Q3 2021 Leadership Letter - Chris Comeaux

September 28, 2021

Chris Comeaux

President/CEO - Teleios Collaborative Network

Chris Comeaux (KO-mo) is currently the President/CEO of Teleios Collaborative Network which is a collaboration between several prominent hospice organizations across the US. The goal of the collaboration is to harness the best of each hospice and enable the network to better care in each community for the patients and families being served as well as introduce innovations across the membership network and work with payors for new innovative solutions for those dealing with serious or advanced illness.

Chris has become nationally known as a leader in our country’s hospice and palliative care industry, where he has spent a large portion of his career as President/CEO of Four Seasons in western North Carolina, a 2009 American Hospital Association Circle of Life Award Winner. In 2005, the Carolinas Center for Hospice and End of Life Care honored him with the Peter Keese Leadership Award.

Matt: Can you tell me a little bit about your background and where your interest in leadership was developed?

Chris: My first job out of college was with KPMG which, at the time, was the world's largest CPA consulting firm. I was very fortunate to experience their incredible leadership training where I was introduced to authors such as John Maxwell and Stephen Covey who authored The 7 Habits of Highly Effective People. During this time, GE (General Electric) was likened to the Google or Amazon of the day. Businesses favored recruiting GE talent because they had an executive development program that many other Fortune 50 companies modeled themselves after. After working with KPMG, I went to work for Cooper Industries, which had an executive development program modeled after GE.  I traveled all over the world for almost two years doing internal audits. While having a functional job, I was groomed for upper-level executive management. At the end of those two years, the program rotated participants through corporate tax, accounting, and treasury, and then the role of a controller. It was a very specific program where they developed participants while doing an actual function in order to groom them for leadership. I was the youngest person to ever go through this program and became fascinated with this concept of leadership, which has over the years has become my passion.

M: Is there anyone in particular that comes to mind that’s had a significant influence on your leadership and life? A mentor, advisor, or friend?

C: The two most influential mentors in my life are Quint Studer and Dr. Lee Thayer. They happened to be in my life during parallel times, but also separately. Dr. Lee Thayer was Stephen Covey's mentor and passed away last year at the age of 97, while working on his 55th leadership book. Dr. Thayer knew Abraham Maslow, Peter Drucker, and Edward Deming – the whole pantheon of incredible leaders. He was my mentor for 8-10 years. It was a total fluke how I met him, and, in some respect for me, an answered prayer. Dr. Thayer was probably the most well-read human being I've ever met in my life. One of my team members met him and described him as “a real-life Yoda”. That's really what it felt like, and he even had a raspy voice like Yoda as well. I got my Master’s in Leadership from The Thayer Institute studying under Dr. Thayer. If you picture one person who read as far and wide throughout history as possible and extrapolated great principles to build any approach to leadership – that is the man who mentored me. Again, the opportunity of a lifetime.

If you do a Google search of the word leadership, you'll get around 750 million hits. That’s 750 million different versions and ideas of what leadership is. Dr. Thayer sifted through much of what was out there and if you ever had an artificial Christmas tree, you’ll notice that you have the pole and then you put the branches on it. That is what I would liken Dr. Thayer’s material as the pole of the Christmas tree.  There is good stuff in the 750 million articles, tools, or books out there but they are branches on the tree and Dr. Thayer is the root or goes to the root of it all.

Dr. Thayer’s magnum opus was a book called Leadership: Thinking, Being, Doing. The thesis: “As we think, so we are. As we are, so we will do.” Stephen Covey was famous for 7 Habits and Thayer was his mentor. Thayer approached habits in a much different way. It's interesting how Covey took that and furthered it even more.

The story by Dr. Thayer that impacted me the most is called the “Cow Story”. As he recalled, during the Great Depression the only place you could eat was on the farm. His parents sent him to live on the farm with his grandparents and every person on the farm had a job. He said about the age of five years old, “My job was to bring the cows in each day to get milk.” And you know what happens when cows walk in the same spot every day, rain or shine? They create ruts. It was also his job to clean off the udders. If cows are walking in the same spot every day, the udders get full of mud. He knew he wanted to grow up to lead leaders one day, and he decided to practice on the cows. It was impossible to motivate the cows to get out of the ruts on their own, and so he took on the task of figuring out how to get them out of their ruts in a different way. When they didn't get out of the rut, he physically pushed all the cows out. He went to the front of the line and told the cows to follow him to the barn, but what did the cows do? They went right back into the rut. He had been trying to understand and working on this problem well into his thirties. Then one day, while working in Europe, he saw these beautiful, gorgeous farms and noticed the lanes where the cows walked had no ruts. Eureka! His translator pulled over so he could speak with the farmer. He said, “I’ve got to know, why are there no ruts in the lane where the cows walk?” The farmer looked at him and said, “That's easy. We move the fences.”

