Jill Steeley: CEO and FQHC Executive Coach

In this episode, Jill Steeley draws on her extensive experience coaching leaders in Federally Qualified Health Centers to explore the unique challenges and opportunities of leading in community health settings. She shares practical strategies for building resilient teams, fostering authentic leadership, and navigating change while staying mission-driven. Jill’s insights offer valuable guidance for healthcare leaders striving to balance operational demands with compassionate, people-centered care.

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Transcript:

Manish Shukla (Host): Thank you so much for tuning back into the Athelas is Taking Back Healthcare podcast. Today, we are joined by FQHC extraordinaire Jill Steeley. Thank you so much for being here today.

Jill Steeley (Guest): Thank you so much for having me. It's great to be here. This is a beautiful studio you have.

Manish Shukla (Host): Thank you. Thank you. I had nothing to do with it. So I'd just love to kind of start off and just hear about your background and how you even got here today.

Jill Steeley (Guest): Yeah, thank you. Well, let's see. How far back do you want me to go? I started out in finance, and I kind of found public health by accident. So way back in the early 2000s, I moved to Montana. I started a county health department in Montana. It was right after 9-11, and there were all those anthrax attacks happening. There was a lot of federal funding being pumped into counties and local government to be able to respond to bioterrorism attacks. So long story short, I started a county health department for one of the counties in Montana there, and then just from there moved on to a bigger county, ran their public health department, and then was recruited to Helena, Montana to be the CEO of their federally qualified health center way back in 2014. So that is how I kind of stumbled into public health and community health. I have since found that it is truly my passion. I was the CEO there for a long time. I left in 23 to help my son with some significant health issues that he has. And when I left, I went to Blue Cross Wushilda, Montana, thinking that I could be on the payer side of things, but it just wasn't the right fit for me. I realized that I really need to be on the FQHC side. And so I started a consulting business and I do leadership coaching and executive coaching and business consulting for FQHCs across the country, and it's been great. Amazing. I look to just kind of dig in a little

Manish Shukla (Host): bit into what actually drew you into joining that county health. Because, I mean, you mentioned a couple of things there, anthrax attacks, post 9-11. Was it a sense of duty that really drew you there, or what was really the intriguing thing for you? I

Jill Steeley (Guest): wish I could say that it was. At the time, it was a very small town that I was moving to in Montana for my husband's career in historic Preservation. And it was the county seat. And I went to the county. I had moved there from Salt Lake City and had worked at Goldman Sachs for several years. And I went to the county and said, you know, this is my skill set. Do you have anything I could do here? And they said, well, we have this grant we're about to lose because we haven't done anything with it. So if you can get us caught up on this, we'll pay you to do that. And what I realized in looking through the grant deliverables was they had to have a county health department and they didn't have one. So I went on a road trip across Montana and visited other county health departments to see what they looked like, how they functioned, what services did they offer. And then I went back and started one.

Manish Shukla (Host): Amazing. Okay. That's very cool. That's very cool.

Jill Steeley (Guest): I really fell into it accidentally.

Manish Shukla (Host): I think that's how the best things happen, honestly. So then you go. So I looked to also chat about the Blue Cross Blue Shield because what intrigued you about joining the payer side? And then when you were there, what made you go, actually, no, I need to go back to the FQHC?

Jill Steeley (Guest): Yeah. So they had recruited me several times over the years.

Manish Shukla (Host): She's too powerful. We have to stop her.

Jill Steeley (Guest): And I, you know, I kept turning them down. I really didn't want to leave my health center. But when my son got sick, and I realized I couldn't do both, I couldn't effectively help him navigate all of that, as well as do my position as the CEO and do it well. They came knocking again, Blue Cross did, and it just felt like the universe was sending me an opportunity to go do something with a little bit less responsibility, but still kept me in health care. You know, it is my personal mission to help people and to serve, you know, to your point earlier, that is a personal mission of mine. And I just didn't feel that I had purpose at Blue Cross Blue Shield. I felt like it was really all about the bottom line and the budget rather than the people that we needed to help the patients.

Manish Shukla (Host): So then out of all of the things that you could be doing within healthcare, what do you think makes FQHCs unique to your skill set and your interests?

Jill Steeley (Guest): It really is the perfect combination for me because my passions are business and public health or community health.  I think that FQHCs are so unique in that they serve everyone, but they are truly there to serve the underserved. And not many other health care entities, regardless of their tax status, profit or nonprofit, are really not serving everyone. If they don't have a payer, if they are underinsured, if they are low income, a lot of times they cannot access affordable health care unless there is a community health center in their area. And so FQHCs are truly just a passion of mine. The people that work there are almost always working there because it fits with their own personal mission to help people. And so it's just salt of the earth people whose whole goal every single day is to see people who otherwise wouldn't have access to health care.

