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      Mary Dittrich of U.S. Renal Care

      We Spoke to Mary Dittrich of U.S. Renal Care on Being an Effective Leader During Turbulent Times

      As part of our series about the “Five Things You Need To Be A Highly Effective Leader During Turbulent Times,” we had the pleasure of interviewing Mary Dittrich, MD.

      Mary Dittrich, MD, FASN is the Chief Medical Officer and Executive Vice President of U.S. Renal Care as well as Co-Founder and Partner of Boise Kidney & Hypertension Institute. She currently serves on the steering committee for the Kidney Care Quality Alliance, an independent organization focused on developing & measuring quality metrics for use in the dialysis care setting. Dr. Dittrich has served as the Chairman of the Medical Advisory Board for Liberty Dialysis, INC., an organization which partnered with nephrologists to own and operate dialysis facilities. She has co-founded numerous dialysis clinics in the states of Idaho and Alaska, where she served as a Medical Director. She has also served as the Senior Medical Director of remedy Partners, the largest Awardee Convener under Medicare’s bundled payment program.

      Thank you so much for your time! I know that you are a very busy person. Our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

      Believe it or not, I grew up on a cattle ranch in rural Nebraska. From kindergarten to eighth grade, I rose early to complete my ranch chores, and then rode a school bus 15 miles into Wood Lake where I attended a small grade school populated mostly with my cousins! It was certainly not a traditional way to grow up, but I learned to deeply appreciate my family and community, and the value of hard work.

      I began my career in medicine as a nurse, providing direct patient care and spending quality time with patients — an experience for which I am truly grateful. Engaging patients as nurse laid the foundation for how my career evolved, how I treat patients as a practicing nephrologist today, and how I operate business at U.S. Renal Care as the Chief Medical Officer.

      Ultimately, I decided to pursue a medical degree in nephrology for three reasons:

      1. For me, dialysis and renal replacement therapy is something close to miraculous. The use of this therapy or transplant to allow individuals with nonfunctioning kidneys to live long, fulfilling lives is incredibly gratifying.
      2. I love chemistry! I excelled in chemistry and biology in school and learning medicine was always a joy that came easily to me. It was a natural progression to earn my medical degree at the University of Colorado.
      3. Kidney disease affects both young and old, men and women, those with comorbidities and those without. There is a disproportionate impact on people from underserved communities. Nephrology allowed me to care for patients of all backgrounds and address both acute and chronic conditions.
         

      Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lessons or ‘take aways’ you learned from that?

      There have been plenty of funny moments throughout my career — some which were funny in the moment, and some that I’ve only laughed about years later. On the whole, however, I’ve learned that when appropriate, using humor and being lighthearted with your teams and patients helps everyone relax and connect with you. My role as a physician and an executive often requires difficult decisions on serious issues. So, whenever there’s an opportunity to have some fun, I will. For example, every year on Halloween, I dress in full costume and remain in character all day. Last year, I dressed as the Wicked Witch of the West (green face paint and all!) and sent a “spooky” video to our remote staff across the country. Needless to say, I looked a little silly, but it was one of our most viewed and loved videos by our hundreds of staff members.

      None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story?

      Too many to count! I’m a true believer in mentorship, partnership and asking for help when you need it. My father was an incredible example of that. He raised me to be a strong, independent woman who believes she can do and be anything. He was a service-oriented businessperson and always talked about our obligation to help others and to be a useful person in our community. As I reflect on my childhood, I see how influential he was in my shaping my career as a physician.

      I’ve also had the privilege to work with Mark Caputo, the CEO of U.S. Renal Care, for nearly 20 years. Our friendship began when he invested in my physician practice in 2003 in Boise, ID. He deeply understands our discipline and is an incredible partner to physicians. Over the past two decades, we collaborated professionally, built teams and dialysis centers together, and invested in all areas of care for people living with kidney disease. Mark believes that physician autonomy and governance in dialysis organizations is critical to the best possible clinical outcomes for patients and is an innovator in building organizations that reflect that philosophy.