Think about that for a second. What are habits? Habits are like fences in our life. Dr. Thayer used that story well into his nineties. Now, we have all this brain science to back up the principle. When we act, or even think, our habits literally create neural ruts or pathways. I also was raised on a farm, and that's where I get my work habits. I've moved a fence and it is hard work! That parable has so many applications. If you've worked in an organization before, you notice people park in the same spot and walk in the building the same way. They've got a routine they follow each day, some of which is human nature, but those grooves get well-worn and then we wonder why our organization is not changing. Why is it not innovating? Our habits are like fences that must be moved so that we can get out of our ruts. That's what we are up against; it’s like trying to defy gravity.

M: Can you tell me a little bit about Teleios Collaborative Network (TCN) and where the concept originated from?

C: I became the CFO for a not-for-profit hospice in Pensacola. While there, I was exposed to another mentor of mine, Quint Studer, who created the Studer Group. He was a CEO that turned around several hospitals including Holy Cross in Chicago and Baptist Health Care in Pensacola, after which he formed the Studer Group. He had a great approach based on his book Hardwiring Excellence where he and his team worked with hospitals to improve their patient and employee satisfaction, with patient satisfaction being the key focus.

While I was the CEO of Four Seasons, I got recruited for a startup between the Studer Group and Covenant Hospice called Studer Covenant Alliance.  My job was to build the business taking the Studer approach to the post-acute continuum. With such a well proven approach with a language specific for hospitals, I had to start thinking about how to repackage this and bring it to hospice. It was great fun traveling all over the country working with so many great health systems and healthcare organizations. During that time I began to think about something that today I call “leadership system”, which is a system to operating any business much like how a  operating system works for computer. For example, if I gave you my computer, you would be able to operate it, even though you've never touched it a day in your life.  I trust you have seen Windows before and, because you've seen that operating system, you literally would be able to start utilizing it as a tool. In using that as a metaphor, I hypothesized that every organization should have a leadership system and would benefit from having one.

My wife jokes with me that I'm a hoarder of tools. I didn’t invent a lot of the tools I use, I've just found them in all these different places. I'm usually reading three or four books at a time. There's nothing new under the sun, but there's always wisdom for you to extrapolate – branches to put on the Christmas tree, if you will. I’ve taken all these different tools and assimilated them into a comprehensive leadership system and we're utilizing that in our work at Teleios Collaborative Network. At Teleios, we aren’t merging hospices together under one large organization. Rather we’re creating more of a co-op of community-based, nonprofit hospices. Our goal is not to create one organization but to take the best of all these different organizations and magnify it. It's a very “bottom-up” approach. Some people would think, “That's crazy. How would you do that?”  The leadership system acts as a force multiplier helping us move outcomes across our entire network.

One of the significant things about this operating system is that it honors the local personality of each organization. We try to create high-performing organizations that honor the unique personality of their community. People may ask how we actually do that because we live in a time in healthcare where the mantra is “standardization, standardization, standardization”. For example, Walmart has a lot of standardization and has been incredibly successful, but there's also an argument about what happened to the Five and Dimes and hometown stores that offered local flavor and heritage. TCN is a model more similar to the local hardware store that’s competing against Lowe's and Home Depot. We come from the perspective that, while everyone loves that local hardware store and doesn’t want to lose it, it has to compete at a broader level. How do we maintain the uniqueness of the niche services we have, but also be part of something larger? Metaphorically, that’s what we're trying to do within TCN.  I credit the concept of TCN from my time of working with Quint.  Working for Quint was one of the greatest times of learning about leadership and about healthcare.

M: How did you go about finding and cultivating mentors in your life?

C: Matt, I was exactly where you were. I was 25 when I became a CFO and I was in over my head. I was praying for mentors, and my wife gave me my first John Maxwell book. In the early years, I viewed him as a mentor through my reading, and I devoured every one of his books. I never got to meet him, although I came within five feet of him at a conference.

Some people say that you get back the energy that you put out. In reading those books, providentially, my actual mentors came into my life. When I was at Covenant Hospice as CFO, one of our board members was the admiral of the Naval Air Station at Pensacola.  I believe he saw potential in me, and I even thought about leaving hospice and going into the military to Officers’ Training School because he made such a great impact on me. He gave me the book he gave every junior officer in the Naval Air Station called The Flight of the Buffalo. It's about the transformation of the Johnsonville Sausage Company written by the CEO Ralph Stayer. That whole transformation was facilitated as a consultant by Dr. Lee Thayer. This happened several years before I met Dr. Thayer and I didn't know he was their consultant until a year after we met. I said, “What did you just say? Johnsonville Sausage Company? You worked with Ralph Stayer?” I tell this story to offer some encouragement that my foundation with mentors effectively started off with books. Interestingly, those people materialized in my life – not necessarily the exact person, but perhaps the actual power behind the ideas or the original person where those ideas originated from.