Manish Shukla (Host): Right. I mean, that sounds incredible because I remember I've heard a saying before, like you can't outcompete someone who's on a mission, someone who's having fun.

Jill Steeley (Guest): Absolutely.

Manish Shukla (Host): So when you stepped into that role of FQHC CEO, obviously, you know, it's kind of all for one, one for all in terms of who you're serving. But what surprised you the most when you were in that role about the business?

Jill Steeley (Guest): I think what surprised me the most was how unique their business model is. And I really walked into a mess. My health center was about to close the doors. We had about a million dollar deficit. The board was very frustrated and kind of at the end of the rope with the health center because it had been financially underwater for so long. And I thought that I've always operated in the mindset of we have to run public health departments like a business. They might be part of their county or city government, but we still have to run them like a business. And when I walked into my FQHC, I quickly realized that they had been trying to run it like a county department, and we were part of the county. We were a public entity health center, which is a fairly rare model for an FQHC, but that is what it was at the time. And so really just relying on the federal funding, any sort of county grants that they could get, and the county's business infrastructure, and really had not been operating like a healthcare organization. It was more like a county government department. And we all know that county governments and city governments aren't the most progressive or move very quickly when it comes to innovation and creativity. And so we were really hamstrung. And so I had to quickly realize that it did need to be run like a profitable business, even though it was a nonprofit slash public entity.

Manish Shukla (Host): So for those who aren't aware, would you mind breaking down what the actual business model of an FQHC is?

Jill Steeley (Guest): Yeah, well, most of them are required to provide medical, dental, and behavioral health services. They also have other required services, and if the FQHC doesn't provide those services, such as prenatal care, more extensive dental care, more extensive mental health, substance use disorder care, if they cannot provide those services, then they have to have an agreement with someone in their community who will see their patients for those services. And the health center has to pay for that, for their patients to go there if their patients cannot afford to go there or do not have insurance. So they really have to provide this comprehensive health care or primary care. So they have to provide medical care, basic dental, and basic behavioral health. A lot of them also have pharmacies. And so, you know, it's not like your hospital. Your hospital doesn't usually have dental. It's not like your mental health center. Your mental health center doesn't usually have primary care or dental. It's not like your dental clinic, because your dental clinic doesn't usually have primary care or behavioral health. So they are very unique. It is a very unique business model. And if it's not done well, then they lose, they have the potential of losing a lot of money because they do end up being the clinic that only serves the people who don't have insurance or people who are low income. And really, they should be trying to attract everyone so that their revenue is more diversified. But all that to be said, there is some federal funding that they receive in order to serve the underserved. And the mission truly is to provide access to health care to those who otherwise would not be able to afford it. So that makes it so that they are a safety net provider. So that adds more challenges as well.

Manish Shukla (Host): Right. So when you are taking place in there, you're saying, OK, we need to turn this around, run this like a business. What are some of the initial steps that you're taking or even what are the things that you're looking at to diagnose the issues?

Jill Steeley (Guest): One of the things that I almost always see is that they are not serving, they don't have a good payer mix. In other words, they might be really, really, really dependent on the federal funding, and they might also have a very high uninsured rate. My first step is to usually say, what are you doing to attract insured patients? And this usually will get a little bit of bristling from an FQHC leader because, again, their mindset has always been, we're a safety net provider. We are here for the people that need it most. But they're not thinking that if they're not serving everyone and they don't serve patients that have a payer, then they're not going to be open for the people who don't have a payer.

Manish Shukla (Host): We want the same thing, but we need to make sure you stay open.

Jill Steeley (Guest): That's right. That's right. No mission, no margin, no mission. That's what I always say. So that's the first place I start is how can we get you more insured patients coming through the door? How can you be the provider of choice in your community? Because there's all kinds of competition now. There are urgent cares. There's walk-in clinics. There are Medicare clinics. There are direct primary care clinics, hospitals, you name it. People have a choice. And so the health center needs to be front and center. When people are thinking about getting medical care or dental or behavioral health care, They should be thinking about that health center. How do we get you top of mind for the people in your community and take away the confusion that most people have in that it is the clinic for the poor? It was interesting when I started at my health center, we were going through a rebrand. And so we were doing a lot of surveys in the community. And we had a 23% brand recognition. And of those 23% of people who recognized our name at the time, 84% of them thought we were the county health department and that we just did vaccinations. And that is very common for community health centers. People don't understand what they are. They don't understand that they provide all these great services under one roof. They don't understand that they have to keep their prices affordable, that they have a sliding fee scale, and so they don't use them, was that most people who recognize the name thought they couldn't go there because they had health insurance. Yeah. So you have to, if you're going to attract people with insurance, you have to take away that confusion. Confused people don't buy. Again, we're running it like a business, right? So it's got to be profitable. We have to attract people with a payer in order to keep the doors open. So how do we do that? Well, we start to go to private employers, large employers. I went around to every single large employer in my area and asked if we could have a partnership, if our health center could be their preferred primary care provider for their members of their insurance plans. So their employees, spouses, and dependents. And in turn, when they came to us, their co-pay would be waived. So it would incentivize them to use the health center. But what it really did was it was an added benefit that the employer now had for their recruiting efforts. It was also free health care for their members, their employees, spouses, and dependents. So they were preventing a lot of emergency room visits, urgent care visits, and people were not sick as much, right? Because they were getting their preventative care. So that right there, we were able to get a thousand new patients every single year, and they were privately insured. They worked for those employers. So that's, you know, one of the first things I teach. And I run a CEO boot camp for executives of health centers. And that's one of the very first things I teach them how to do and give them all the resources to do it, but because it is so effective.

