TH: What were you like as a kid growing up in California?
RK: Well, we played sports constantly. The three main ones: baseball, football, basketball, depending on what season it was. In southern California, the seasons are a little less pronounced than they are here in the Midwest so they kind of run together. I was a good student, but I was really committed to sports as a kid.

TH: Did you participate in any sports in college?
RK: I played basketball and tennis at UCSD. I played basketball and tennis and ran cross county in high school. I played trumpet in the band. I got my trumpet out of cold storage a couple of months ago for a promotion of our attempts to become recognized as a magnet hospital. It was not one of the finer moments.

TH: Looking over your family information, I have to ask: What is it with the "Ch" names for the kids?
RK:It was never part of grand plan, until we got to about the third one, then we felt we were committed to it. Actually, Chelsea was just a name we liked. Chet is named for his great-grandfather, my wife's grandfather. Then the rest kind of fell into line and we ran out of CH names so we stopped having kids.

TH: What do you like to do when you're not hospital administrating?
RK: Well, the thing that I actually live for every week is playing basketball at noon at the Y. If I couldn't do that, I would miss that terribly. That's about the only non-sedentary thing that I do anymore. I occasionally play a little tennis, but very, very rarely. But I love playing basketball. That's definitely my favorite.

TH: Did this decision on the John Deere plan come to you pretty suddenly or through the course of bidding and negotiations? Did you have a sense that maybe it was not going to go your way?
RK: We knew fairly in the year that the Medical Associates Health Plan would no longer be an option for John Deere people but that Medical Associates Clinic would be asked to submit a proposal, just as we would. Sometime toward the end of spring, I guess it was, we heard that the Independent Physicians Association had entered into a long-term exclusive contract with the John Deere Health Plan. So when we heard that, then we realized that it would be a long shot for Mercy to be paired with the Independent Physicians, not so much because of the internists, surgeons, obstetricians, pediatricians, but primarily because of the hospital-based physicians: radiology, anesthesiology, emergency medicine. There's no practical way to match the independent groups there, who are based at The Finley Hospital with Mercy. So at the moment that the Independent Physicians Association entered into an exclusive six-year deal, we knew that the prognosis for our hospital was not very bright.

TH: Have there been some unintended outcomes from your various the 125th-anniversary events?
RK: Yeah. There have been just a lot of amazing things and a lot of connections made and relationships reinforced. But one of the ones that really struck me was that a key community leader walked into my office earlier in the year, unannounced, unscheduled, and said, "I know it's your 125th anniversary. I know you're conducting a capital campaign. I know you're going to ask me for money and I know I'll probably contribute. But I would like to do something specifically for your employees because they do such a tremendous job of fulfilling the values." When you walk through the door, you can feel that it is real. It's not just words on a poster on the wall, but it comes to life and it comes to life because of your people, not my people, the people working at Mercy. This person said, what could we do for employees? I said, you know, I would love to have a party, cookout party and I would love to do it at the National Mississippi River Museum and Aquarium. But it's expensive because we have 1,500 people who would want to come. This person said, "I'll give you the money to make that happen." I was just blown away.

TH: You won't tell me who it is.
RK: It's an anonymous donor.

TH: It wasn't Dave (Kettering, TH photographer, who is also in the room), was it?
RK: I'm not sure it was Dave. In fact, we had a staff nurse who heard about this and was inspired to make a $1,000 donation of her own, just when she heard the story. But it was great. You asked about unexpected things. That was just a wonderful thing that happened. We had 1,300 people down there in September, on Mercy Day, for a great party.