M:  Do you have any strategies or tactics that you do or are there any habits you feel have had a positive impact on you throughout your life?

C: Reading is a gift that my parents gave me as a child. I was an avid reader starting at five years old, and was a little bit of a nerd and bookworm growing up. I’ve never lost that love and passion for reading. Because of my eclectic reading background, I had a tendency to be the “flavor of the month” leader, pulling from the latest thing I’d read. Once I became mentored by Dr. Thayer, his influence was always in the back of my mind, reaffirming that being eclectic is actually not helpful. I'll never forget, at age 30 I was the CEO of Four Seasons. Getting back from a conference, one of my staff members said out loud, “Great. What are we going to have to do now?” It was a poignant moment, thinking that if you become flavor of the month, it’s actually not helpful. Being an avid reader has a shadow side; you have to ask yourself: are you extrapolating wisdom and putting it into a comprehensive approach or are you becoming the “flavor of the month”? Those are two habits that have helped me: reading, but also reading to better understand things I thought I already knew, or even to relearn something I thought I knew. Not be the flavor of the month. That's one reason I’m passionate about a leadership system that provides a comprehensive approach to running organizations, not to make them Stepford organizations, but to implement a comprehensive approach. Much like how you do different work than I do on my computer, but yet we're utilizing the same operating system.

Another habit I adhere to is literally trying to live my life in the “learning mode”. Every day there's something new to learn. After spending 30 years in healthcare, I’ve found that there’s a shadow side in the industry which I would call the “knowing mode”. There are highly credentialed and educated people, which is great. I would want the most highly credentialed brain surgeon operating on my brain. But there is a shadow side to that kind of knowing mode: he who knows the most, wins. The learning mode is the flip side of that. You may have been exposed to many incredible things, but can you approach life today as if starting from scratch? Not necessarily wiping the slate clean, but starting today new, in a curious mode. I would say reading and learning are probably two of the things I'm most passionate about. I have intentionally cultivated habits assimilating them into a comprehensive system and approach.

M:  Can provide more background about how the leadership operating system is structured so we can get a high level overview of what that looks like?

C: When I started at Four Seasons, we were a pretty small program and grew from 30 employees and 25 patients to almost 180 employees and 200 patients in a fairly short amount of time. A staff member once said in a meeting, “Do you guys know what the hell you're doing? Because it sure doesn't feel like it from a staff perspective,” Then she added, “Is there not a book that you could go and read, and is there not a better way that you could do this?” On one hand, I knew she was right. It was painful growing like this. Secondly, I wasn’t aware of one book that would solve our problems. That was a catalytic moment for me. I thought, “Is there a comprehensive approach to growing from a startup or a comprehensive system by which you can run your organization?” Again, I'm a hoarder of tools, and our leadership system encompasses everything from how to do strategic planning - all the way down to how you teach leaders to organize themselves on a day-to-day basis. How to pick the right priorities, along with everything in between. And that is the metaphor for how it becomes an operating system. I recently read a book by Gino Whickman called Traction. His concept is called the “entrepreneurial operating system”. It’s the first time a book I’ve read has truly resonated with my theory. His approach is for smaller companies, and although we have more tools than he has, I love his system. It affirms we're on the right track with this concept.

Ours is an operating system for any type of business. I have a love and passion for hospice and palliative care, but also, having come from the corporate world working for a fortune 50 company, I believe the old adage that “if you make it on Broadway, you can make it anywhere”. I know that if this system works in this space, it will work in any business.
We teach our leadership system at our TCN Leadership Immersion Program, and we typically have three or four people per course who work totally outside of the hospice industry. One time, we had someone come through our leadership immersion course who was a missionary, but used business as a mission. They go into places such as India, where women are stuck in prostitution, and create businesses such as bakeries or coffee shops and help people turn their lives around by bringing them into these businesses. After going through our course he was able to take our system back, and apply it well beyond the scope of hospice.

M: Do you have an apparent failure that later led to success? If so, what did you learn from that experience?