Manish Shukla (Host): So what are some other strategies that you like to employ? Because I will say, one of the places I get health services from right now, I was doom scrolling on Instagram, but I saw an ad from that. But it's because I asked them about it and they said, you can just get so targeted in your marketing.

Jill Steeley (Guest): Absolutely. Yeah, that's another way. So when we rebranded, we launched a huge marketing campaign. Now, remember, we were a million dollars in the red. And here we were pumping hundreds of thousands of dollars into a rebrand and marketing campaign. But the reality is, we hadn't attracted a new patient in years, we were losing patients. So we really couldn't afford to not make that investment in marketing. Again, people either don't know the health center exists or have the wrong idea about it. They think it's for the poor. They think they can't go there because they have insurance. They think that they need to go to urgent care, whatever their, you know, misconception is, that is stopping them from going there. So we put a lot of money into our marketing. And it's interesting because I do a lot of consulting and strategic planning with FQHCs. And I've literally had to tell them like, you have to market, you have to be front and center, you have to have a strong market presence and a strong brand. And they just look at me like, yeah, we don't think we need to do that, right? Because it's worked until this point, it's worked for them to be the safety net provider and depend on the federal funding and kind of live grant cycle to grant cycle, but that's not working anymore. The funding is just too unstable and too uncertain for them to be like that. So they really have to think about how do we attract new insured patients to our health

Manish Shukla (Host): centers. It's kind of like, you know, musicians want to write. They want to kind of keep doing what they do. And probably it's kind of like when you don't want to look at your bank account after you've been spending, you're like, I just hope that it gets better.

Jill Steeley (Guest): Right, exactly, exactly. And what happens is we just got some funding approved to the end of the year. Well, that's great. But if that means that you are bailing yourself out of debt every time, or you think, okay, well, I can take my foot off the gas and wait until the next funding cycle next year to really address our revenue leaks and our really high costs of care, then you're already behind the eight ball. You've got to use this time, this funding to start to think about stability and

Manish Shukla (Host): sustainability. Yeah, that makes sense. Have you ever interviewed some of these net new patients and asked them about how they've kind of done a 180 on their opinion of the center? Oh, yeah.

Jill Steeley (Guest): We did that same survey every single year for years. And so we were serving 700 to 1,000 people on, and we did focus groups at our health center to see, like, what was it that made you start coming here? And it was a few things. So it was those ads that sort of stalk you on the internet, you know, which kind of freaked me out, but they're effective. it was also the fact that we could get people in quickly. So when you start calling around, it's because you need medical care, or you are finally ready to get that tooth fixed, or you are finally ready to address some mental health issues that you're having. If you start calling around and you can't be seen for eight, nine, 10 weeks, even longer than that, then you're going to either A, schedule the appointment and no-show it when it finally does arrive, or B, keep looking and go somewhere that can get you in faster. And that's when we see emergency room visits go up. Dental is one of the highest reasons people go into the emergency room is for an abscessed tooth, an infection, toothaches, whatever. So if we are scheduling them so far out, then they're going to go somewhere else. They're probably going to seek more expensive care and more urgent care. And so our health center, I just kept adding providers so that we had the capacity to keep seeing people right away when they scheduled the appointment. That really helped us be attractive to our, you know, with our patients. It helped us beat the competition in the area because they couldn't get anybody in for three months. And it reduced our no-show rate. Because again, if you schedule something because you're in crisis right now, and then it's three months from now, most likely you don't need it anymore at that three-month mark. And you've totally forgot that you made the appointment. So you just no-show it.

Manish Shukla (Host): So in your experience, what are some of the biggest barriers in preventing FQHCs from becoming sustainable financially?