      The final person who I want to deeply thank is Sherri Stanley, a nephrology nurse in Boise who taught me about home dialysis as a young doctor. Sherri was patient, caring, and kind as she educated me on the complexities of caring for patients. She helped me stay grounded in putting patient care and experience at the center of everything I do. I feel so fortunate to have had an opportunity to work with and learn from Sherri.

      Extensive research suggests that “purpose driven businesses” are more successful in many areas. When your company started, what was its vision, what was its purpose?

      Healthcare at its core is a purpose-driven business and our purpose as nephrologists is to help people with kidney disease live healthy lives. Our vision and belief at U.S. Renal Care is that when physicians lead healthcare organizations and are empowered to make decisions for their patients (not business operators or corporate agendas), patients achieve the best possible clinical outcomes and have the best experience.

      Thank you for all that. Let’s now turn to the main focus of our discussion. Can you share with our readers a story from your own experience about how you lead your team during uncertain or difficult times?

      Never has my leadership been challenged as much as it has been in the past year, and never have I learned so much about resilience, perseverance, and the fortitude of healthcare providers. The learnings from living through a global pandemic are innumerable, but one that stands out is the importance of communication in the face of uncertainty. In the first few months of the COVID-19 pandemic, there was so much we didn’t know. All of us were learning about the virus in real time — its symptoms, how it spreads, and how to keep people safe. The entire leadership team at U.S. Renal Care decided to communicate with our staff, physician partners and patients as frequently and transparently as possible, often on a daily basis. We ensured that our community had the best information available and continued to inform and educate in real time. At times over-communicating felt anxiety-provoking, but ultimately it established trust and credibility with everyone we served.

      Did you ever consider giving up? Where did you get the motivation to continue through your challenges? What sustains your drive?

      I never thought about giving up, but I certainly did question whether I had the skills and stamina to lead a healthcare organization through a global pandemic. Ultimately, I knew that there was no option other than to keep going. Our patients needed us, the organization needed us, and our country needed us. I drew great strength from others around me who were dealing with the same challenges. Leaders in healthcare across all disciplines came together, supported each other and learned from one another. I’m also very fortunate to have an incredibly loving family; they provided me with a profound source of encouragement and motivation. My husband is a physician, and he and our kids were always understanding of what we were trying to do at USRC.

      What would you say is the most critical role of a leader during challenging times?

      Decisiveness. Mistakes early in my career were often a result of inaction — not making a decision out of fear of the unknown. What I quickly learned is that inaction resulted in worse outcomes than acting and course correcting along the way. As I’ve matured in my career, I’ve become much more decisive and as a result, much more flexible. I find that the people who rely on me — my peers, patients, and staff — now depend on my decisiveness to move forward and aren’t afraid to come to me with ideas on how to continually improve upon decisions when necessary.

      When the future seems so uncertain, what is the best way to boost morale? What can a leader do to inspire, motivate and engage their team?

      Listen and acknowledge. Check in on your team. Ask them how they are doing, listen with empathy, let them know you appreciate them, and provide guidance and support whenever possible. In times of great uncertainty, all of us can become fatigued, anxious, and even fearful. Sharing gratitude and recognizing achievements — even small ones — is a simple action that goes a long way.

      What is the best way to communicate difficult news to one’s team and customers?

      Delivering difficult news, unfortunately, is part of the job as a healthcare provider. It is our responsibility to educate our patients to the best of our ability and be a reliable source of information and strength. I find that being direct, fact-based, and thorough is most important in delivering difficult news, but also listening to and empathizing with our patients ensures the best possible outcome.

      How can a leader make plans when the future is so unpredictable?

      First, understand your mission and values, then build a fact base and understanding of challenges, and create a vision. If COVID taught us anything, it is that change is constant. Strong leaders build dynamic, adaptable teams of individuals who are both resilient and flexible when presented with new evidence and who are capable of making small, incremental decisions knowing that what needs to be done today to pursue our vision, might change tomorrow. I try to proactively check in with myself and ask, “what do I need to know in a week?” and “where do we need to be in two weeks, a month, a year as we strive to meet our goals?” Particularly in times of crisis, making shorter-term decisions with a clear plan to frequently reassess those decisions is comforting to the leader and the team.