C: We could talk about this all day long! Looking back, I was a pretty mediocre CFO. I can't point to one major failure, because I do try to live life in the learning mode. I think a lot of people who worked with me thought I was pretty good at the role, but being a visionary and seeing where the organization was headed, I knew what it was going to take to be the very best CFO for that organization, and it wasn't my passion. Luckily, I decided to go with my passion of leadership. When Four Seasons took a chance on me at the age of 30 to be CEO, I was better positioned for what the role required in terms of skill. As a CFO, I knew our hospice was going to do a bond offering. I had never had exposure to that and all of the technical expertise it would take to do it well. I could have “gone to school” there, but it didn't really feed my cause and purpose and I think that could have been a big failure. Trying to anticipate that - constantly bringing myself closer to my cause, purpose, and passion - I believe this has headed off some major failures.

Four Seasons was known as the pioneer of palliative care. We made a significant amount of mistakes in that space because it was so new when we were pioneering. The good thing is that we are putting all those learning lessons into the work we're doing within TCN. My passion for the leadership system came out of a failure. Four Seasons grew incredibly well and became nationally known. In fact, most people from the outside looking in thought it was a raving success in those early years of 2002 to 2006.   But here’s how I know God has a good sense of humor. I left Four Seasons and went to the Studer Group for two years, then went back to Four Seasons. Not too long after my return I said, “Who's the bonehead that made those decisions…oh wait, that was me!” There were a lot of things I had to face up to. Looking back during my first time at Four Seasons, I was very much a cheerleader and encouraging leader. Mission, vision, and values were the extent of tools in my toolbox, and that left a lot of work undone. I had to face up to all of that undone work when I came back to Four Seasons. Providentially, the best thing that happened to me was coming back to an organization that I grew quite dramatically. I came back with a better skill-set in my toolbox, knowing how to go wide and deep. I’m known for something I call “the vision of the eagle”, which is based on a presentation I heard years ago from a Vistage speaker.

When an eagle flies they see the horizon and they look down for their food at the same time. It's a real-life example of the x-axis and y-axis. It is such a great metaphor for leadership because some people are all about the vision while others are about executing, when, in reality, it takes both. Very few people have both axes in their toolbox. I've been blessed to have been exposed to both sides of that equation and that is one of my greatest lessons from my failures.

In fact, that is another metaphor for the leadership system: there are tools for both sides. There are people who are more naturally geared towards vision and other people who are naturally geared towards execution. The key is creating a team around you where you can do both incredibly well. Some leadership books, especially into the late 90s and early 2000s, were about being the big visionary and the idea that you can delegate vision to your people, whereas Larry Bossidy was one of the first people who said, “You can’t delegate vision. You've got to be as passionate about the execution as you are about the vision itself.” This viewpoint encapsulates the metaphor of the vision of the eagle.

M: How do you focus on internal leadership development for your people and members of TCN, are there any tactics or strategies used to develop those people?

C: That's why we developed our Leadership Immersion Course. It is an orientation to our leadership system, where we help our different TCN members have frequent leadership training within their organization. We are the facilitators and, at times, include incredible outside experts. We're always tailoring the leadership training based on the current needs of the organization, but also realizing we're not trying to be flavor of the month. There's a method to our madness, which is why the framework of the leadership system is so important.

Going back to Dr. Thayer’s book, the title of his magnum opus was Leadership: Thinking, Being, Doing. As a person thinks, so they are. As you are, so you will do. Where do we work on that problem, if you will? That's Teleios University. We are helping people with the concept and art of showing up. How do they show up on a day-to-day basis? Why do you show up the way that you do? How would you like to show up in the future? That's where Teleios University is helping people work on themselves. Because if you are not working on becoming a master of yourself, it's very hard for you to lead other people. That's how we can work on each side of that equation.

M: Do you see any common challenges or themes across the organizations that you work with through TCN?

C: One of my favorite John Maxwell quotes describes how everything rises and falls on leadership. Hospice is interesting as an industry because the vast majority of programs are small. There are national for-profits that look like big corporations but, at the ground level, they’re a series of small programs. There’s a whole lifecycle going from a startup to a larger organization. Are people able to make that transition from being a smaller program, meet the mission of the organization by serving more people, and able to grow?
This is why the learning mode is so critical. There's a school of thought that a certain type of leader is good as a startup leader, but then you need a different type of leader later. With a limited workforce, good luck finding those perfect profiles. Wouldn't it be better to help grow people through those different stages of lifecycles? That is the theme of what we believe.

There's a lot of challenges currently in terms of not having enough staffing due to the volume of people needing more serious illness care in the future. But that's also where I believe in the law of attraction by creating an incredible culture.