Jill Steeley (Guest): Well, I think that when you are putting out fires every single day, it's really hard to be strategic. And it's really hard to look long-term. I think most health centers are well-intentioned. They are wanting to serve their communities that are in most need. But they get so focused on the day-to-day putting out fires that they don't get to think about, how can we be more profitable in 2026? How can we set ourselves up so that we are not in this place of a deficit in 2027? What do we need to do to be a provider of excellence? What do we need to do to attract new patients? What do we need to do to attract high quality talent? And what are those steps that we need to take now in order to be there in the near future? When you are constantly in crisis mode and just trying to survive month to month, you instead start to do the one thing that you shouldn't do, which is to cut. And most health centers will start cutting services, cutting staff, cutting sites, because they just can't figure it out. They can't figure out that financial stability. Their mindset is still, we're just a safety net provider and the funding isn't coming like we expected. And so we just have to cut. But what they're really doing is cutting the things that patients need most and will actually drive revenue for them. Right. It's interesting

Manish Shukla (Host): that you're saying it's almost just like a paradigm shift mentally of like absolutely going from survival mode to thriving mode and hey we're not just for the lowest common denominator we're

Jill Steeley (Guest): for everyone possible yep i mean shameless plug here but i'm doing a webinar this friday talking about that exact thing the mindset shift that has to happen to use this time in the funding instability, and I hope I can say kind of this dysfunction in government, to think about how you can become a profitable business in 2026 and 2027. Stop thinking about how do we just survive? How do we get to the next funding cycle? Where's the next grant coming from? And start thinking about if you were a business and you weren't getting that funding, how would you be sustainable?

Manish Shukla (Host): Right. And so then what are the phases of improvement you see once some of these steps are taken? So obviously we need to kind of diversify the payer mix, kind of appeal to some more folks who are insured or have more ability to pay for services. But then also we need to do these paradigm shifts. We need to do these marketing. What can they expect once they start

Jill Steeley (Guest): to see those improvements? Well, it's like a flywheel.  A flywheel, once you get it moving, then the momentum keeps it going and gets it going faster and faster. When I started to attract new insured patients to our health center, it was like a flywheel of momentum. So one revenue lever helped me then attract new staff, new providers. In fact, they had not been able to hire a medical doctor in five years at my health center. And then after we started growing and attracting all these new patients and we could pay them well, and that was that I then had providers coming to ask for a job at our health center. So we went from not being able to recruit to having to turn away providers from our health center. It really truly was and it will be like a flywheel of momentum. So if you pull on one revenue lever, then it makes it much easier to start looking at those other levers like workforce and attracting talent and partnerships in your community. You know, healthy, attractive health centers will attract good partners in the community. So if you are looking to expand, but you don't want all the overhead or you don't want to run a capital campaign and to build a building, well, there's probably someone out there that you can partner with and put a site in their location. You're probably serving the same people. But that doesn't happen if you are barely keeping your own doors open. They're not going to come around because they don't want to get in business with a business that's barely making it. So when you fix your financial health, then everything starts to fall into place. And you become much more attractive to people who are looking for medical care, looking for dental, looking for behavioral health. There are a lot of statistics that show that happy patients will refer three to five people to their provider.

Manish Shukla (Host): Everyone loves having a guy. You got to go to Mike.

Jill Steeley (Guest): That's right. You got to see my guy. But if you were to attract 1,000 new patients and they referred your health center to three to five people, that's the potential of 5,000 new patients right there. And I do this math in my webinar, but you can really make $2 million a year just off 1,000 new insured patients. Because most primary care patients will come to your health center four times a year. Most of them are going to use your pharmacy. Most of them are going to use other services in your health center if they are happy. And again, it's that flywheel, right? So happy patients are referring. They are using more than one of your services. They're using your pharmacy. And that just is going to drive up your revenue and make you a lot more financially stable.

Manish Shukla (Host): Right. And you already may have touched on it, but what would you say is the most overlooked operational or financial lever that can have a significant impact on the practice?

Jill Steeley (Guest): I think it's a lot of things. I think that having more insured patients is a really big one. But I also think it does nothing for you to increase your revenue if you can't control costs. So, again, no shows are a huge cost. There's also this, there's a lot of billing errors. There's a lot of, you know, and I know that you guys focus on this a lot, but there are, there's the revenue cycle that really needs to be assessed and audited because so many times we have people that have been doing it for 20 years. and they're not really interested in, you know, using new technology and using new software, using AI. And so we're just doing things the way we've always done it. And that's costing a lot of

Manish Shukla (Host): money. And from what I've seen in that revenue cycle portion, it's really just kind of like whack-a-mole or even that scene from I Love Lucy where just the chocolates are going down the and bear belt on their stuff. You know, they're just trying to like catch up constantly. And then because of that, it's kind of like what you're saying. You can't back up and be strategic. You're kind of just trying to.

Jill Steeley (Guest): You're whack-a-mole.