      For example, when we implemented a universal masking policy (requiring our patients and our staff wear masks) in the very early days of COVID-19, I made sure to communicate that every two weeks we would reassess that decision based on our supply of PPE and any new guidance from the CDC and WHO. Ultimately, universal masking became a significant protection against COVID-19 and helped us to continue treating patients while safeguarding staff, patients, and their families.

      Is there a “number one principle” that can help guide a company through the ups and downs of turbulent times?

      Make decisions that are in the best interest of the patient and all other successes will follow. I often put myself in the shoes of my patients and consider how I would want my leaders to behave, how I would want to see the staff treated, and what rules I would want to see in place.

      Can you share 3 or 4 of the most common mistakes you have seen other businesses make during difficult times? What should one keep in mind to avoid that?

      1. Some organizations fail to communicate or fail to communicate effectively. Clear, frequent and honest communication leads to alignment and trust.
      2. I’ve also seen certain organizations stumble in thanking their staff. At USRC, we know that every employee and department is important and has unsung heroes. For example, we wrote letters to our janitorial services team recognizing their efforts in keep our clinics sanitized and our patients safe from COVID-19. We regularly express our thanks to all individuals across the entire organization.
      3. A last point I’d like to highlight is the importance of admitting when you do make a mistake or the “wrong call”. In the past, we made decisions based on limited information that we thought were the right call. When it turned out that they were not, we communicated, apologized, and corrected course. In my experience, admitting mistakes only increases your credibility.
         

      Generating new business, increasing your profits, or at least maintaining your financial stability can be challenging during good times, even more so during turbulent times. Can you share some of the strategies you use to keep forging ahead and not lose growth traction during a difficult economy?

      Throughout the pandemic, we wanted to continue accommodating patients by giving them access to care and continue accepting new admissions at a time when closing a care center might have felt safer.

      Early in the pandemic we didn’t know whether a COVID-19 positive patient could be treated safely outside of a negative pressure room in a hospital. At USRC, we took early and aggressive measures to try and keep our patients in our centers. We regard our dialysis centers as the medical home for our patients and we were perhaps more willing than other outpatient centers to treat these individuals given the lifesaving aspect of their care and that failure to provide care would have placed an severe burden patients and hospitals.

      Another way USRC continued momentum during the pandemic was by continuing to innovate. With COVID-19 as the driving purpose, we were able to stand up new technology and data programs that have had tremendous applications post-COVID-19. The pandemic forced innovation and I’m proud to say we really leaned into that space and made some great advancements.

      Interestingly, in the pre-pandemic world, developing new processes or programs often involved months of meetings and planning. COVID’s urgency forced us to shrink the cycle-time of new process creation to days or hours. We learned that we can change and make improvements in our care processes much faster, and this new skill is incredibly valuable and rewarding for our teams and patients.

      Here is the primary question of our discussion. Based on your experience and success, what are the five most important things a business leader should do to lead effectively during uncertain and turbulent times?

      1. Communicate even when you’re uncertain. The more you can talk to the people impacted, the more trust you gain and anxieties you soothe.
      2. Admit what you don’t know. Throughout the pandemic, waiting for perfect information was impossible and was not always necessary. Sometimes acknowledging what you don’t know as a leader gives you and your team the opportunity to find a solution together.
      3. Engage experts that have a different skill set or understanding. Leveraging my community and not trying to solve everything on my own was key to evolving as a leader.
      4. Express gratitude and thanks to the people who are carrying out your mission, who you are leading, and who are leading with you. This is so simple and so fundamental to ensuring work is a supportive place for all.
      5. Check in frequently on your plans and progress. Setting both long and short-term goals, evaluating progress and course correcting in real time was an incredibly valuable lesson that allowed us to move forward while putting safety at the forefront.
         

      Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

      The one I thought of most during the pandemic is by C.S. Lewis: “You can’t go back and change the beginning, but you can start where you are and change the ending.”

      This quote has been an excellent reminder to work towards my goals without ruminating on everything that I haven’t done well. I think it’s very important that you don’t dwell on your mistakes, and that you look forward with a clear vision of what success looks like for you.

      How can our readers further follow your work?

      You can follow us on LinkedIn at https://www.linkedin.com/company/us-renal-care/ and on Twitter @USRenalCare.