TCN itself, along with three other TCN member organizations, was recognized this year by Modern Healthcare as one of the best places to work in America. They include Four Seasons, Carolina Caring, and Pace @ Home. We don't know what our ranking is yet, but we know we've been named based upon employee engagement. We focus on creating a highly attractive culture that brings out the best in each team member. I meet with all new employees when they start at TCN within their first month and weave into the conversation our mission, vision, and values while getting to know each other and talking about critical things in the culture of TCN. One of the things I say to them is, “I really hope you retire from TCN, and I hope when you look back at your time here you say, ‘I grew more as a human being in this organization than in any other place I've ever worked before. I was a better mom, a better dad, a better person, and absolutely a better leader. I enjoyed the work that we did.’ That's my vision for you being part of this organization.” Then we continue creating a culture that's more than an interesting phrase, it really is a culture that's literally trying to live up to that. I then call them into that because they’re not a consumer, they’re a participant with a responsibility. I may have the ultimate responsibility as the CEO, but you have a responsibility as an employee as well.

M: How do you see culture-building being a catalyst for helping address the forthcoming staffing challenges as the demand for advanced care continues to grow faster than the supply of caregivers?

C: I think it's going to be necessary, otherwise you're going to be scraping the bottom of the barrel of people who are looking for “a job”. Dr. Thayer has a famous phrase: “The derivation of the word ‘job’ means, I got a lump.” We want people that want to be part of a cause and purpose not a job. But, focusing on the core of your question, even if I'm attracting the best of the best and I get all the volume of the best of the best, am I still going to have enough people for the volume of consumers? No. We are going to have to figure out an interesting challenge, which is how to bring more technology into a space that involves a high level of human interaction, and is very much about human connection, and not lose that. That’s going to be an interesting frontier, and the organizations that do that well are going to be the ones that are going to solve that issue. How do you bring technology so you can leverage the people you have over a broader number of patients, yet not lose that specialness, that high-touch model of care that hospice and palliative care really is at its core?

M: Can you give an example of one or two of the top core values at TCN and how you went about developing those?

C: Despite having made so many boneheaded mistakes in my prior career, TCN was the first time I was able to create an organization from the ground-up.

As a Studer coach, I was able to travel the country. I’ve seen over 150 different hospice and palliative care programs in my career, which has been a blessing. But I am also a connoisseur of talent, and I was able to meet some of the best people in the country. I developed a “hit list” of people I wanted to work with one day, and I recruited those people to TCN from the very get-go. That's why we have such an incredible team. If you look at our TCN profile on our website, it is filled with incredible people who are tops in their field. So together with that team, we created those values from the start. Instead of having a preconceived notion, and while there's certainly principles that I believe in, we developed those together.

One of our team members was really good at acronyms. As we got the words down, CLILES (sea lilies) became the acronym. We did a quick Google search and found lilies are symbolic of humility and devotion. So even our acronym is symbolic. CLILES is an acronym for Collaboration, Learning, Integrity, Leadership, Excellence and Stewardship. In fact, during every leadership meeting, a team member takes one of those words, our mission or vision, and does a mini presentation. It's so awesome because it keeps it fresh as each person presents from their perspective creating a constant conversation around the topics.

The TCN logo and name are very intentional. First off, there are several interpretations of the word Teleios. My personal favorite is the purpose beyond the purpose, because I believe there is such purposeful work in what we're doing. There's life transforming work that happens by the bedside with patients and families. But Jim Collins, famous for the book Good to Great, wrote a book before that called Built to Last. He said organizations are built to last over a decades. I’m working with hospices who’ve been in existence for 30 – 40 years. 25 years is the norm for many programs. Collins is great at delivering sticky concepts or metaphors and said those organizations are like a hurricane: there are all these changes swirling about, but there's a somewhat unchangeable core of their mission, vision, and values. The TCN triangle is the swirling hurricane, derived from Jim Collins. TCN is constantly revisiting ourselves and whether we should tweak our mission or vision statement or values. Sometimes tweaking and playing with words just makes it crisper and crisper, just like the eye of the hurricane shifts. We believe in it so much we put it in our logo.

M: Are there any emerging technologies that you’re tracking that you feel will have a transformational impact on healthcare?

C: In Good To Great by Jim Collins, one of the last chapters is “Technology As An Accelerator”. To me, it was one of the most profound parts of the book. He said that their premise going into the book was that someone with the best technology was the differentiator. They realized that wasn’t the case, but rather that they understood fundamentally who they were as an organization and they applied technology as an accelerator. You and I live in a time where technology is looked as a panacea and everyone in healthcare keeps making the same mistake, thinking that a certain EHR is going to solve all their issues and be a silver bullet. But that’s not what Collins and his team found, they found that the best organizations fundamentally understood what they’re trying to do and applied technology to accelerate it.

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