Manish Shukla (Host): Exactly. Exactly.

Jill Steeley (Guest): There's no strategic planning with whack-a-mole. You're just in crisis mode. Yeah. And they are easy problems to fix. I always say in healthcare, we're so lucky because there are so many great tools that we can use. You think about other nonprofits. They don't have the technology that healthcare has. They don't have the data that healthcare has. And so they're kind of flying blind where we have the data. We know who is coming to our health centers. We know every single thing about them. We know how to market to them. We know how to get them to attend their appointments. We know how to get them to schedule other appointments. We know all these things and there is technology to do that. But if we keep operating in 1984 and that technology environment, then no, we can't be more efficient. And it is going to cost us a lot more.

Manish Shukla (Host): Right. Not like Orwellian, but more floppy disk era.

Jill Steeley (Guest): Right. When I started at my health center, like I said, we were part of the county and it was like I had taken a step back 20 years in time. when it came to our technology. And it was a huge investment to get our staff. So I ended up separating us off from the county and we became a private nonprofit health center. And in doing that, I was able to buy all new computers, laptops, improve the Wi-Fi access, all the things, improve the softwares. And by doing that, I not only improved my staff satisfaction, But my providers were able to see a lot more patients because you think about slow technology, right? We get so frustrated if our phone isn't lightning fast or computers are not lightning fast. But yet we are handing a doctor a really old laptop that is sitting and spinning for 10 minutes before they can even get to a patient chart and then wondering why they're behind on their patient schedules or they're not willing to see more patients. We have to make some investments in technology and tools in order to, you know, again, reduce the cost of care.

Manish Shukla (Host): Absolutely. And not just the cost of care, but for the providers who are offering those services, ensuring that they don't get burnt out. Right. Because I've seen some providers who are talking about, okay, I do my 8, 10, 12 hour day, and then I had to do two to four hours of notes. I had to catch up to them on weekends and then, no, my wife wants a divorce.

Jill Steeley (Guest): Right. Or you're on vacation sitting on the beach. I had providers, you know, I've worked with my executive coaching. I have chief medical officers who took their laptops to the beach and did their work there. You know, that's crazy. We wonder why there's such a large rate of burnout right now in healthcare. And again, it doesn't need to be that way. We have so much technology. Does it require an investment? Yes. But if you do your research and your homework, you should be able to find, you know, software and solutions that will give you a fast return on your investment and save you a lot in the long run. If you can prevent one MD from leaving your health center and going to the hospital because the hospital's got all the new technology and they're not fighting with your technology every day. I mean, you've just saved your health center $500,000. So what does that mean in investing in a good AI scribe?

Manish Shukla (Host): Absolutely. Absolutely. So I'd love to just chat a bit more about what you're doing now and kind of coaching and consulting with these different FQHCs. Talk to me about kind of what your average interaction with some of these clients looks like.

Jill Steeley (Guest): Well, it depends on if they are a one-on-one coaching client or if they are in my CEO boot camp. So I do a few different things. I teach leadership skills to FQHC leaders. What I have found and what was true in my health center is that we promote clinicians into leadership positions, which is great. They are usually very good at what they do. They are great with the technical skills of being a dentist or being a medical doctor. But a lot of times they have no leadership experience and no management experience. So people, leadership, management, running a team, running a high performing team.

Manish Shukla (Host): The plot of the office, Michael Scott is an incredible salesman.

Jill Steeley (Guest): Exactly.

Manish Shukla (Host): Not the best manager.

Jill Steeley (Guest): One of my favorite shows. So, and then we wonder why they're struggling, why their teams aren't being productive, why there's a lot of tension, why charts aren't being locked, why, you know, all the things, because they don't have that 10,000 foot view. They've been a clinician and that's how they're trying to now be a executive. So I teach a lot of leadership skills, such as communication and time management and people-first leadership and change management to FQHC leaders. I then have a CEO boot camp, which is for executives, and that's a five-month program. So they're with me and my partner on that, Steve Weinman. We've both been CEOs of FQHCs. We are both consultants, and that's been really great. We are getting ready to start our fourth cohort on that, but they are with us for five months, and we teach them everything from increasing and diversifying revenue, reducing costs, how to build a strong market presence, kind of everything that I've talked about today. They get a lot of coaching from us, and they also get to be with a network of their peers from across the country, which I always wanted when I was a CEO.

Manish Shukla (Host): I mean, it sounds like it's an FQHC MBA.

Jill Steeley (Guest): Yeah, pretty much. Yeah, that's a great way to put it. And then I do one-on-one executive coaching. And that's usually with a CEO, a CFO, a COO, a CMO that has a lot of skills, but they are feeling burnt out. They are feeling like they can't be strategic. They don't know where to go from here. They don't even know if they want to be in this position anymore because it's just constant crisis mode. And so I really work with them on, you know, what is the next right action for you? Is it to fix this part of your health center? Is it to fix something that's going on with your team? Is it to fix something going on with you, you know, as a professional? And then we work, you know, kind of hand in hand on doing that. And then we move on to the next thing.

