later when I was trying to understand why I have so much visceral passion about some things that a lot of it might've had to do with my experience as the sibling of someone with a hearing loss. But so in my childhood, I watched her go through things that I never had to go through myself. And I watched my parents at that time doing what they thought was the best thing to do, was really pushing to have her mainstreamed. And we grew up in rural western New York state in the Finger Lakes region. My parents were both teachers, so certainly knew how to advocate for us and for themselves. But watching Rebecca go through a childhood that was really different from mine, and I didn't realize this until later, you don't go back and you don't know it when you're in it. You're just struggling. I have a memory that I'll share that's hard to share. I remember being on the bus when I was about eight, and Rebecca had the typical kind of a speech impediment speech difference that you noticed, and people were making fun of her on the bus, and I didn't stop them. And I remember sitting there wanting to shrink into my seat and feeling shame that I didn't. And they were big kids. I was eight, they were probably 15 or 16. And of course, there was probably nothing that I should have been able to do, but the real, very, very intense feeling of failing my sister in that moment who frankly didn't need me to save her and didn't want me to save her anyway. So I think that those experiences and many others, I think what has given me a real, we all want the world to be a better place, and we all, I think in different ways maybe care about justice and fairness and empathy. There's something that happened with me as I was developing as a human that maybe helped me to be a little bit more attuned than many other people might be on difference and power and what it means to have all your tools in your toolbox and what it might be like for people who are just as smart, just as capable, but might not have the same set of tools and the creativity that they have to draw on and the strength they have to draw on to find the right tools to flourish in the world. And sometimes they do and sometimes they don't. That informs a lot of the way I think about what we do in healthcare and how I show up every day for the people I work with. That's so powerful. And I think it speaks to the idea that you brought forward this idea of underlying at all empathy. And it doesn't mean that you're not going to ask people to do hard things, but at least try and understand where people are coming from and never assuming that you really have the ability to know that. And I'm having a thought as I'm listening to you. So it's the empathy. But then I also think that the thing that I work on a lot is the why and the vision forward. So we have to have empathetic connection. What I'm working on now is a leader is being really effective at painting a picture of where we need to go and why we need to go there. And even if it sometimes means dismantling things that we've spent a career building or having really hard conversations on the ground with folks who we need to find a way to adapt what they're doing in order to unleash the power of the magic of what they do every day in a different way. So the why and the vision are as important, I think, as the empathy. Yes. And this comes back to having people at all the levels and in all the different leadership type roles, whether they're formal or informal, to be able to bring that why. So Andy, Patstone shows up and here's my why, and I'm going to share it with this group of people, but to make sure that whatever the message is that people that you've talked to are going to be able to carry that message forward and be able to carry it across and through and up and down. And I think that is also the tricky thing is that what's coming out of your own mouth, but you have to make sure that other people have the ability to process what you're saying and then share this information. And I think that is a challenge sort of the further along your go. Right? I think you nailed one of the, we boil that down to communication and the idea MaineHealth's vision is working together. So our communities are the healthiest in America. Every leader at MaineHealth needs to understand that and then make it their own. Just running around parroting the vision, make sure that people remember what it is, but really thinking deeply and then about it. And also being able to pick up the elements of it and make it their own so that they're authentic when they're talking about the why. And you have to actually drill that very lofty mission working together so our communities are the healthiest in America, down to something that's meaningful and connects on the ground to people's regular experience. And helping people do that across levels of leadership in the organization is a huge task and one that I think we need to spend a lot more time thinking about than we do. I could not agree more with this. Yes. I want to make sure that, I mean, again, you and I could have session one, session two, session three. Maybe we'll end up bringing you back perhaps, but I also want to make sure that we talk about your actual connection to the Portland Art Gallery. You have one, and it's pretty special actually. Yeah, it's funny. That's such a wonderful space, and my husband and I are really early and on our journey as having resources to fill our home with beautiful things. I mean, what a privilege that is, right? Every time we're on a date night or we are running errands down in downtown Portland, that's a place we often find ourselves