TH: In our operation at the TH, like yours, there are people who are there literally all hours of the day and night. When you have special events or you need to communicate with so many people who are working around the clock, that takes some special thought in terms of communication and process. How does the hospital address that?
RK: It's a challenge. When we have the special events, unfortunately, it's never possible for everybody to come because we never shut down. We are always open every day of the year, every hour of the day. So, sometimes people do miss things when it's their turn to miss. We try to stay in touch with the people on all three shifts by being physically present in the hospital, people who are in leadership roles make rounds on the evenings and weekends and occasionally at night, probably not as much as we should. We come in for special events, like during Nurses Week, we'll come in in the middle of the night and deliver cake and pizza to each of the nursing units just so they know we haven't forgotten about them and we appreciate the fact that they're there around the clock when we're home sleeping. But, yeah, you're right. It's a challenge when you have an organization with this many people who are so diverse and work in such a wide variety of roles and times and locations. To communicate with all of them is not easy.

TH:As the president of a hospital, how much influence to you feel you can offer to the quality of health care, a patient's experience when they come into this facility or your Dyersville facility? A lot of it seems to be out of your hands.
RK:I think it's an enabling role as much as anything else. Probably the more important things that I can do are to foster an environment in which everyone else can do well what they do best, so that they have the facilities and the equipment and the staff and the managements and the processes and systems in place so that they can excel at what they are naturally good at doing. I think a hospital CEO can either help that to occur or can prevent that from occurring. Obviously, I feel like it's my responsibility to try to foster an environment where people can excel; whether we're talking about a cardiac surgeon or a respiratory therapist or a registered nurse or someone providing physical or occupational therapy or whatever the role may be. People like to have an environment where they feel like their efforts are supported.

TH:Can you give me some examples you can think of where you've been able to start a program or just help foster that type of environment you've spoke of?
RK:Probably one of the areas where I've had some impact would be in forming and developing partnerships with physicians. I think the efforts of the hospital to fulfill its mission are magnified when we can find productive ways to collaborate with physicians, who traditionally really value their independence and appreciate the hospital for the resources that it represents, but don't necessarily want to get overly involved with the hospital as an organizational structure. Working with Medical Associates Clinic, we've been able to develop and expand the family care network for primary care in outlying areas. We've put together a superb ambulatory surgery facility on the Medical Associates West Campus. We offer a health plan together. We sponsor an occupational health program together. I think in some of these areas, many of them pre-dated me, certainly, but I think I've been able to help some of the partnerships along a little bit.

TH: When you hear the news that all the flu vaccine has gone bad, does that warm your heart? Do you welcome the patient census going up?
RK: (Laughs) Yeah. It is kind of schizophrenic to be in the business of providing health but to benefit only when people are sick. It's just a product of a strange financing system. I think, to its credit, the community of Dubuque got together and came up with a rational plan on this flu vaccine distribution. Dr. Viner does a terrific job, kind of leading that process. We got all of ours. We were lucky enough to have ordered from the one manufacturer who was able to produce, so we had about 3,600 doses. We don't have them now. They went to nursing home residents, health care workers who provide direct patient care, and then when we were done with that, we distributed on a pro-rated basis to the physicians, depending on their assessment of how much they needed. Which I think was the right way to do it. But I'm hoping there will not be a horrible outbreak of flu. If there is, we'll be ready to take care of them, but that's not our desire.

TH: It seems that with the direction of health care, it seems that facilities are just getting bigger and the smaller ones have trouble surviving. As you have observed health care over the years, is bigger better?
RK: I don't think bigger is necessarily better from a quality standpoint or the care that is provided at the bedside. There are some advantages that do come with size, mostly in terms of the breadth of services that are available. It takes a certain volume to support a high degree of expertise in some of the specialized areas. So if by quality we mean extent of specialization, then size and volume are definite advantages. TH: What's next for you, personally or professionally? You're 51. Are you going to ride it out to retirement?
RK: Is there an option?

TH: Will anybody else take you? I don't know.
RK: My plans are to stay in Dubuque as long as the board of trustees and medical staff and employees are willing to have me stay here. I like it here a lot. I have no desire to go anywhere else. I occasionally receive inquiries, but nothing that I'm interested in pursuing. I think Dubuque is a great community. Our kids have thrived in Dubuque. They've benefited from the school system and from outside-the-school activities. They've got great circles of friends. I enjoy doing what I'm doing, so I have no desire to leave.