Manish Shukla (Host): Kind of sounds like, you know, you're helping them get out of this panic mode, crisis mode, and kind of allow them to see the forest for the trees.

Jill Steeley (Guest): Absolutely.

Manish Shukla (Host): I'd love to hear just kind of like some success stories of some folks that you've coached there.

Jill Steeley (Guest): So we, I mean, we, with our CEO boot camp, you know, again, we do a lot of coaching. We have seen our health centers that have gone through that increase revenue by 20%. Think about, you know, a $30 million budget. What does 20% look like for them? That's a lot of money. We've seen health centers reduce costs by 30%. And I think probably the coolest part is seeing them go from having the reputation of the clinic for the poor to like the preferred provider in their communities. And we've seen a lot of health centers have success with that. When I have coached a lot of CMOs, actually, so chief medical officers, because again, I think they are usually promoted into that position and usually don't come with a lot of leadership experience. And now they are trying to manage a team of their peers, which is hard. So I coach that I've seen CMOs who have had virtually, you know, zero confidence in that position to being able to increase their team's performance or improve their team's performance. They have, you know, repaired relationships on the team that have gone south because of this new dynamic between them, they will typically let a lot of toxic behavior go on or behavior that isn't great for a team go on because they don't know how to address it. So I help them, I coach them on dealing with issues as they come up rather than letting them tear the team apart. So I have, if you talk to a lot of my clients, it's a lot of work like that. It's, you know, I don't know how to talk to my team about this underperformance or these metrics we just can't seem to make because they're all telling me they're going to leave, you know. So we really have to start at ground zero and start working our way up, repairing the relationships, building the trust, and then addressing the performance issues.

Manish Shukla (Host): Right. I mean, hopefully we're getting some good sound bites and clips here because I feel like if I was, you know, one of these FQHC leaders listening, watching right now, we've had a good conversation so far where they can probably self-diagnose and be like, oh, this kind of sounds, it sounds like me. Yeah. I mean, you know, remember I did it for a long

Jill Steeley (Guest): time. I coached and mentored not just my leaders in their positions, but many, many other leaders that other health centers would send to me because they would say, I'm just not getting through to this person or this person and I are really struggling like the CEO and the CMO or the CEO and the dental director. And so I would kind of take them on as a mentor to them and coach them. And I never really realized that that's what I was doing. I just took it as, let me just help out my fellow CEO over here and take this person under my wing and try to help them reach a level of success in their position. And so I've seen everything. I have seen the really confident, you know, clinician get moved into a director position. And then the team just struggles because they genuinely don't know how to run the team. Or I've seen a really resistant medical doctor get moved into a director position and just have no idea what to do. So, you know, it's a lot of hand-holding, but I think that's important because those are hard jobs. And a lot of times we put them in those positions and we say, well, we still want you to see patients and we're going to give you 20% of your time to manage the team. And they don't even know. I mean, time management just is not even on their radar. So it just becomes a complete disaster. Given that this has kind of

Manish Shukla (Host): been the last 20 plus years for you, as you have been doing this new coaching, what was something like net new for you that you learned about and helped, you know, kind of coach through?

Jill Steeley (Guest): I mean, I've just learned so much. I learn every day. Honestly, it's what I love about my CEO boot camp is that they're not only learning from us, but I learn from them every day in our community. I learn, you know, what big health centers in New York are doing and where they are achieving some success. I learn what's not working, you know, across the country. And I learned that I have to stay sharp on all of this. I'm not in the trenches doing the work anymore. And so, and they are depending on me to be knowledgeable in those areas. So I do a ton of research on what does work now, you know, how have the requirements changed? Has the healthcare landscape changed? What are patients expecting now with their healthcare? And so I'm constantly adjusting what I teach and how I teach it according to how things are changing.

Manish Shukla (Host): Yeah, now that you pointed out that way, it must be nice when you are working with a leader and trying to do that paradigm shift. You can be like, listen, it's not just here. It's also happening in New York. It's also happening in Idaho. And, you know, this is what they did to get over it. And you're not alone and you can do it too.

Jill Steeley (Guest): Yes. And that's one of the things that we offer in our CEO Bootcamp is for Steve or I or both of us to attend a board meeting with a CEO or an executive to tell the board that this is not just your health center that's struggling. This is happening all over the country. And this is how we are going to help this person get things turned around. Here's a 90-day plan. Here are some measures that you can keep an eye on to know that it's getting turned around. But you are not unique. This is happening all over the country. And not just with FQHCs. It's happening with all health care. Things really changed from the pandemic. Consumer behaviors have changed. Patient expectations have changed. The technology has changed. Things are more expensive. You know, inventory is more expensive. Physical space is more expensive. And everything for health care got more complicated.

Manish Shukla (Host): Even patient trust.

Jill Steeley (Guest): Yeah. Oh, absolutely. We're in a big trust deficit right now.

Manish Shukla (Host): Yeah. Everyone's doing their own research.

Jill Steeley (Guest): Yeah.

Manish Shukla (Host): So something I'm curious about, actually, is, you know, when it does come to the topic of, you know, burnout, these FQHC leaders are coming in, they're burned out. How do you help them get through it? Because, I mean, it comes from emotional stress, time stress, all those kinds of things. So as they're, you're trying to get them to be quick to action now, but they're still exhausted.

Jill Steeley (Guest): Yeah.

Manish Shukla (Host): How do they work through that?

Jill Steeley (Guest): What we usually start with is looking at what they can get off their plates. So especially overachievers, when we talk about executives, when we talk about doctors, dentists, behavioral health providers, pharmacists, you know, these are people who are used to kind of having to do things on their own. They're used to going through a really difficult schooling and having to do well in that. And so they don't like to struggle with things. And a lot of them are taking on so many things that they don't need to, and it's just weighing them down. It's making it so they can't see patients. They're kind of stuck in this cycle paperwork and meetings and all of this. And so what I usually do is do a time audit with them, figure out how they're spending their time all day, every day. And then we go through each thing that they're doing and we figure out if they need to be doing that. Does it need to be you that's doing this? Can we get rid of it altogether? Can we delegate it? Who can we delegate it to In order to free up their time to do the things that are important to them, or are those kind of $1,000 tasks is what I call them, things that only they can do as the CMO, as the dental director, as the CEO. So just that right there prevents a lot of burnout from continuing because we're eliminating so many things from their calendar. We're getting things off their plate. I give them a script to use when they need to stop going to a meeting that is not purposeful anymore. And we all have those. And so that right there really helps them sort of see the forest through the trees. And they can finally take a breath and say, OK, here are the things that are important to me and only I can do. And those are the only things that should be on my calendar and on my to-do list. Once we work through that, then we start to look at where are those big pain points for them? Is it a relationship with somebody on the team? Is it, you know, the team can't seem to hit certain measures? Is it that the team is frustrated and or the technology? So I do a complete assessment with them. And then I just start to pick things from the assessment that I think would offer them the fastest relief from that burnout. And then we just keep working down that list and, you know, tackling those big pain points.

Manish Shukla (Host): Yeah, that sounds pretty much like music to my ears. I'm sure to their ears, because I know I've done some leadership training in the past and I did something similar and they said, don't be a hero, delegate.

Jill Steeley (Guest): Yeah, that's right. It is a skill. It's hard to do. I have a hard time with it. I'm a perfectionist. So I always think I'll just do it. I could do it right. If I want it done right, I'll do it myself or they won't be able to do it like I do or it's going to make me look bad. But it is a skill. It's something that I teach actually delegation because it's something that you have to practice all the time and just keep doing all the time. It's not something that comes naturally to people, especially if they are overachievers or high performers.

Manish Shukla (Host): Or you've even had some folks say, like, I felt bad asking them to do this. It's like, well, it's our job. I don't care.

Jill Steeley (Guest): Or they're so strapped. It's like, who are we going to ask to do this? You know, there's options. Even a virtual assistant is an option.

Manish Shukla (Host): Or even now, I mean, that's why AI is so powerful. I think one of the biggest unlocks is really just operational efficiency and getting back your time.

Jill Steeley (Guest): Absolutely. I mean, I work with a CEO and he says he's in Claude every single morning, you know, chatting with Claude, brainstorming. And that's how I am, too. I don't use it to write my content. I use it as like a second brain. Like, how can I help my clients more with this? Or what am I missing here? Or, you know, how can I create this procedure? This is what they could do. you know, write a procedure for me rather than them trying to think about writing the procedure and having it done right. It can do a lot and you can just be the reviewer.

Manish Shukla (Host): So on that topic of technology and obviously FQHCs, with some of the FQHCs and health centers that you're working with right now who maybe are doing a good job of employing technology, what are still some open areas that still need to be solved?

Jill Steeley (Guest): There's still some resistance there. I think that they don't trust that it's going to do a good job, that it's going to take more time. This is what I hear from my CMOs that I work with, that I try to get to look into AI scribes. Well, I'm just going to have to read it all and fix it anyway, so I might as well just do it myself, right? Again, that perfectionism. And I get that. Their license is on the line. The notes have to be correct. It has to pick up the right things at the right time. And they feel like they still have to go in and do quality control. So what is the point? What I try to get them to understand is even if you just have to read through it, that's a lot faster than you typing it out. You're also able to make eye contact and sit and listen to your patient rather than sit at your laptop typing through that whole thing. And you can get your chart locked a lot faster. And also, it should help you with some coding as well, right? So if you aren't sure what code, and most providers, especially FQHCs, will undercode, then you're helping your health center as well. Again, I do think that there is a big trust deficit still when it comes to using AI. And that is one area that I see a lot of resistance. I think, too, that most health centers have gone through the trauma of implementing a new software. And it brings down their EHR for five days or whatever it is because something didn't go right or there's just constant fixes that have to be done. And so a lot of them say it's just not worth it. If it has to be integrated with our EHR, it's not worth it to us.

Manish Shukla (Host): And to the point of the AI Scribe, I mean, you know, I've worked with one clinician who said, you know, this used to take me two hours. I just got I just locked my notes in four minutes.

Jill Steeley (Guest): Right.

Manish Shukla (Host): And also, you know, it is very what is nice about, you know, the AI Scribe, too, is, you know, we'll do pilots and it's like, hey, you don't need to buy it immediately. Why don't we show you what it's like to because you do have to do a bit of workflow adaptation to it. But to your point, you know, it's better to review it than, you know, write in a journal.

Jill Steeley (Guest): everything. The same thing. Exactly. Yeah. I, I'm a big proponent of it. And especially if you have a newer provider, they're usually used to it by now. They're used to technology, you know, it's like my generation, like I've had to get used to a lot of things that I didn't have. I didn't have a smartphone growing up, but my son has, you know, since he was 10. So that'll, he, he can't imagine a world without that technology at his hands. And so a lot of these new providers are the same way. They're going to adopt it much faster than somebody that's been practicing for 30 years. And, you know, they just are, they're kind of resistant to the technology altogether.

Manish Shukla (Host): But to the point of like, you know, like just educating business leaders, You have to take that as a face value. Like the rate of technology adoption and evolution is just going to get quicker and quicker.

Jill Steeley (Guest): Right.

Manish Shukla (Host): I mean, I was talking to my mom. She was like, I just got on Facebook. Facebook's not cool anymore. And I'm like, it's not. I'm sorry. But yeah, it's just one of those things where it's like, just take it at face value. Your resistance doesn't really mean anything in the face of it just being.

Jill Steeley (Guest): I mean, what are the alternatives? The status quo? How's that working for you? You know, that's what I say to my clients. Like you are in already in trouble financially. I get it that it just feels like too big of an investment. But if six months from now, you're able to see more patients, your providers are not leaving, everybody's much happier and you have not needed to replace, you know, three front desk people or two medical assistants or whatever it is that people are doing a lot of manual work that now the technology is doing for you, you've just made your money back and then some. And, you know, the compound interest on that investment is huge.

Manish Shukla (Host): Just to kind of round it out here, let's hear from your perspective, a pitch to my nephews. They want to be YouTubers. They want to be Twitch live streamers. But I don't think anything replaces just the kind of mission drivenness you get from being involved with something like an FQHC. How do we get them to take part in this?

Jill Steeley (Guest): Oh, gosh, I know. I have the same thing with my son. It's all about for him at this age. He's 17. It's all about fast money, right? How can I make a lot of money and without a lot of effort? And do it quickly. And I'll be honest in that I was in the same mindset at his age. You know, I've always had an inherent desire to help people, but I didn't know what that looked like until I found public health and community health. And so for your nephews, I think that we, for this generation, first of all, we have to kind of let them be on their own journey and realize that it's never going to be easy money. If you want to make good money, you have to do it. You have to work. You know, my mom used to have me be an intern in the summers, and she would arrange for me to have a really terrible experience and a really great experience and would say, you know, which are you going to pick? Are you going to pick something that is a steady paycheck, that it's something you like to do and you go to work and you feel purposeful? Or is it this really crappy job that you hate going to? It takes a while for people to have that value come out in them. You know, if it's there, if they want to help people and they want to be servants of their community, that value is probably in there, but they're just so young and they see so many people making it online. And so I think they just think that's, you know, that's how you do it, but they'll just have to figure it out. They'll have to realize that if you don't do something that brings you purpose, it's going to be a long, long road. That makes sense. I mean, then something we say here is

Manish Shukla (Host): you really need to play long-term games with long-term people. Absolutely. Jill Steele,

Jill Steeley (Guest): is there anything you'd like to plug? Join us for our webinar this Friday. It's free, 12 p.m. Pacific time. I'll give you the URL and you can put it in the show notes. And then if you're interested in working with me, you can just schedule a call with me from my website, jillsteley.com. Amazing. Thank you so much for being here today. Thank you. It's great to be here.

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